HIV in Asia – A Tale of Two Cities

With its sleek and stylish white store front and big plate windows Pulse Clinic is a sharp contrast with the rowdy gay clubs and the dim massage parlors that dot Silom up toward Lumpini Park in Bangkok.

Open since May, there’s no mistaking Pulse’s clientele, however, or its mission. Posters of shirtless men encourage testing for HIV and a sign in front advertises courses of treatment.

“We wanted MSM, who walk by, to come in,” said the clinic’s counselor Charnwit Pakam, referring to men who have sex with men.

“This is an important location.”

That visibility is in sharp contrast to what HIV activists face in Jakarta, where infection rates of about 30 percent among young gay men are every bit as high as they are in Bangkok. Indonesia’s swirling homophobia, and sheer bureaucratic incompetence makes it tough to reach vulnerable groups.

This has been a year of anti-gay hysteria. And it got its start early. In February I wrote that universities in Indonesia sought to jettison LGBT groups from campuses and that the broadcasting regulator banned depictions of homosexuals or transgendered men.

Bookending the year, a religious hate group forced police to break up an alleged gay sex party in late November. The police failed to find any drugs at the private residence where the gathering was taking place. Instead they found condoms and HIV medication, which they confiscated.

Of course, there are brave HIV clinics aimed at gay men in Indonesia, but the NGOs that run them ask me not to publish their names for fear they will become targets for Islamic vigilantes. Their effectiveness is doubly hampered by bureaucratic incompetence. For several weeks in the middle of the year the country ran out of the generic form of the single dose pill that is prized by HIV workers in developing countries for its ease of use. The government agency charged with buying the country’s drugs was slow to place its order. An emergency purchase by the Global Fund to Fight Aids Tuberculosis and Malaria kept the meds stocked for three months through to September. A friend of mine on HIV meds tipped me off about the shortage in May. An aid worker confirmed it.

These cultural and institutional headwinds suggest Indonesia’s HIV-AIDSepidemic will get worse before it gets better. Even in tolerant Thailand – awash as it is in cheap effective medication – HIV is still on the march.

One in three visitors to Pulse seeking a test for HIV is positive, says Pakam. On a recent afternoon, shortly before Christmas, clinic staff unpack a shipment of HIV medication carried in half dozen boxes each the same dimension of a crate of wine.

A veteran with 17 years of counseling HIV-AIDSpatients, Pakam says, when he was just starting out he thought the disease would be in retreat by now.

“I’m surprised it’s still going up.”

Editor: Edward White