The article on HIV in MSM (men having sex with men), which appeared in the Dec. 1 issue of the Philippine Daily Inquirer) is indeed alarming, considering that the true picture of HIV infection in the Philippines is unclear due to underreporting and inefficient collection of data on people infected with the virus, as well as on individuals getting tested. Having worked on this concern in New York City for 14 years, I can say that the approach to reach out to Filipino MSM is no different from those used in other ethnicities, though religion and cultural backgrounds need to be factored into the intervention designs. I do recommend the following:

1. Aggressive outreach activities such as promotion of HIV and STD screenings in bars, clubs, where high-risk MSM congregate. MSM websites and publications should be used to send messages on HIV prevention and treatment. These activities should be multifaceted and multilayered.

2. Ongoing nationwide summits or dialogues among government, NGOs and stakeholders. Caregivers can represent the ?closeted or invincible men? to voice their needs and concern.

3. Current interventions should be reviewed and modified, if necessary. With modern technology, programmed activities should be designed around them.

4. There is no one-size-fits-all. Preventive messages should be tailored according to their age range and within the MSM subgroup. A young man may not be able to relate to a message meant for middle-aged men; likewise, a bi-sexual or straight-acting gay man to a message meant for a transgender individual.

5. Make HIV testing part of a routine health care. Just like diabetes and hypertension screenings. Early detection is the key for living longer.

6. Pretest counseling must be client-centered. In this manner, the root cause of someone?s risk behavior can be identified and addressed immediately ? e.g., internalized homophobia, low self-esteem or self-worth. It will also address issues on stigma and discrimination.

7. Make for easy access to condoms and literatures in bars, clubs, motels, hotels and other high-risk venues.

8. Encourage collaboration and dialogue with sex venue owners, local police, health department and NGOs. Police raids drive sex venue owners underground, which makes it difficult for NGOs and the health department to reach out to high-risk MSM.

9. Conduct trainings for all staff ? from frontline volunteers to program managers. By doing so, the staff members are provided the latest information, data and trends regarding the disease. The trainings should include self-care for caregivers. This will promote, among others, role-clarification and self-awareness and address ?burn-out? issues. Timely implementation is a key to preventing the spread of the disease.

Before HIV reaches epidemic proportions in our country, Filipinos should look into how Thailand was able to curb HIV infection among its MSM.

BRIC BERNAS (via email)