The last full day at the Sixth International Congress on AIDS in Asia and the Pacific focused on the role of gender and sexuality in HIV/AIDS. Women in the region are among the most vulnerable to infection because of their lack of empowerment and control over their own sexuality. Empowerment of women through social and economic empowerment is key to countering high rates of HIV infection among women.

"HIV in India has not only reaffirmed, but compounded the existing gender biases," Lalitha Kumaramangalam from Praktri in South India. This is true not only in India, but in much of the Asia-Pacific region. Women are expected to be good mothers, raise families and not be sexual unless they are sex workers.

"Women's honor is linked to and preserved by a non-expression of sexuality," said Geeta Sodhi, trained pediatrician and founder of Swasthya, a nonprofit in India. "Women's sexuality is strictly policed through marriage and they are denied access to information, even about their own bodies."

Nongovernmental organizations and government funded programs in the region are reaching out to adolescents and women to teach them about sex and sexuality, as well as giving them training in 'life skills.' These life skills include vocational training and education about managing aspects of daily life like opening bank accounts. Men in the region are generally the main breadwinners and control money in the family. Economic independence can empower women socially, giving them more control over their own bodies and lives.

Sodhi cited the example of an adolescent girl who was able to negotiate the postponement of her marriage after taking a life skills course through Swasthya. By learning basic skills like sewing and beauty aid, young women can earn an income and increase their status within their family and community.

Gender issues cannot just limited to women however. Men and their role in the spread of HIV need to be addressed to break down gender constructs in the region.

"Gender is about the relationship between men and women," said Kumaramangalam. "Gender has been feminized, but unless we actually start addressing men we'll never be able to deconstruct the prescribed roles- which have been constructed by men." On the ground this translates into programs that target boys and men to teach them about HIV/AIDS as well as about sexuality. Destigmatizing sex and sexuality is a key component of these programs. Simultaneously males have to learn to respect women.

"They (boys) seem to have freedom of sexual expression, but it cannot be actualized because girls are controlled and not permitted to interact with them," said Sodhi. "There is no plan to sexual intimacy, any opportunity is grabbed which results in coercive sex or rape."

Gender is not simply a question about men and women. "Even in relationships between men, gender plays a huge role--especially sexual relationships," said Kumaramangalam. "Most of the men having sex with men are not homosexuals. The best western term that can apply to them is bisexual and you'll always have an effeminate versus the macho man in the relationship and the power differentials are exactly the same."

Popular discourse, especially within the context of HIV/AIDS does not address the needs of these men. In the Asia-Pacific region men who have sex with men are usually married and do not identify as homosexuals. They do, however, have sex with men, often in public places like parks and usually without protection. They also continue to have sex with their wives, increasing the risks for women who are generally monogamous and unaware that they are at risk for infection.

"There are indigenous communities of men in the region who are not homosexuals, but they have sex with men," said Lok Prakash from Naz Foundation International. "In urban areas you might find a small section of the population who identify as gay, but in the rural areas the question is of sexual practice, not sexual identity."

The unacceptability of homosexuality in many Asian societies, compounded by the taboos surrounding talk of sex and sexuality complicates the access of these marginalized groups to information and resources. The Naz Foundation has set up programs in five cities in India to target these men and teach them about condom use and the threat of HIV/AIDS. The process is laborious and gaining access to these men can take up to a year. Advocates also cannot find the correct terms to explain the position of these men in an international forum.

"The level of understanding is not clear," said Agniva Lahiri, a man who has sex with other men, but does not identify as homosexual. "I feel very frustrated. There are no terms in English for who I am. Transgendered would be the best term."

Despite the many programs and interventions underway in the region, more must be done, said Geeta Rao Gupta, Director of the International Center for Research on Women in the United States.

"As has been typical of other aspects of this epidemic, our discourse is way ahead of the realities on the ground," she said. "I am convinced that stigma is the single most powerful barrier to our combined efforts to slow down this epidemic and that barrier is seriously compounded by existing norms of gender and sexuality."

In the Exhibition Center, across the Yarra River from the Convention Center, a photo exhibit about HIV-positive people drew support and praise. The international photo exhibition, titled 'Positive Lives,' portrays personal stories of men, women and children living with HIV. The powerful photographs, in both black and white and color, provide personal accounts of living with the disease.

A striking color photograph of the tatooed chest of a Thai man bore a chilling caption. "I'm a military policeman," it read. "I discovered I was HIV positive this year after finding rashes under my skin. I haven't told my wife yet; she would probably kill herself if she knew. I feel fine myself. I play around with women and I don't like condoms."

The exhibition has already been seen by over 2 million people and will continue touring through East and South East Asia. "When you see pictures and people's stories together it becomes more personal," said Madeleine Berry, a visitor to the exhibition. "It makes you grateful to live in a developed country and, as a woman, that you aren't forced to do certain things to make a living."

As the day's sessions ended delegates were heard talking about the communique expected from the International Ministerial Meeting. Australian Foreign Minister Alexander Downer, who hosted the meeting, will present the statement during the Wednesday morning plenary. Political commitment from the governments of Asian-Pacific countries is greatly anticipated, especially following the lack of high level representation at the United Nations Special Session on AIDS in June.

"I doubt things have changed very dramatically in the four months since UNGASS," said Mary Moran of Medecins Sans Frontiers, Australia. "But this is certainly a good first step."