Global epidemiology of HIV infection in men who have sex with men

Abstract

Epidemics of HIV in men who have sex with men (MSM) continue to expand in most countries. We sought to understand the epidemiological drivers of the global epidemic in MSM and why it continues unabated. We did a comprehensive review of available data for HIV prevalence, incidence, risk factors, and the molecular epidemiology of HIV in MSM from 2007 to 2011, and modelled the dynamics of HIV transmission with an agent-based simulation. Our findings show that the high probability of transmission per act through receptive anal intercourse has a central role in explaining the disproportionate disease burden in MSM. HIV can be transmitted through large MSM networks at great speed. Molecular epidemiological data show substantial clustering of HIV infections in MSM networks, and higher rates of dual-variant and multiple-variant HIV infection in MSM than in heterosexual people in the same populations. Prevention strategies that lower biological transmission and acquisition risks, such as approaches based on antiretrovirals, offer promise for controlling the expanding epidemic in MSM, but their potential effectiveness is limited by structural factors that contribute to low health-seeking behaviours in populations of MSM in many parts of the world.

Blood, sex and trust: The limits of the population-based risk management paradigm

“…We do not deny that the 'MSM population', as currently constituted in epidemiological surveillance data, suffers from disproportionately higher levels of HIV and other BBI's: as series of epidemiological studies across a range of national settings have shown (Beyrer et al 2012). But our question relates precisely to the way data are constituted.…”

“…Even in studies where diversity within MSM is recognised the relevance of condom use is marginalised and ultimately, diversity is subsumed in favour of reconfirming the category 'MSM' as high-risk (see Pathela et al 2011: Beyrer et al 2012. Furthermore, assessments of MSM risk are always relational to those calculated for the 'general [heterosexual] population'.…”

Optimum resource allocation to reduce HIV incidence across sub-Saharan Africa: a mathematical modelling study

“…4 Female sex workers (FSW) have an HIV prevalence as high as 60% in South Africa, 5 and limited data put prevalence among men who have sex with men (MSM) at 18% across the continent. 6 The distribution of domestic funding across countries in SSA directly reflects neither disease burden nor financial need, 7 whilst international donors vary in how they prioritise countries; but a better funding configuration has not been offered. Some previous studies have argued for targeting HIV treatment and prevention efforts by geography 8 or risk group, 9 and reaching marginalised high-risk populations is widely viewed as crucial to epidemic control.…”

Sexual identity stigma and social support among men who have sex with men in Lesotho: a qualitative analysis

“…1 Even in the context of the broadly generalised HIV epidemics of Southern Sub-Saharan Africa, MSM have been found to carry a higher burden of HIV compared to other age-matched reproductive age men. 2,3 In a recent study of more than 500 MSM in Lesotho recruited via respondent-driven sampling across two urban centers, prevalence was 31.1% in the capital of Maseru and 35.4% in Maputsoe.…”