The increase in global HIV epidemics in MSM

Abstract

Epidemics of HIV in MSM continue to expand in most low, middle, and upper income countries in 2013 and rates of new infection have been consistently high among young MSM. Current prevention and treatment strategies are insufficient for this next wave of HIV spread. We conducted a series of comprehensive reviews of HIV prevalence and incidence, risks for HIV, prevention and care, stigma and discrimination, and policy and advocacy options. The high per act transmission probability of receptive anal intercourse, sex role versatility among MSM, network level effects, and social and structural determinants play central roles in disproportionate disease burdens. HIV can be transmitted through large MSM networks at great speed. Molecular epidemiologic data show marked clustering of HIV in MSM networks, and high proportions of infections due to transmission from recent infections. Prevention strategies that lower biological risks, including those using antiretrovirals, offer promise for epidemic control, but are limited by structural factors including, discrimination, criminalization, and barriers to healthcare. Subepidemics, including among racial and ethnic minority MSM in the United States and UK, are particularly severe and will require culturally tailored efforts. For the promise of new and combined bio-behavioral interventions to be realized, clinically competent healthcare is necessary and community leadership, engagement, and empowerment are likely to be key. Addressing the expanding epidemics of HIV in MSM will require continued research, increased resources, political will, policy change, structural reform, community engagement, and strategic planning and programming, but it can and must be done.

Results from a Method for Estimating HIV Incidence Based on the First Cd4 Count among Treatment-Naïve Cases: Brazil, 2004-2013

“…Despite earlier concerns about an increase in heterosexual cases and "feminization" of the epidemic, it seems the actual scenario is the predominance of HIV infection among MSM, similar to data from many other countries [49,50]. In a study conducted in two Brazilian cities in 2013 using laboratory tests to distinguish recent from long-term infections, the estimated incidence rate was greater than 1% among MSM [25].…”

National HIV Care Continua for Key Populations

“…1 There were an estimated 1.1 million AIDS-related deaths and 2.1 million new HIV infections, much higher than the target of fewer than 500 000 AIDS-related deaths and new HIV infections by 2020. 1 Achieving 90-90-90 within a short timeframe of 5 years and ending AIDS by 2030 will not be possible without addressing the HIV epidemic in key populations including men who have sex with men (MSM), people who inject drugs (PWID), sex workers, prisoners, and transgender that bear disproportionate burdens of HIV [8][9][10] and account for 36% of new HIV infections. 1 In many countries, HIV care and treatment services for key populations are inadequate and of poor quality.…”

Stigma, gay men and biomedical prevention: the challenges and opportunities of a rapidly changing HIV prevention landscape

“…[15][16][17][18] The relationship between syndemics and individual sexual risk behaviour is complex and contested. However, when communities experience high levels of widespread health and social challenges such as syndemics, we know this undermines the accessibility and effectiveness of prevention programs, testing services and access to treatment.…”

“…The combination of GMSM sexuality and HIV-related stigma have been found to reinforce and multiply other social inequalities such as race and class, exacerbating the impact of stigma on minorities. Recent studies 16 concerning black and white GMSM, particularly in the US and UK, provide an example. Beyrer et al 16 in their review about the increases in the global GMSM epidemic, summarised multiple studies and reviews comparing black and white GMSM, particularly in the US and UK.…”