A call to action for comprehensive HIV services for men who have sex with men

Abstract

Where surveillance has been done, it has shown that men (MSM) who have sex with men bear a disproportionate burden of HIV. Yet they continue to be excluded, sometimes systematically, from HIV services because of stigma, discrimination, and criminalisation. This situation must change if global control of the HIV epidemic is to be achieved. On both public health and human rights grounds, expansion of HIV prevention, treatment, and care to MSM is an urgent imperative. Effective combination prevention and treatment approaches are feasible, and culturally competent care can be developed, even in rights-challenged environments. Condom and lubricant access for MSM globally is highly cost effective. Antiretroviral-based prevention, and antiretroviral access for MSM globally, would also be cost effective, but would probably require substantial reductions in drug costs in high-income countries to be feasible. To address HIV in MSM will take continued research, political will, structural reform, community engagement, and strategic planning and programming, but it can and must be done.

Figure 1. Global surveillance of HIV in MSM, through 2011

Data collected by year-end 2011; includes peer-reviewed publications, national and biobehavioural surveillance reports. MSM=men who have sex with men.

Figure 2. Proportional costs and HIV infections in MSM averted, by income category

Bars show the proportion of total estimated global costs (see text and supporting information) and cumulative global HIV infections in MSM averted over 10 years, according to World Bank income category. Note that high-income countries shoulder most costs (especially for drugs) while averting few HIV infections. This suggests that a more equitable balance could be achieved by prioritising the response in lower-income settings (where unmet burden is highest and resources most constrained) while simultaneously lowering drug prices in high-income areas. MSM=men who have sex with men. PrEP=pre-exposure prophylaxis. ART=antiretroviral therapy.

Figure 3. Strategic framework for action on HIV in MSM

STI=sexually transmitted infection. MSM=men who have sex with men.