Engagement of Gay Men and Other Men Who Have Sex with Men (MSM) in the Response to HIV: A Critical Step in Achieving an AIDS-Free Generation

Abstract

Men who have sex with men (MSM) continue to be at elevated risk for HIV acquisition and transmission secondary to biological and behavioral characteristics, social and sexual network characteristics, community environmental factors, and structural factors. HIV incidence rates remain high among MSM in both low- and high-income settings, and in both concentrated and more generalized HIV epidemic settings. While data quality tends to be poorer, the best estimates collectively suggest that MSM have up to 20 times the odds of living with HIV as compared to other reproductive aged adults across low- and middle-income countries. Recent prevention strategies to lower biological HIV transmission and acquisition risks, including the early use of antiretrovirals to decrease infectiousness for those living with HIV, and pre-exposure prophylaxis for those at significant risk of HIV acquisition, have demonstrated the potential to change the trajectory of the HIV epidemics among MSM. However, the coverage and effectiveness of these approaches is limited by structural factors including the punitive legal frameworks and institutional discrimination that contribute to limited uptake, challenges to adherence, and suboptimal health-seeking behaviors among MSM. More intensive efforts will be required to reach MSM who do not currently have access to relevant and effective prevention and treatment services or elect not to access these services given enacted and/or perceived stigma. Respect for human rights, including efforts to aggressively confront and combat the forms of stigma that are preventing us from achieving an AIDS-Free generation, are needed for all people including gay men and other MSM.

Keywords: Epidemic; HIV; MSM; Men who have sex with men; Risk factors.

Figure 1.

Global HIV prevalence in MSM, from studies published 2007–11 Data are prevalence (95% CIs). Reprinted from The Lancet, Volume 380, Beyrer C, Baral SD, van Griensven F, Goodreau SM, Chariyalertsak S, Wirtz AL, and Brookmeyer R. Global epidemiology of HIV infection in men who have sex with men, pages 367–77, Copyright (2012), with permission from Elsevier.

Figure 2.

Pooled HIV prevalence among MSM, and among all men of reproductive age, by region, 2012 HIV prevalence among adults. Data from UNAIDS report on the global AIDS Epidemic: 2012. Joint United Nations Programme on HIV/AIDS (UNAIDS). Geneva: 2012. Adapted from The Lancet, Volume 380, Beyrer C, Baral SD, van Griensven F, Goodreau SM, Chariyalertsak S, Wirtz AL, and Brookmeyer R. Global epidemiology of HIV infection in men who have sex with men, pages 367–77, Copyright (2012), with permission from Elsevier.

Figure 3.

HIV Prevalence among MSM in Africa Modified from (57).