HIV among MSM examined at CROI


The ongoing disproportionate burden of HIV/AIDS borne by gay, bisexual and other men who have sex with men (MSM) in the United States as well as around the world was the topic of a number of sessions and posters at the 20th Conference on Retroviruses and Opportunistic Infections Exit Disclaimer in Atlanta this week.

In a compelling plenary session, The Global MSM HIV Epidemic: Time to Act Exit Disclaimer, Chris Beyrer Exit Disclaimer, MD, MPH, of the Johns Hopkins University Bloomberg School of Public Health noted that MSM around the world have markedly higher HIV prevalence rates than the general population of reproductive-aged adults. This is true in every region of the world, including sub-Saharan Africa and the Caribbean, which has the highest HIV prevalence rate among MSM. (For more on the global epidemiology of HIV in MSM, see this study published by Dr. Beyrer and colleagues in The Lancet, 2012 Exit Disclaimer.)

While HIV incidence data (i.e., the number of new HIV infections) are less available worldwide than are prevalence data (i.e., the number of all persons living with HIV, both new and existing infections), the incidence data in hand suggest that there are stable or rising rates of new infection among MSM around the world, particularly in the last 5 years. As an example, Dr. Beyrer—who is also the President-elect of the International AIDS Society Exit Disclaimer—shared 5-year cumulative incidence data from a Bangkok, Thailand, cohort of MSM in a recently-published study Exit Disclaimer. Over the course of 60 months, 23% of sexually active Thai MSM of all ages who participated in the study became infected with HIV. Even more alarming, 31% of MSM ages 18-21 became infected with HIV over the same time period. Dr. Beyrer noted that these new infections occurred in a country with good ARV access, where homosexuality is not criminalized, and where the heterosexual HIV epidemic is in decline.

Dr. Beyrer discussed how the high background prevalence of HIV in many MSM communities drives new infections and increases the lifetime likelihood of HIV acquisition among its members. Exacerbating this is the fact that young MSM in the U.S. and in many other countries have the highest rates of new HIV infections, but they are also the least likely to be in HIV care and treatment. Further, structural factors such as discrimination based on sexual orientation or HIV status, criminalization of same-sex sexual practices, and barriers to health-care access for MSM also limit the impact of HIV prevention efforts for these communities. Dr. Beyrer pointed out, however, that modest increases in the use of condoms can have very positive impacts on these epidemics.


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