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
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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.
KeywordsMen who have sex with men MSM HIV Epidemic Risk factors
We thank Michael Cowing for critically reviewing and providing valuable input on this paper.
Compliance with Ethical Standards
This publication was made possible with help from the Johns Hopkins University Center for AIDS Research, an NIH funded Program (P30AI094189), which is supported by the following NIH Co-Funding and Participating Institutes and Centers: NIAID, NCI, NICHD, NHLBI, NIDA, NIMH, NIA, FIC, NIGMS, NIDDK, and OAR. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.
Conflict of Interest
Chris Beyrer is receiving a donation of Tenofovir/Emtricitabine (Truvada) from Gilead, Inc. for an effectiveness study of a multi-level combination HIV preventive intervention with and without daily oral Truvada pre-exposure prophylaxis among young men who have sex with men in Bangkok, Thailand (R01AI118505; PI: Beyrer). Kenneth H. Mayer has received unrestricted research grants from Gilead Sciences and ViiV Healthcare. Shauna Stahlman, Patrick S. Sullivan, and Stefan D. Baral declare that they have no conflict of interest.
This article does not contain any studies with human participants or animals performed by any of the authors.
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