Men who have sex with men

Men who have sex with men

The expanding epidemics of HIV type 1 among men who have sex with men in low- and middle-income countries: diversity and consistency.

Men who have sex with men have borne a disproportionate burden of human immunodeficiency virus (HIV) infection and remain a markedly underresourced population globally. To better describe HIV epidemics among men who have sex with men in low- and middle-income countries, the authors conducted a systematic review of published and unpublished literature available after January 1, 2000 (2000-2009). A total of 133 HIV prevalence studies from 50 countries met the search criteria. Data were used to develop an algorithmic approach to categorize these epidemics. The authors found that the HIV epidemic in low- and middle-income countries may be described using the following 4 scenarios: 1) settings where men who have sex with men are the predominant contributor to HIV cases; 2) settings where HIV transmission among men who have sex with men occurs in the context of epidemics driven by persons who inject drugs; 3) settings where HIV transmission among men who have sex with men occurs in the context of well-established HIV transmission among heterosexuals; and 4) settings where both sexual and parenteral modes contribute significantly to HIV transmission. The authors focused on Peru, Ukraine, Kenya, and Thailand to describe the diversity across and similarities between proposed epidemic scenarios. This scenario-based categorization of HIV epidemics among men who have sex with men may assist public health agencies and civil societies to develop and implement better-targeted HIV prevention programs and interventions.

Editors’ note: This fascinating article highlights the need for more data to better understand the diversity of HIV epidemics among men who have sex with men and to design and tailor strategies to different epidemic contexts. But the overarching typology of four distinct scenarios characterising the majority of epidemics in low- and middle-income countries among men who have sex with men is extremely useful in stimulating thinking about what strategies would be most effective. The detailed country examples are illustrative: Peru (scenario 1 with MSM predominance), Ukraine (scenario 2 high HIV prevalence among MSM in the context of a primarily drug injecting-related epidemic), Kenya (scenario 3 MSM risks occurring in the context of a widespread heterosexual epidemic), and Thailand (high HIV incidence in MSM in a complex epidemic). Using this typology, Ghana’s prevention efforts should have a major focus on MSM because it likely falls into the scenario 1 with MSM predominance, despite its geographical location in a continent that mostly falls into the scenario 3 category of MSM risks within widespread heterosexual epidemics. Repressive legal contexts and pervasive social stigma are critical barriers to effective HIV prevention, treatment, care and support for men who have sex with men. Regardless of which epidemiological scenario best describes countries, decriminalising same sex relations and affirming the human rights of sexual minorities are essential steps to an effective response to HIV among men who have sex with men.