inthe current, more widespread, understanding of HIV epidemiology

inthe current, more widespread, understanding of HIV epidemiology among MSM and transgender
people is illustrated in Appendix 5. Cohort studies are under way in Thailand and have allowed the measurement
of HIV incidence data among MSM, including disaggregation by age group. These data show that the incidence
has increased in each biennial survey (2003 onwards), with a notable increase in incidence among the youngest
group of MSM (15–22 years old).
A smaller number of surveys have also measured the prevalence of other STIs among MSM and transgender
populations, and have found prevalence levels ranging between 1.1% among MSM in Jakarta to 19.3% among
transgender people in the same city.
3.2.4 South Asia
MSM are included in surveillance and survey activities across South Asia. In some settings, a distinction is made
between MSM, men who sell sex and transgender people. In other settings, (e.g. a large number of survey districts
in southern India), no differentiation is made and results are reported for MSM, transgender people and male sex
workers as a combined group. A wide range of STIs are prevalent (usually acute syphilis infection, gonorrhoea and/
or Chlamydia), with extremely high levels of acute syphilis infection recorded among transgender groups in Pakistan
(up to 60% in Karachi, for example). Some surveys report a higher prevalence of acute syphilis compared with
either of the bacterial anal infections (Chlamydia or gonorrhoea).11
3.2.5 Central and Eastern Europe
The HIV epidemics in Central and Eastern Europe are predominantly focused among people who inject drugs and
MSM. Data from surveys in central Europe (Cyprus, Croatia, Slovenia, Hungary, Slovakia) indicate that the epidemic
among MSM accounts for a substantial proportion (over 30%) of all HIV infections in the country. However, other
parts of the region are experiencing epidemics which are primarily concentrated in injecting drug user populations.
Interpretation of the data is confounded in some areas by an underreporting of HIV transmission among MSM.
3.2.6 High-income countries
Interpreting evidence from high-income countries is facilitated by the existence of repeated data points over time.
High HIV prevalence and mortality among MSM were key features during the 1980s in many urban settings in the
United States of America (USA), Western Europe and Australia. Community advocacy, changing community norms
and a strong public health intervention led to observed declines in incidence (followed by prevalence) in the 1990s.
More recent epidemiological and behavioural evidence, however, points to a resurgence of HIV and other STI
epidemics among MSM in many high-income countries. Data from one country, the United Kingdom (UK), are
illustrative.