populations are highly affected by the HIV epidemic

Key conclusions and issues on strategic information
3.3.1 MSM and transgender populations are highly affected by the HIV epidemic
The regional presentations and published literature point to a higher prevalence of HIV among MSM and transgender
people compared with men in the general population. Data on the proportion of men in the overall population who
report MSM behaviours either over a lifetime or in the past twelve months are presented in Table 1. These data are
important for understanding the proportion of HIV transmission that is attributable to male-to-male sexual activity
in a country. Population-attributable fractions can help to address this issue and can thereby assist programme
planners to ensure that the resources and programme effort devoted to any particular group of people is
commensurate with the size of the problem.
The meeting heard that:
• Around 50% of all HIV infections in Latin America are assumed to have arisen through unprotected anal sex
between men, but this is lower in some settings (e.g. 13% in Brazil).
• Data from Central and Eastern Europe show that sex between men accounts for a wide range of new HIV
infections, from 0.1% of all new HIV infections in Ukraine to 60% of all new infections in Slovakia.
• Gouws et al. found that MSM activity may account for 20% of all new HIV infections in Thailand and 4.5% in
Kenya.14
These calculations are important for ensuring that the distribution of resources, including financial resources, is
proportional to address the identified need.
3.3.2 Behavioural survey data are important in understanding risk
As noted above, measurement of MSM and transgender behaviours is not straightforward. While the United Nations
General Assembly Special Session (UNGASS) has defined a set of minimum indicators to assess key behaviours
indicating both risk and risk reduction, applying these seemingly straightforward measures across time and place
can make intercountry comparisons difficult. Nonetheless, information presented from several regions highlighted
the following common themes:
• Many MSM have female as well as male sexual partners; in some parts of the world, the majority of MSM may
be married to women.
• The prevalence of unprotected anal intercourse is relatively high in some settings, and may be more common
with regular sexual partners.
• MSM and transgender people are inadequately covered by prevention services and commodities, and have
poor access to appropriate interventions in many settings.
• Information on violence, when collected, shows that it is a prevalent feature in the lives of many MSM and
transgender people, and is perpetrated by families, communities, clients (in the case of men and transgender
people who sell sex) and representatives of the state.
• Stigma, discrimination and criminalization of sexual behaviour hinder the collection of accurate data and
information from participants in surveys.