As we inch closer to achieving global targets in HIV prevention, we remember how far we have come in fighting this epidemic and all the work that there still is to be done.
Overall, the odds of having HIV infection are markedly and consistently higher among gay and bisexual men and other men who have sex with men than among the general population in adults of reproductive age in every region and country in the world. The reasons for heightened vulnerability to HIV stem from violations to the right to health and are driven by stigma, discrimination, and violence.[i],[ii],[iii],[iv]
According to the 2016 UNAIDS Gap Report, the risk of HIV acquisition for gay men and other men who have sex with men is 24 times more likely than compared to adults aged 15 years or older in the general population.
UNAIDS reports that there are 1.8 million [1.6 million – 2.1 million] people who became newly infected with HIV in 2016. Gay men and other men who have sex with men are disproportionately represented among new infections, with an estimated 12% of new infections attributed to gay men in 2015.
Since 2010, new HIV infections among adults have declined by an estimated 11% globally. However, among men who have sex with men, the opposite is true—incidence is stagnant or rising for gay men in most regions across the world.[v],[vi],[vii],[viii]
In 2016, only 53% [39–65%] of all people living with HIV had access to antiretroviral treatment globally. Data on treatment coverage among gay and bisexual men is almost non-existent because governments refuse or don’t know how to safely and respectfully collect and report this data. The little data that is available comes from standalone studies, which suggest low treatment coverage.
Despite these troubling trends, HIV prevention and treatment services for gay men remain severely under-resourced. It is estimated that less than 2% of global HIV prevention funding is targeted towards men who have sex with men. As a result, HIV prevention services only reach approximately 10% of gay men worldwide.
Investment in country-based HIV services rarely reflect the reality of who is most impacted by the epidemic: funding for key populations is consistently less than programming for the general population. What programs do exist often do not sufficiently meet the unique needs of men who have sex with men, transgender women, sex workers, and people who use drugs. Investment and support on a global scale is critical for the empowerment of key populations to exert ownership over the design and delivery of services to communities.
Stigma, discrimination, and exclusion continue to impede access to essential services and prevent meaningful political commitments to the health and HIV needs of gay and bisexual men. Same-sex relations remain criminalized in over 70 countries, which further deters gay and bisexual men from accessing HIV services. It is essential that the human rights of all key populations are protected and fulfilled first and foremost in the global response to HIV.
This year and every year on World AIDS Day, we remember the lives lost to this epidemic and the voices of those who stood against it. Gay men living with and affected by HIV have been the champions of this fight since the very start. MSMGF works to amplify their voices.
With advances in biomedicine and mobilized communities, we are closer to achieving global targets in epidemic control than ever before. However, until we are able to eliminate structural barriers and provide easy access to life-saving medicines, social services, and basic care for those who need it most, we will not see an end of AIDS. Health is a human right that must be upheld. As gay and bisexual men, we must continue to empower, educate, and support ourselves and each other in our work against AIDS.
MSMGF is an expanding network of advocates and other experts in sexual health, LGBT/human rights, research, and policy, working to ensure an effective response to HIV among gay men and other men who have sex with men. We are directly linked with more than 120 community-based organizations, across 62 countries.
[i] Beyrer, C., Baral, S.D., van Griensven, F., et al. (24 July 2012). Global epidemiology of HIV infection in men who have sex with men. Lancet, 380(9839): 367-77.
[ii] Baral, S., Holland, C.E., Shannon, K., et al. (10 July 2014). Enhancing benefits or increasing harms: community responses for HIV among men who have sex with men, transgender women, female sex workers, and people who inject drugs. JAIDS, 66 (Suppl 3): S319-28.
[iii] Smith, A.M., Grierson, J., Wain, D., Pitts, M., Pattison, P. (2 December 2004). Associations between the sexual behaviour of men who have sex with men and the structure and composition of their social networks. Sexually Transmitted Infections, 80(6): 455-8.
[iv] Johnson, A.S., Hall, H.I., Hu, X., Lansky, A., Holtgrave, D.R., Mermin, J. (2014). Trends in Diagnoses of HIV Infection in the United States, 2002-2011. JAMA, 312(4): 432-434.
[v] Beyrer, C., Sullivan, P., Sanchez, J., et al. (12 July 2013). The increase in global HIV epidemics in MSM. AIDS, 27(17): 2665-78.
[vi] Baral, S.D., Grosso, A., Holland, C., Papworth, E. (22 January 2014). The epidemiology of HIV among men who have sex with men in countries with generalized HIV epidemics. Current opinion in HIV and AIDS, 9(2): 156-67.
[vii] Baral, S., Trapence, G., Motimedi, F., et al. (28 March 2009). HIV prevalence, risks for HIV infection, and human rights among men who have sex with men (MSM) in Malawi, Namibia, and Botswana. PloS One, 4(3): e4997.
[viii] Stahlman, S., Johnston, L.G., Yah, C., et al. (2 October 2015). Respondent-driven sampling as a recruitment method for men who have sex with men in southern sub-Saharan Africa: a cross-sectional analysis by wave. Sexually Transmitted Infections.