Men who have sex with men (MSM)
An oral abstract from Siberia (Efremov, abstract MOAE0204, http://pag.aids2014.org/session.aspx?s=1125) described a combination HIV prevention program from MSM and transgender persons which demonstrated a significant increase in HIV awareness (by 34%), with accompanying prevention behaviors (specifically, HIV testing, serosorting and monogamy) but the level of condom use decreased from 49.6% to 41.3%. However, the program also noted an increase in violence, discrimination and closeted behavior in the population since the adoption of Russia’s anti-gay "propaganda law" in 2013, emphasizing the important role that stigma can play in harming effective prevention. Another oral abstract, from Nigeria, reported that MSM had increased fear of seeking health care and increased feeling of no safe place to socialize after recent anti-gay legislation was implemented (Schwartz, abstract TUAD0305LB, http://pag.aids2014.org/session.aspx?s=1111).
An oral abstract session focused on MSM (http://pag.aids2014.org/session.aspx?s=1119). One presentation from that session (Holt, THAD0101) addressed risk reduction strategies used by Australian gay and bisexual men who had had anal sex without condoms with casual partners. Three-quarters of men consistently used at least one strategy for casual sex, with the most common strategies being serosorting by HIV status and condoms. HIV-positive men were much more likely to rely on serosorting than HIV-negative men (60% versus 44 %). HIV-negative men were more likely to use a combination of strategies. A second (Ifekandu, THAD0103) presented qualitative research with MSM in Abuja, Nigeria, among whom an estimated 36% are HIV positive. MSM described multiple sexual partners, inconsistent condom use, transactional sex, poor access to services and harassment from the police, and societal pressures to maintain the appearance of being heterosexual. Most men used social networking websites to meet partners. This is one of several presentations of MSM in Africa, India and Jamaica, which indicate that in countries with harsh laws against homosexuality and entrenched homophobia, MSM have less access to HIV prevention, and are at significantly increased risk of HIV.
In another oral session on MSM (http://pag.aids2014.org/session.aspx?s=1128) [http://www.natap.org/2014/IAC/IAC_45.htm] a comparison of London and San Francisco highlighted the differences in the HIV testing care cascade (Brown, THAC0205LB). Using 2010 data from CDC and Public Health Evaluation data from London, whereas linkage to care within 3 months and retention in care were higher in London, an estimated 21% of HIV positive MSM are undiagnosed in London, compared to about 10% in San Francisco. London and San Francisco had an estimated 70% and 60% of diagnosed HIV infected MSM who were virally suppressed in 2010, which has gradually increased since 2006. The key challenges are increasing HIV testing in London, including among MSM who are in-migrants to London, earlier ART initiation (given ART guidelines are based on CD4 ≤350) and retention in care in San Francisco to achieve higher rates of viral suppression. Recreational drug use is an important issue, as suggested by rising hepatitis C prevalence in London, and high levels of recreational drug use in a recent London Shigella outbreak and based on research in high-risk venues (through the Chemsex study). The investigators highlighted the importance of increasing HIV testing, awareness, disclosure, and the importance of challenging the safety of serosorting.
From Thailand (Thienkrua, THAC0202 presented by Pattanasin,) HIV incidence among young MSM enrolled in the Bangkok MSM Cohort Study was estimated. Men were recruited at venues, Internet, male sexual health clinics, and social or friendship networks of outreach workers between 2006 and 2010. Of the 1744 young MSM, HIV-prevalence was 21% and incidence was 7.5 per 100 person years. Multivariate risk factors for HIV-incidence were unprotected receptive anal intercourse AHR, 2.8), being paid for sex (AHR 2.2), having a casual sexual encounter at a sauna or at home (AHR 1.9 and 1.6, respectively), and living alone or with a roommate (AHR 1.5). This high HIV incidence among young MSM in Bangkok highlights the urgent need for combination HIV prevention interventions.
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