"Prevention for all MSM, but with a positive spin!" Top2Btm MSM Symposium Presentation

Published: May 23, 2011

Outline
• Prevention failure and missed messaging opportunities
• Risk-reduction interventions
– Behavioural
– Biomedical
• Crystal Meth and sex
• Some recommendations – combination prevention

MSM Prevention Scorecard
– 2000–2005 increased by 3.3% per year
Sullivan PS et al. Re-emergence of the HIV epidemic among men who have sex with men in North America, Western Europe, and Australia, 1996–2005. Science Direct 2009; 19:423–431
• England / Wales / Northern Ireland
– MSM account for 55% of new HIV infections High rates of risky sexual behaviours
– MSM account for 58% of new syphilis diagnoses
– Syphilis rates increased by 616% between 1999-2003 Fenton, K et al. Increasing Rates of Sexually Transmitted Diseases in Homosexual Men in Western Europe and in the United States: Why? Infect
Dis North America 2005; 19:311-331
• South Africa
– Emerging data show rates of 10.4 to 33.9% in various studies
– 49.5% Johannesburg / 27.5% Durban (>80% black African MSM)
JEMS Study. HIV prevalence and risk practices among men who have sex with men in two South African cities. J Acquir Immune Defic Syndr. 2011
Feb 4
– iPrEx recruitment in Cape Town: 4-5% HIV incidence overall
– Grant R et al. Pre-exposure Chemoprophylaxis for HIV Prevention in MSM. NEJM 2010; 363(27);2587-2599.
Lots of HIV positive MSM out

Failure of Messaging?
• USA / UK targeted MSM for HIV prevention

HIV Prevention in SA
• Hetero-normative and often not relevant to MSM
• Targeted mainly HIV negative population
• Non-gay identifying MSM hard to reach
• Stigma about sexual orientation and status
• Institutionalised homoprejudice in state facilities
• Other barriers to accessing health care

Behavioural Interventions
– Variety of different interventions aimed at modifying behaviours associated with HIV risk
– Different models including individual counselling, motivational interviews, cognitive-behavioural models…
– Aims:
• Knowledge of status and engaging with that fact
• Communicating status to sex partners
• Understanding, assessing and modifying risks
• Looking for triggers of risky behaviour (int’ and ext’)
• Drugs / alcohol
• Teaching new approaches and skills e.g. Condom negotiation / reducing numbers of sex partners /
serosorting / seropositioning

Full access to presentation available at link below –

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