By Liz Highleyman

An ad campaign by the Gay Men’s Health Crisis is intended to reach gay and bisexual men of color in their neighborhoods and daily lives.

Newly revised U.S. incidence figures, released on August 2 in advance of the XVII International AIDS Conference taking place this week in Mexico City, showed not only that the number of annual infections is higher than previously believed, but also that men who have sex with men (MSM) make up 53% of all new infections. Incidence rates are particularly high -- and rising -- among young gay/bisexual men and MSM of color.

The Epidemic among U.S. MSM

At a session on Wednesday looking at various aspects of the U.S. epidemic, Ronald Valdiserri provided further information about HIV rates among MSM. He reported that the number of AIDS cases among U.S. MSM peaked at around 25,000 in 1992, decreased until the late 1990s, but then slowly began to increase.

In 2006, MSM accounted for 43.5% of all adult and adolescent AIDS cases. Nearly two-thirds of cases occurring between 2001 and 2006 in 33 states with consistent name-based reporting were among men aged 25-44 years. Whites accounted for 42% of these cases, blacks for 36% (even though the percentage of blacks in the population as a whole is just 12%), and Hispanics for 19%.

Valdiserri noted that according to the National Behavioral Surveillance System, 47% of MSM reported engaging in unprotected anal sex during the past year, indicating that "peer norms regarding condom use simply are not as robust as they were in the first 2 decades of the epidemic." However, he added, "prevention has been scientifically proven to be successful" -- though clearly effective prevention efforts have failed to reach all at-risk groups of MSM.

While lauding the Center for Disease Control and Prevention's initiative to increase HIV testing, Valdiserri said "testing alone will not end this epidemic," adding, "it is imperative that as a nation we continue to invest in prevention research, both biomedical and behavioral."

Advocates Demand More

Advocates took advantage of the AIDS conference to call attention to the disproportionate effect of the epidemic on MSM. While such is the case in developed and developing countries alike, MSM in many developing countries have been virtually excluded from programs and funding aimed at prevention and treatment of HIV/AIDS.

The Saturday preceding the conference, more than 1000 participants took part in the 1st International March against Stigma, Discrimination, and Homophobia, calling attention to the needs of MSM and other marginalized groups -- including transgender people and sex workers -- affected by HIV/AIDS.

On Monday, the American Foundation for AIDS Research (amfAR) released a report detailing how local governments and global health agencies have failed to adequately address the epidemic among MSM. While global efforts often target women and children, MSM have been, and continue to be, the group at highest risk of infection -- about 19 times more likely to contract HIV as the rest of the population worldwide. Further, many countries do not even collect data on HIV/AIDS rates among MSM, an indication of the level of denial, stigma, and even criminalization these men face.

AmfAR's Kevin Frost

AmfAR's Kevin Frost said it was "indefensible" that the Global Fund to Fight AIDS, Tuberculosis and Malaria, the President's Emergency Plan for AIDS Relief (PEPFAR), and the World Bank had failed to allocate significant resources toward reducing HIV rates among MSM. "These organizations have policies on women, drug users, migration -- but not one of them has a comprehensive policy on MSM," he stated.

On Wednesday, the International AIDS Society (IAS) and the Global Forum on MSM and HIV issued a joint statement decrying the lack of HIV prevention programs for MSM, noting that this failure has contributed to escalating rates of new infections in the global south.

According to the statement, 25 years into the AIDS epidemic, only 1 in 20 MSM have access to HIV prevention programmes and 91 out of 128 low- and middle- income countries fail to report on access for MSM to HIV prevention programs.

"Research has demonstrated over and over again that reducing the social exclusion of men who have sex with men through the promotion and protection of human rights is not only consistent with, but a prerequisite to, good public health," said IAS Executive Director Craig McClure.

"Perhaps the most dangerous misperception in relation to men who have sex with men and HIV is that the overall downturn in the HIV epidemic and the increase in rights won by gay men and lesbians in the West are a reflection of the true state of affairs of gay, bisexual and other MSM globally," said Robert Carr of the Global Forum on MSM and HIV. "In fact, nothing could be further from the truth. Gay, bisexual and other MSM are largely invisible in many parts of the developing world, and in the majority of cases subject to varying degrees of discrimination, violence and human rights abuses."

8/08/08

Sources

K Fenton. HIV/AIDS in the States: Current trends and future challenges. XVII International AIDS Conference. Mexico City. August 3-8, 2008. Abstract WEAC0302.

HI Hall, R Song, P Rhodes, and others. Estimation of HIV Incidence in the United States. Journal of the American Medical Association 300(5): 520-529. August 6, 2008.

R Valdiserri. The HIV/AIDS epidemic in MSM in the United States. XVII International AIDS Conference. Mexico City. August 3-8, 2008. Abstract WEAC0303.

American Foundation for AIDS Research (amfAR). TITLE.

Kaiser Family Foundation. MSM Remain at High Risk for HIV; Official Data Lacking, Report Finds. DATE?

International AIDS Society and the Global Forum on MSM and HIV. Social exclusion and lack of HIV prevention programmes for men who have sex with men escalating new HIV infections in major cities of the global south. Media release. August 6, 2008.