HIV rates among MSM vastly higher than general population in developing countries

Dec 3 2007

Responding to a new study demonstrating the severity of the HIV epidemic among men who have sex with men (MSM) in low- and middle-income countries, amfAR, the Foundation for AIDS Research, called on policymakers to put aside their prejudices and to provide the resources and the leadership that the epidemic demands.

Researchers at Johns Hopkins University's Bloomberg School of Public Health today published the results of a new study showing that in 38 low- and middle-income countries men who have sex with men have an average 19 times greater chance of being infected with HIV than the general population. In some countries MSM are more than 100 times more likely to be infected, the study found. A press-only preview of the embargoed paper, to be published in the open-access journal PLoS Medicine, can be found here: http://www.plos.org/press/plme-04-12-beyrer.pdf

In the most comprehensive analysis of HIV among MSM populations to date, researchers found that in the Republic of Georgia, MSM were about 24 times more likely to be infected than the general population; Senegal – 27 times more likely; China – 45 times more likely; and Mexico – 109 times more likely. The study indicates that even in countries with low HIV prevalence in the general population, the epidemic among MSM is raging. The term “MSM” includes those who identify as “gay,” but also encompasses any men who have sexual encounters with other men, including groups whose gender and sexual identities defy Western categorization.

“Even in countries that have made progress overall, we are still seeing very high rates of HIV among MSM,” said Dr. Stefan Baral, lead author of the study and resident physician, Department of Epidemiology, Center for Public Health and Human Rights.

Kevin Frost, amfAR's chief executive officer, called on policymakers to provide the resources to match the severity of the epidemic among MSM.

“Populations with very high HIV prevalence are largely ignored in HIV prevention policies,” said Frost. “Increased surveillance, research, and HIV prevention can curb HIV transmission among MSM and reduce the global HIV burden. But if we don't overcome institutional prejudices and treat this epidemic seriously in the populations that are most affected, we will never beat AIDS.”

The study reinforces the view that the HIV epidemic among MSM is widespread and in many cases exacerbated by stigma, criminalization and lack of services. Eighty-five countries around the world criminalize male-male sex, yet donor funding for HIV prevention flows through some of the same governments whose policies criminalize or discriminate against MSM. According to UNAIDS, fewer than one in 20 MSM around the world has access to HIV prevention, treatment, and care – and far fewer in lower income settings. Compared to the HIV testing rates of 63–85 percent seen among MSM in Australia, Europe, and North America, rates among MSM in much of Africa, Asia, and Latin America are often under 20 percent.

“This study not only reveals how severe the epidemic is among MSM in many countries, but how huge the research gaps are,” said Dr. Chris Beyrer, a co-author of the study and director of the Johns Hopkins Fogarty AIDS International Training and Research Program in the United States. “HIV transmission among MSM is not regularly tracked in most countries, and more research is urgently needed to inform more effective HIV prevention efforts.”

Despite these challenges, some progress is being made. Grassroots movements are forming in Africa, India, Southeast Asia, and other regions where discrimination is commonplace and the epidemic has reached crisis proportions. To nurture and expand these efforts, amfAR recently launched the MSM Initiative, which is providing seed grants to grassroots organizations in developing countries around the world to fight stigma and discrimination; support HIV/AIDS research and prevention efforts, and catalyze more attention and funding for HIV/AIDS among MSM.

“This study shows the need for more comprehensive research around incidence and prevalence of HIV among men who have sex with men in the southern African region,” said Friedel Dausab, Project Officer for the PRISM Project in Namibia, which works on prevention research in sexual minorities. “This will provide African governments, international development organizations and donors with the evidence they need to help save the lives of millions MSM and their partners who are endangered by the HIV and AIDS epidemics.”