Men who have sex with men and HIV.

A presentation outlined the epidemiology, response and human rights issues in the context of HIV among men who have sex with men (MSM). The same results are seen in every HIV prevalence study among MSM, with rates much higher than the general population. A systematic review carried out in 2007 showed odds ratios of 33, 19 and 4 for the Americas, Asia and Africa respectively for HIV prevalence in MSM compared to other adults of reproductive age. Risk and vulnerability of MSM to HIV are influenced by human rights violations, criminalisation of sexual orientation, stigma, discrimination and homophobia. 86 countries criminalise sex between consenting adult men, including more than half of African countries that report some of the highest HIV prevalence rates in the world. (1)

At the Global Forum on Men who have Sex with Men and HIV, which preceded the AIDS Conference, a series of surveys of MSM in southern Africa were reported. Researchers at Johns Hopkins School of Public Health and partners in South Africa, Botswana, Namibia and Malawi recruited convenience samples of 200 MSM in each country. In Malawi, MSM had high levels of behaviour likely to enhance HIV spread. Nearly two-thirds had had sex with women as well as men in the last six months, and nearly half had steady female partners. Only a third consistently used condoms in casual sex with other men and only a quarter with women. The average number of male partners in the previous six months was four, but amongst those with HIV it was 14. HIV prevalence was 21%, while in the general population prevalence was 12%. HIV status was related to self-defined sexuality: 15% of the 106 men who defined themselves as bisexual had HIV, 26% of the 79 who identified as gay, but none of the 15 who identified as heterosexual. In the multivariate model, the only significant risk factors for HIV were meeting partners on the internet, not always using condoms and being over 25. Only 6% had told immediate family members about their sexuality and 18% said they had been afraid to seek health care due to their sexuality. Early results from 79 men in Cape Town show 34% HIV prevalence compared to 18-20% in the general population. Results from Botswana have been delayed as the government at first refused permission for the study, and there have been difficulties in recruitment due to the illegality of homosexuality. (2)

(1.) Saavedra J, Izazola JA, Beyrer C. Sex between men in the context of HIV. Jonathan Mann Memorial Lecture. XVII International AIDS Conference, Mexico City, August 2008.

(2.) Barat S, et al. HIV epidemics among MSM in Africa: examples from Malawi, Botswana, Namibia, Nigeria and South Africa. Workshop R9 from The Invisible Men: Gay Men and Other MSM in the Global HIV/ AIDS Epidemic. Pre-conference satellite, XVII International AIDS Conference, Mexico City, 2008. At: <www.msmandhiv.org/documents/2008_MSM_Program_2008_0729.pdf>.