MSM continue to face discrimination, barriers regarding HIV services

WASHINGTON — Men who have sex with men continue to be excluded from HIV prevention and services in a systematic way, according to Patrick Sullivan, PhD, of the Rollins School of Public Health at Emory University in Atlanta.

Sullivan presented findings from a study that appeared recently in The Lancet as part of a series highlighting challenges MSM face in combating HIV/AIDS. He cited stigma, discrimination and criminalization as key components to this exclusion.

“This situation must change if global control of the HIV epidemic is to be achieved,” Sullivan said.

It is feasible to institute effective combination prevention and treatment approaches, including condom and lubricant access for MSM worldwide, according to the researchers. Using ART as prevention and providing ART access to MSM worldwide may be feasible and would be a cost-effective management measure. However, substantial reductions in drug costs in high-income countries would be required for this to be achieved.

Ongoing research, political will, structural reform, community involvement and strategic planning and programming are necessary if the epidemic among MSM is to be curbed, according to Sullivan.

“There is a high risk of HIV acquisition linked to anal sex,” Sullivan said. “If we can reduce it to the level of vaginal risk, then 80% to 90% of risk among MSM would be reduced.”

Another driver of HIV infections in this population is the high prevalence of unknown HIV in partner pools. “We are seeing low HIV testing rates,” he said. “We are also seeing high viral load in HIV-positive partners. We need to reach goals for MSM in treatment.”

There are structural barriers preventing MSM from finding safe spaces for prevention and culturally competent care, according to Sullivan. “We must take steps to provide places for these men to go,” he said. “And we need to reduce stigma and criminalization. There is prejudice, threats and violence against MSM that prevent them from seeking the services they need, and health care workers are not properly trained to deal with these obstacles.”

The study included simulation of three prevention approaches, including oral pre-exposure prophylaxis, an early ART prevention package and condom promotion.

Sullivan said if these packages are employed, one in four infections could be prevented in MSM.

“With existing technology, smart packaging, appropriate scale, appropriate use of resources and political will, we can give these men safe places for prevention and treatment. We can take what we have today and bring these interventions to scale,” he said.

“Criminalization of same-sex behaviors still exists,” Sullivan said. “There are technical challenges to testing these prevention packages. These barriers must be eliminated.”

References:

Beyrer C. Lancet. 2012;doi:10.1016/S0140-6736(12)61022-8.

Sullivan P. #TUSY0702. Presented at: XIX International AIDS Conference; July 22-27, 2012; Washington, D.C.