HIV Prevention for Men Who Have Sex with Men - amfAR Issue Brief No. 4

This Foundation for AIDS Research (amfAR) issue brief cites recent evidence indicating that HIV infection is re-emerging in new cohorts of men who have sex with men (MSM) in developed countries and is an emerging epidemic in MSM in developing countries. Thus, this document assesses the 2006 trends in HIV infection in MSM and the status of effective and promising interventions for these populations.

The population characteristics of SMS encompass a range of gender identities and behaviours which differ by location and cultural labelling. "Thus, it is important to understand the interaction of identity and behaviors when devising and implementing interventions to prevent sexual transmission of HIV in MSM". Certain possibilities of gaps in screening for sexually transmitted infections (STIs) and delivery of health care may increase the likelihood of HIV exposure. Behavioural factors have also been shown to be factors associated with increased risk of HIV infection and include: unprotected sex; multiple sex partners; inconsistent condom use; lack of knowledge about HIV risk; prevalence of alcohol and drug use among MSM; depression linked to risky behaviours; history of childhood sexual abuse; negative or complacent attitudes toward safer sex; and wider availability of contacting MSM through the use of the internet.

As stated here, individual-level, small group, and community-level behavioural prevention interventions focused on at-risk MSM have been effective in changing risk behaviours that facilitate HIV transmission and acquisition. Trends include the following:

• Of 54 behavioural interventions for MSM reviewed in the United States (US), 38 resulted in a 27% reduction in acts of unprotected sex.
  
• Another review of 33 behavioural interventions conducted globally incorporated interpersonal skills-building, utilised several delivery methods, and were delivered over multiple sessions. They increased condom use by 61% and reduced unprotected sex by 23%.
  
• Two community-level models that have been widely replicated involve: mobilising young gay/bisexual men to shape a healthy community for themselves and to encourage their friends to have safer sex; and using popular opinion leaders in gay/bisexual communities to change norms around sexual behaviours. "In communities where these interventions have been implemented, rates of unprotected anal sex decreased, condom use increased, and overall numbers of sex partners decreased."

Barriers to reaching MSM may be increased by HIV prevention programme policies, such as abstinence-only programmes that implicitly and explicitly condemn or deny the existence and sexual rights of gay, bisexual, and transgendered people, according to the brief. Educational curricula may convey medically inaccurate information about STIs and HIV infection, and include discouragement for use of condoms by describing their failure rate.

The brief concludes that data collection on MSM in developing countries, difficult in part due to ongoing stigma and discrimination, remains a barrier to effective intervention. "In order to mitigate the HIV epidemic in MSM, both domestically and globally, adequate resources must be dedicated to improving accurate data collection, addressing the sociocultural factors that contribute to MSM risk behavior, and implementing evidence-based behavioral, biomedical, and social interventions that address growing rates of HIV infection in multiple settings."