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The increase in global HIV epidemics in MSM

Beyrer, Chrisa; Sullivan, Patrickb; Sanchez, Jorgec; Baral, Stefan D.a; Collins, Chrisd; Wirtz, Andrea L.a,e; Altman, Dennisf; Trapence, Giftg; Mayer, Kennethh

doi: 10.1097/01.aids.0000432449.30239.fe
Editorial Review

Epidemics of HIV in MSM continue to expand in most low, middle, and upper income countries in 2013 and rates of new infection have been consistently high among young MSM. Current prevention and treatment strategies are insufficient for this next wave of HIV spread. We conducted a series of comprehensive reviews of HIV prevalence and incidence, risks for HIV, prevention and care, stigma and discrimination, and policy and advocacy options. The high per act transmission probability of receptive anal intercourse, sex role versatility among MSM, network level effects, and social and structural determinants play central roles in disproportionate disease burdens. HIV can be transmitted through large MSM networks at great speed. Molecular epidemiologic data show marked clustering of HIV in MSM networks, and high proportions of infections due to transmission from recent infections. Prevention strategies that lower biological risks, including those using antiretrovirals, offer promise for epidemic control, but are limited by structural factors including, discrimination, criminalization, and barriers to healthcare. Subepidemics, including among racial and ethnic minority MSM in the United States and UK, are particularly severe and will require culturally tailored efforts. For the promise of new and combined bio-behavioral interventions to be realized, clinically competent healthcare is necessary and community leadership, engagement, and empowerment are likely to be key. Addressing the expanding epidemics of HIV in MSM will require continued research, increased resources, political will, policy change, structural reform, community engagement, and strategic planning and programming, but it can and must be done.

aCenter for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland

bRollins School of Public Health, Emory University, Atlanta, Georgia, USA

cImpacta, Lima, Peru

damfAR, The Foundation for AIDS Research, Washington DC

eDepartment of Emergency Medicine, Johns Hopkins Medical Institute, Baltimore, Maryland, USA

fLaTrobe University, Melbourne, Australia

gCenter for the Development and Education of People, Blantrye, Malawi

hFenway Community Health Center and Harvard University, Boston, Massachusetts, USA.

Correspondence to Chris Beyrer, MD, MPH, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, E 7152, Baltimore, MD 21205, USA. Tel: +1 410 614 5247; fax: +1 410 614 8371; e-mail:

Received 6 May, 2013

Revised 30 May, 2013

Accepted 11 June, 2013

© 2013 Lippincott Williams & Wilkins, Inc.