1. English audio file (mp3 format, 26 MB)

1. Caceres (Peru): Limited data from developing countries. Prevalence of HIV/STI in MSM higher than previously thought. Conducted a metanalysis from multiple studies in diverse countries. 561 studies. Mainly S Asia. Prevalence of MSM in population samples: 2-8% in S Asia, 4.1% for East Asia, Latin America-broad range. Last year estimates of prevalence of same sex male partners are about 10-25% of lifetime figures. HIV prevalence 0-24% in S Asia, Latin America 3-36.5%. Lowest in Northeast Asia and the MENA region. Consistent condom use generally under 30% x/f  some cohorts in Latin America. Sex with women up to 50%. Prevalence varies within region, e.g. India high and Bengladesh low, increased  HIV prevalence in Poland, but lower prevalence further east in former Soviet Union. Diverse patterns, need to develop specific interventions.

2. Stall (US): Re-emerging MSM epidemics. Literature review with Google, PubMed, ISI, Scopus. (did not include studies from behavioral or vaccine trials. He classified the data into community-based samples, HIV test site samples, STD Clinic samples. The pooled community-based mean HIVincidence 1.9, 2.2 for HIV VCT sites, and  3% for MSM recruited at STD clinics. 8% prevalence among MSM age 20. Used the lower incidence rate of 1.9%,  8% prevalence calculate the lifelong risk for HIV infection for young (20 y.o.) Americans. Age 30 ¼, age 40 about 40, 50 around half are infected. Economic marginalization, risk behavior, substance use, psychological variables play a major role. STARHS increased crystal, poppers; Black-high prevalence, but modest levels of HIV risk taking. Incidence among young Black men 4%, 23-29 y.o. 15%-using the model, 50% would be infected by age 40, by age 50 ¾. 2/3 unrecognized almost half infected. Examine stigma, racism, and homophobia. Need better surveillance, need more resources for heavily stigmatize population.

3. van Griensven (Thailand): MSM trends in southeast Asia. Traditional acceptance of homosexuality. Prevalence of same sex behavior 3% in Thailand, 18% in Laos, 4% in Hong Kong. Diverse expression of male same sexuality. Generally > 50% report recent unprotected anal intercourse. STD prevalence high. Prevalence of reactive syphilis serology is high 7% to 14%. HIV prevalence up to 28.3% in Thailand, 15% in Myanmar,  9% in Phnom Penh, 8% in Ho Chi Minh City, 1.5 to 5 % in China. Male same sex behavior is common in South East Asia. Prepation for biomedical interventions.

4. Mallouk (Morocco): HIV prevention challenges facing MSM in MENA states. Male homosexuality is taboo, homosexuality is illegal, homophobia rampant. Male sex work “tip of the iceberg,”1 to 30 partners per week, anal sex 97%, low condom use, lots of violence. Psychological and social support provided, with outreach workers distributing condoms, lubricant, and safer sex educational materials.

THBS02 -  Emerging and Re-Emerging HIV Epidemics among Gay and non-Gay Identified MSM.

Globally, and in nearly every country, men who have sex with men (MSM) are at high risk for HIV infection and AIDS.  Despite continued denial and stigma in many places, and after twenty-five years of a worldwide pandemic, MSM are now described as a priority for HIV interventions in many national HIV plans.  Dozens of surveillance studies throughout Asia, Africa, Eastern Europe and the Americas are succeeding in describing the extent and needs of MSM populations.  And, in some cases, HIV-related networks and services are being created specifically by and for MSM. 

However, more extensive research is needed to define the diversity of MSM around the world, and the diversity and scale of the HIV epidemics and related needs in MSM sexual and social networks.  A recent study, led by Peruvian researcher Carlos Cáceres in collaboration with researchers and health advocates in more than ten countries, attempted to collate a global overview as a starting point.  In compiling epidemiological and research data from eight global regions, the study found similar challenges in addressing HIV among MSM around the world, including high rates of unsafe sexual behavior, high rates of HIV prevalence, and inadequate rates of condom use.

Researchers in specific countries echoed this finding with detailed data and anecdotal experience. 

* In Southeast Asia, serious HIV epidemics exist among MSM in Thailand and Cambodia, while in Vietnam, Laos, and elsewhere in the region, networks of MSM have as-yet new HIV epidemics being fueled by high rates of unsafe sex and STIs.  (van Griensven)

* In Morocco, MSM in many cities also report high rates of unsafe sex; interventions to reach these groups have only recently been funded, but remain restricted by cultural and legal constraints.  (O. Mallouk, ALCS)

* In the United States, MSM are being infected at a rate of approximately 1.9-2.9% per year, which if not reduced, is capable of indefinitely sustaining prevalence rates of more than 25% among MSM older than 30.  Black gay men in the U.S. are among the hardest-hit population in the world, with rates of HIV now due to infect more than half of all young Black gay men by the time they reach age 35.  (R. Stall, U.Pgh)

Research has documented concentrated HIV epidemics among MSM in every region of the world.  To end these epidemics, further research and resources must be targeted to halt HIV infections, provide HIV treatment, and address the factors that impede health and human rights.