Need for Sustained HIV Prevention Among Men who Have Sex with Men
Young and Minority Men at High Risk
Historically in the United States, HIV-related illness and death have had the greatest impact on men who have sex with men (MSM). Even though the toll of the epidemic among injection drug users (IDUs) and heterosexuals has increased during the last decade, MSM continue to account for the largest number of people reported with AIDS each year. In 1997 alone, 21,260 AIDS cases were reported among MSM, compared with 14,698 among IDUs and 8,112 among men and women who acquired HIV heterosexually.
Among white MSM, the estimated number of AIDS diagnoses each year (AIDS incidence) has been declining since 1993, reflecting in part the success of prevention programs in these communities. Yet, AIDS incidence among African-American and Hispanic MSM continued to increase until 1996, when new treatments began to have an impact on trends in these populations. The new combination drug therapies have now slowed the progression from HIV to AIDS in many people, resulting in fewer AIDS diagnoses among all populations -- but, the declines have not been as significant among MSM of color as among white MSM.
These data highlight the need to design more effective prevention efforts for gay and bisexual men of color. The involvement of community and opinion leaders in prevention efforts will be critical to overcome cultural barriers to prevention, including homophobia. For example, there remains a tremendous stigma to acknowledging gay and bisexual activity in African-American and Hispanic communities.
Continuing Risk Among Young MSM
Abundant evidence shows a need to sustain prevention efforts for each generation of young gay and bisexual men. We cannot assume that the positive attitudinal and behavioral change seen among older men also applies to younger men. Recent data on HIV prevalence and risk behaviors suggest that young gay and bisexual men continue to place themselves at considerable risk for infection with HIV and other STDs.
Need to Combat Other STDs
Studies among MSM who are treated in STD clinics have shown consistently high rates of HIV infection, ranging from nearly 4% in Minneapolis to a high of 31% in Houston. Scientists know that the likelihood of both acquiring and spreading HIV is 2-5 times greater in people with STDs, and that aggressively treating STDs in a community can help to reduce the rate of new HIV infections. Along with prompt attention to and treatment of STDs, efforts to reduce the behaviors that spread STDs are critical.
Prevention Services Must Reach Both Uninfected and Infected
While the number of AIDS cases is declining, the number of MSM living with HIV infection is growing. This increased prevalence of HIV in the population means that even more prevention efforts are needed, not fewer.
Research has shown that high-risk behavior is continuing in some populations of MSM, including those who are infected with HIV. For example, studies of HIV incidence among MSM treated in STD clinics show high rates of new STDs in HIV-infected clients, indicating that unprotected sex is common. As the numbers of gay and bisexual men living with HIV increase, greater efforts must be made to reach them with behavioral interventions that can help them protect their own health and prevent transmission to others.
Invest in What Works Best for Communities at Risk
CDC's role is to provide communities with the best available science to guide comprehensive HIV prevention programs. As part of this process, CDC conducts an ongoing research synthesis process that seeks to identify the most recent and relevant scientific findings from around the world, both published and unpublished, and make them available to prevention program planners. CDC constantly combs the scientific literature, reviews domestic and international scientific databases, and speaks with colleagues around the world to identify effective interventions for all populations at risk, including MSM.
Many prevention interventions for gay and bisexual men have proven effective, as well as cost-saving, over the years. CDC will continue to work with communities to help develop these and other lessons learned into even more effective prevention programs.
CDC will continue to provide surveillance data, biomedical and behavioral prevention research, evaluation of prevention programs, and technical assistance in communications and other aspects of prevention to communities so their prevention efforts -- for all groups -- are supported by the best science possible.
This article was provided by U.S. Centers for Disease Control and Prevention. Visit the CDC's website to find out more about their activities, publications and services.