A report released by the Centers for Disease Control and Prevention (CDC) reviews the collective success, remaining challenges, and lessons learned over the course of the HIV epidemic among gay and bisexual men.

Since the 1980s, when CDC investigated the first cases of AIDS among men who have sex with men (MSM), the agency has worked closely with state and local partners and affected communities to develop, implement, and evaluate HIV-prevention programs for those at greatest risk.

Today, although HIV has affected men, women, and children of all ages, races, ethnicities, and demographic categories, MSM are still disproportionately affected, accounting for an estimated 42 percent of new HIV infections each year.

To strengthen HIV prevention for MSM, CDC carefully monitors disease trends, provides funding for science-based HIV-prevention programs at the local level, and conducts research to improve approaches to prevention for MSM and other communities.

Even before prevention funding was available, gay men mobilized to fight the disease, mounting safer sex campaigns encouraging men to reduce the number of sexual partners and to use condoms to prevent transmission. Service organizations created by gay men provided vital information and support to people living with AIDS and advocated for a stronger national response to the problem. The result of these early interventions had an effect on decreasing HIV transmission in the United States.

However, recent research suggests that MSM remain at significantly greater risk then other groups in the United States.

Statistics on HIV and MSM

• MSM account for an estimated 42% of total HIV infections in the United States each year and approximately 60% of annual infections among men.

• The CDC’s Young Men’s Survey examined HIV and STDs among MSM between the ages of 23 and 29 in six United States cities: Baltimore, Dallas, Los Angeles, Miami, New York City, and Seattle.

  In theses cities:

  • 13% of all MSM, 7% of white MSM, 32% of African American MSM, and 14% of Latino MSM were HIV-positive before the age of 30.
  • 4.4% of all young MSM (ages 23-29), 2.5% of young white MSM, 14.7% of young African American MSM, and 3.5% of young Latino MSM were infected each year.

• In 1999, the rate of new AIDS cases (cases per 100,000 population) for African-American MSM was more than five times that of whites; the rate of new cases among Latino MSM was 2.5 times that of white MSM.

STD Occurence in MSM

• In a 29-city study of STD clinics, the proportion of gonorrhea cases occuring among gay men increased three-fold, from 5% in 1992 to 13% in 1999. Gonorrhea can increase the chance of contracting or spreading HIV by as much as 2 to 5 times.

• STD outbreaks in several major cities across the United States have shown that 25 to 73% of MSM with syphilis and 25 to 54% of MSM with gonorrhea are co-infected with HIV.

High-Risk Behavior Among MSM

• 24% of African American MSM with HIV/AIDS identify themselves as heterosexual, compared to 15% of Latino and 6% of White.

• In a 12-city study, 19 percent of HIV-positive MSM engaged in unprotected anal sexual intercourse between 1996 and 1998, compared to 13 percent between 1995 and 1996.

Additional Challenges

The CDC identified remaining challenges within HIV-prevention strategies as follows:

• The difficulty practicing safer sex every time. Research has demonstrated the difficulty of sustaining sexual behavior change over time in any population.

• The incorrect assumptions about partners’ HIV status. Surveys of MSM have found that some MSM may make false assumptions about their partners’ HIV status.

• The growing population of HIV-positive MSM. With more people living longer, healthier lives, as a result of antiretroviral therapy there are increased opportunities for HIV transmission.

• The lack of direct experience with HIV/AIDS. There is less motivation to practice safer sex in younger MSM who have never known anyone infected with HIV or seen the toll of AIDS first-hand.

• Racism, stigma, and lack of services in minority communities. Social and economic factors serve as barriers to receiving HIV-prevention services, particularly for MSM of color.

• The role of substance use in HIV transmission. Use of illegal drugs continues to be popular among some MSM, which in turn is often accompanied by increased sexual risk behavior.

CDC and its community partners are aware that a major challenge for the future is to strengthen and accelerate HIV-prevention efforts among all MSM. For this reason, CDC has developed a five-year strategic plan designed to cut annual infections in the United States in half.

Action Agenda

• Prioritizing prevention for MSM of color.
  These populations face an urgent public health problem and prevention practitioners from all sectors need to mount an effective response.

• Addressing disparities in prevention funding.
  Community planning groups, as well as state and local health departments must re-evaluate their funding priorities to ensure an appropriate level of support for HIV-prevention programs targeting MSM of color.

• Ensuring access to voluntary HIV counseling and testing, increasing research on programs for MSM who don’t identify as gay.
  Expanding HIV testing services to non-traditional locations -- like bars, bathhouses, and special community events -- and providing anonymous HIV testing may increase the number of individuals to learn their HIV status.

• Monitoring and responding to emerging trends.
  Gaps in epidemiological information needed to help plan, target, and evaluate HIV/STD-prevention activities for MSM should be addressed.

• Targeting HIV-positive MSM.
  Interventions for those who are infected can help them benefit from physical, emotional, and social therapy and take steps to protect their partners.

• Integrating STD and HIV-prevention and care services.
  Integrated data on HIV and other STDs is important for directing prevention programs. Many MSM lack key information about STDs, including knowledge that infection with an STD can increase the likelihood of HIV transmission.

• Evaluating prevention.
  Health departments should evaluate whether HIV and STD counseling, testing, and partner notification activities are reaching MSM.

• Involving clinicians in preventing new infection among MSM.
  Clinical settings can play an important role in HIV prevention by providing prevention services and referrals to care for HIV-infected people.

• Developing prevention programs for youth.
  Effective HIV prevention must address young people’s common misconceptions about safer sex and assist them in developing and sustaining safer sexual skills relevant to their life circumstances.

• Integrating HIV prevention into broader health promotion efforts.
  For both gay-identified and non-gay-identified MSM, HIV- and STD-prevention interventions should be better integrated into health and social service programs, such as mental health, violence prevention, and substance use treatment programs.

For more information: "No Turning Back: Addressing the HIV Crisis Among Men Who Have Sex with Men," Centers for Disease Control and Prevention, November, 2001.