No Turning Back
Addressing the HIV Crisis Among Men Who Have Sex with Men
Factors Behind a Possible Resurgence
Based on past prevention achievements, many people -- both within and outside the gay community -- mistakenly assume that the problem of HIV transmission among MSM has largely been addressed. However, ongoing and emerging challenges have meant that prevention must continually adapt to keep pace with an evolving disease. These challenges include:
A Shifting Epidemic Among MSM
Most of the prevention initiatives that proved so successful in the 1980s were implemented among white men with strong gay identities. Infection rates today remain high among African-American and Latino MSM, many of whom may not identify as gay or bisexual. Reaching these men requires new approaches to HIV prevention.
Difficulty Practicing Safer Sex Every Time
Research has demonstrated the difficulty of sustaining sexual behavior change over time in any population. Twenty years into the HIV epidemic, many older men who adopted safer sex practices in response to the initial health crisis may be finding it difficult to maintain these practices over the course of a lifetime.
Incorrect Assumptions About Partners' HIV Status
Surveys of MSM have found that some MSM may make false assumptions about their partners' HIV status. For example, an HIV-infected man may assume that his partner must be infected as well or he would insist on using a condom, while an uninfected man may assume his partner is also uninfected or he would use a condom.
Less Concern About Infection Due to New Treatments
The advent of combination therapy for treating HIV infection in the mid-1990s has posed new prevention challenges for MSM and others. Optimism about these treatments has led to increased risk behavior among some MSM, while some MSM mistakenly assume that they, or their partners, are not infectious when they take therapy and have low or undetectable viral loads.
Growing Population of HIV-Positive MSM
As a result of antiretroviral therapy, HIV-positive men are living longer, with substantially improved quality of life. Today, there are more HIV-positive individuals -- including more infected MSM -- living in the U.S. than at any time in the epidemic. With more HIV-infected people living longer, healthier lives, there are increased opportunities for HIV transmission.
Lack of Direct Experience with HIV/AIDS
Younger MSM -- many of whom have never known anyone infected with HIV or seen the toll of AIDS first-hand -- may be less motivated to practice safer sex.
Racism, Stigma and Lack of Services in Minority Communities
Social and economic factors including racism, homophobia, poverty, and lack of access to health care are 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, and studies indicate that substance use is often accompanied by increased sexual risk behavior.(20)
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.