The Invisible Worldwide HIV Epidemic: MSM

In many regions of the world, national and locally sponsored HIV prevention initiatives have left men who have sex with men (MSM) out of the picture, advocates said at a Mexico City meeting on HIV/AIDS and MSM before the recent International AIDS Conference.

MSM "are systematically missing in most of our national surveillance systems," said David Wilson, head of the World Bank HIV program. In the last five years, data have shown that "HIV epidemics are far more concentrated than we had believed," he said.

"General population, heterosexual transmission is only the major source in two regions: Africa and the Caribbean," said Wilson. "Everywhere else, we are facing concentrated epidemics of sex workers, drug users, and [MSM]. They are the norm, not the exception. And our programs globally need to reflect this."

In Latin America, MSM represent 50-90 percent of local HIV infections. "It is massively higher than in sex workers," Wilson said. "I don't think that is sufficiently understood." And in Africa, even the scant data available show that MSM are about four times more likely than heterosexuals to be HIV-infected, he noted.

"What we are seeing today in Asia, in every single major city that we have looked at, are epidemics of [MSM] that remind me of what we saw in the US, and Western Europe, and Australia in the 1980s," Peter Piot, executive director of UNAIDS, told the conference. "Homophobia in all its forms" is "one of the top five obstacles to really stopping this epidemic."

The inclusion of programs for women is a default funding guideline for countries applying for grants from the Global Fund to Fight AIDS, TB and Malaria, said David Winters, a manager with the fund. Another assumption should be that MSM everywhere are disproportionately impacted by HIV, he said. "Make that the given and ask countries to prove otherwise" when competing for the funds, he suggested.

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