AIDS 2010 Roundup: Men Who Have Sex With Men (MSM)
August 10, 2010
Here are some noteworthy transmission, testing and sexually transmitted infection (STI) stories related to MSMs:
CDC Says PrEP Safe for Prevention Among Gay Men
On the last day of the conference, the CDC reported that a study of Viread (tenofovir) taken daily for HIV prevention among gay and bisexual men suggests no significant safety concerns. A prior study in Africa found that pre-exposure prophylaxis (PrEP) was safe for heterosexual women. In a press release, the CDC stated:
The approach of taking a daily antiretroviral drug to try to prevent HIV infection is known as pre-exposure prophylaxis, or PrEP, and studies around the world are currently underway to determine if it is effective at reducing HIV infection among individuals at high risk, including MSM. While the results of those studies will be needed to determine if PrEP can prevent HIV, this safety study lends additional assurance that the strategy may be well-tolerated among MSM, should it prove effective.
The Phase II safety study was conducted by the U.S. Centers for Disease Control and Prevention in collaboration with the San Francisco Department of Public Health, the AIDS Research Consortium of Atlanta, and Fenway Community Health in Boston. The trial examined whether a 300 mg tablet of tenofovir disoproxil fumarate taken daily was safe among 400 HIV-negative men who have sex with men (MSM) in San Francisco, Atlanta, and Boston.
And while more testing needs to be done to show if PrEP can actually prevent HIV-negative people from contracting HIV, the CDC stressed:
If PrEP proves effective, it could provide an additional safety net for MSM and other individuals at high risk, when used in combination with other proven prevention strategies, like HIV testing, correct and consistent condom use, and reduction of partners. PrEP could also provide a much needed option for women who are unable to negotiate condom use and could provide some protection for discordant couples (i.e., in which one partner is infected and the other is not).
And while this does seem promising, there are concerns. The Black AIDS Institute reported:
Experts also worry that PrEP for HIV may encourage risky behavior in individuals taking it. Yet, access to the drug itself has triggered the biggest controversy around PrEP. If there is already limited access to funds for treatment of HIV and AIDS -- as activists insisted loudly all week -- will those not infected take life-saving drugs away from those who are living with HIV and need it to survive?
"That's a valid concern," notes Jim Pickett, of the AIDS Foundation of Chicago and chair of International Rectal Microbicide Advocates. "If [PrEP] is proven to be effective how do we square that in a setting where people who are HIV positive don't have full access to treatment? Who do you decide gets the tenofovir? These are questions we are trying to ask ourselves in the field right now."
The Sexual Abuse and HIV Infection Connection
Researchers from the Multicenter AIDS Cohort Study (MACS) reported that gay and bisexual men who reported sexual abuse and homophobic experiences in childhood have a substantially higher risk of HIV infection. AIDSmeds.com wrote:
[Researchers] found that almost 10 percent of the volunteers reported that they had been victims of childhood sexual abuse and nearly 30 percent had experienced gay-related victimization between the ages of 12 and 14, including verbal insults, bullying, threats of physical violence and physical assaults.
MACS volunteers who experienced childhood sexual abuse and a sense of "masculinity failure" were more likely to engage in substance use, experience depression and sexual compulsivity and to be involved in intimate partner violence -- all known to be independent risk factors for unprotected anal sex and, ultimately, HIV infection. This finding, Lim reported, confirmed the occurrence of syndemic outcomes in this particular population of men.
"Our study shows that the early socialization experiences of gay men can be deeply stigmatizing and increase their risks for these syndemic conditions in adulthood," Lim said. "Given the long-lasting impacts, effective interventions should address multiple interrelated social issues early on rather than focusing on each problem in isolation."
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