For all of the "Yes, we can!" attitude at the 19th International AIDS Conference last week, there was one group the attitude didn't extend to - men who have sex with men (MSM). The HIV epidemic is still going strong in MSM, driven by biology as much as behavior, and many of the novel interventions that the policy makers and researchers are most proud of probably won't effect them very much at all. Ending maternal to child transmission by 2015 is a laudable goal. Treatment as prevention (Tas) and PrEP for serodiscordant couples may be as well. However, the first is not terribly relevant to MSM around the world, and the second two may be difficult to access.
In much of the world, gay and bisexual men are still subject to legal and social discrimination. It can be difficult for them to access healthcare and be honest with their providers about their risk. Furthermore, sex between men is still illegal in 80 countries. On a purely practical note, this means that some of the serodiscordant couples who need PrEP the most may not be able to get it - because they are not recognized as couples by the government, medical and social institutions that establish what it legally means to be a pair.
There was a fascinating discussion at AIDS 2012, which I wish more people were talking about. People often discuss the HIV epidemic in MSM as being an outcome of promiscuous behavior. They make gay men seem as though they have put themselves at moral risk. However, the major reasons gay men have risks of HIV transmission that are so much higher than heterosexual couples are biological. At the Lancet special panel on HIV in MSM, Dr. Stephan Baral from Johns Hopkins reviewed data that suggested that if the risk of contracting HIV from anal sex was the same as contracting from vaginal sex, 80-90 percent of infections in MSM would be eliminated.
I'm ashamed to admit that, during the early part of the conference, I got caught up in the hype. I failed to notice that, in all of the excited discussions, there were groups of people who were being left out. Therefore, I am compelled to point out here that, while it's true that researchers, scientists, and politicians are moving towards an end to the epidemic, that end needs to be for everyone. We can't afford to forget about gay men* - who as scientists, activists, and study volunteers have contributed so much to the fight... and who have an enormous stake in the win.
*We also can't forget about injection drug users and sex workers, but that's a post for another day.
Source: http://std.about.com/b/2012/08/01/gay-men-hiv.htm
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