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Gay men everywhere have higher rates of HIV than in the general population, Fenton said. It is estimated that the HIV rate in MSM is eight times that of the general population in low-income countries and 23 times the general-population rate in high-income countries. The most reliable prevalence figures suggest that, regionally, Latin America and the Caribbean have especially high rates, but in no country of the world is HIV prevalence lower in MSM than in the population as a whole.

Other jurisdictions criminalise people who do not disclose their HIV status to sexual partners as well as actual cases of HIV transmission. A mental health problem causing long-lasting low mood that interferes with everyday life.

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Social attitudes that suggest that having a particular illness or being in a particular situation is something to be ashamed of. Stigma can be questioned and challenged. Receptive anal intercourse refers to the act of being penetrated during anal intercourse. When viral load is detectable, this indicates that HIV is replicating in the body. If the person is taking HIV treatment but their viral load is detectable, the treatment is not working properly. There may still be a risk of HIV transmission to sexual partners. However, in terms of the rate of increase of new diagnoses, it is central-European countries such as Poland, the Czech Republic and Hungary, historically with very low prevalence, that are seeing the fastest-growing European epidemics in MSM.

In the lower-income world, reliable estimates of incidence are harder to come by, but over the last few years studies have found huge increases in HIV diagnoses in MSM in countries ranging from Thailand and China through Kenya to Nicaragua and Peru.

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Unfortunately, African countries — and some in other areas of the world — initially denying they had MSM at all or any HIV problem in them, are now responding to the realisation that many people with HIV are MSM by introducing repressive measures such as increased criminalisation. HIV was especially high, Fenton said, partly for biological reasons. It is now estimated that anal sex is 18 times better at transmitting HIV than vaginal sex. The chance of HIV being caught from having receptive anal sex once with a partner with a detectable HIV viral load is about 1.

Gay men do not just have more HIV for biological reasons, however, noted Fenton. Underpinning these are higher rates of traumatic experience such as child sexual abuse CSA and intimate partner violence IPV. In several studies that looked at rates of depression, drug use, CSA and IPV in gay men, and related them to HIV prevalence and high risk sex, gay men with three or four of these conditions were twice as likely to have HIV and three times as likely to have had recent high-risk sex than men with none of them. How can we start to reduce the burden of HIV in gay men?

He called for healthcare workers to have training in the diversity of MSM and their health issues; culturally competent care is a basic human right, he added, especially as healthcare workers may be able to help MSM in their coming-out process because of their unique social role. We have more HIV prevention options than we used to, and others based on antiretroviral therapy — such as pre-exposure prophylaxis PrEP — were in development, he said.

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HIV testing was now not just a gateway to treatment if MSM tested positive but could also be a gateway to a more tailored approach, and access to, behavioural and biomedical interventions for HIV. HIV testing frequency needed to increase in gay men, and options such as testing in routine care, at home and within social networks needed to be considered. Gay men also needed to be helped to develop communication skills and more respectful attitudes towards their own health and towards other MSM.

For a video of Dr Fenton's presentation, see here and for slides see here. Men who have sex with men MSM. Primary tabs View active tab Preview. Gus Cairns. This article is more than 8 years old. for more recent articles on this topic. Find out more in our About HIV s. Related topics.

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Access to healthcare. HIV prevention policy. Human rights. Structural factors.

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