Official websites use. Share sensitive information only on official, secure websites. Where surveillance has been done, it has shown that men MSM who have sex with men bear a disproportionate burden of HIV. Yet they continue to be excluded, sometimes systematically, from HIV services because of stigma, discrimination, and criminalisation. This situation must change if global control of the HIV epidemic is to be achieved.
On both public health and human rights grounds, expansion of HIV prevention, treatment, and care to MSM is an urgent imperative. Effective combination prevention and treatment approaches are feasible, and culturally competent care can be developed, even in rights-challenged environments.
Condom and lubricant access for MSM globally is highly cost effective. Antiretroviral-based prevention, and antiretroviral access for MSM globally, would also be cost effective, but would probably require substantial reductions in drug costs in high-income countries to be feasible. To address HIV in MSM will take continued research, political will, structural reform, community engagement, and strategic planning and programming, but it can and must be done.
But the fact that HIV was first identified in gay men indelibly marked the global response, stigmatised those living with the virus, limited effective public health responses in some cases, and drove coercive and punitive ones in others. This situation must change. The newfound optimism in the HIV specialty, that early antiretroviral therapy is an effective preventive intervention strategy, 4 and that new prevention methods such as the combination of tenofovir and emtricitabine Truvada chemoprophylaxis have efficacy for MSM, 5 opens up real possibilities for the eventual achievement of control of HIV subepidemics in MSM.
In too many settings in , MSM still do not have access to the most basic of HIV services and technologies such as affordable and accessible condoms, appropriate lubricants, and safe HIV testing and counselling. In , the global AIDS community is at a crossroads. But donor aid declined in , as has general interest in HIV. For MSM, even more challenging realities exist than for the rest of the population. As reported by Beyrer and colleagues, 10 HIV infection rates in MSM have been increasing in many settings in the era of highly active antiretroviral therapy.
