The HIV Epidemic Among MSM is Still Expanding

On Friday, December 7, the Johns Hopkins Bloomberg School of Public Health and The New York Academy of Sciences (NYAS) hosted a half-day conference focused on the HIV epidemic among men who have sex with men (MSM). The conference—co-sponsored by amfAR—highlighted groundbreaking work by eminent researchers at Johns Hopkins and elsewhere, including Drs. Chris Beyrer and Stefan Baral of Johns Hopkins, Dr. Kenneth Mayer of Harvard Medical School, Gregorio Millett of the Centers for Disease Control and Prevention (CDC), and amfAR Vice President and Director of Public Policy Chris Collins.

Held at NYAS’s offices in lower Manhattan, the conference—titled New Paradigms of Risk and Protection: Understanding the HIV Epidemics Among Gay and Bisexual Men—was born from a July 2012 themed issue of British journal The Lancet that focused on HIV in MSM. The Lancet series was spearheaded by Dr. Beyrer, who assembled what he called a “dream team” of editors. Dr. Beyrer also acted as moderator for the conference, introducing the theme of the day:

“While the global trajectory of HIV in so many places and in so many populations, happily, is in decline,” said Dr. Beyrer, “that is not true for men who have sex with men. This is one of the relatively uncommon components of global AIDS that’s still expanding. It’s happening in rich countries and poor countries. It’s happening where MSM face criminal penalty, social stigma, and sanction, and it’s happening in places like France, where they don’t.”

“The bottom line is that with current technologies and tools that we have in hand, we can have an enormous impact on these epidemics…But we’re not there yet.”

One of the key speakers at the conference was Gregorio Millett, senior behavioral scientist in the Division of HIV/AIDS Prevention (DHAP) at CDC and a former senior policy advisor in the White House Office of National AIDS Policy, where he was one of the principal writers of the President’s National HIV/AIDS Strategy. Millett was the lead researcher on twopapers in The Lancet issue, and he gave a riveting talk on his work looking at the growing HIV epidemic among black MSM internationally and in the U.S. 

“When you look at the HIV epidemic in the United States, most new infections that take place are among men who have sex with men,” said Millett “They are only two percent of the population but comprised about 61 percent of new HIV infections in 2009 (and a similar number for 2010).” 

“There is also a race and ethnicity dynamic, with most of the new infections taking place among Latino and African Americans—primarily African Americans,” said Millett. “African American men who have sex with men are certainly the epicenter of the HIV epidemic in the United States.” 

Citing the HPTN 061 study announced during the 2012 International AIDS Conference held in Washington, D.C., in July, Millet noted that the incidence rate for African American gay men was found to be astoundingly high at three percent, and the rate for young African American gay men was double that number. “There are very few populations in the U.S. where you see incidence rates as high as that,” he said. “It certainly rivals incidence rates that we find in more generalized epidemics around the world.” 

amfAR’s Chris Collins co-authored a “call to action” in The Lancet issue that focused on the urgency of addressing HIV among MSM on both public health and human rights grounds. Referring to that article at the NYAS conference, Collins emphasized the important role that gay people have played as advocates for all people affected by HIV, as well as the irony that they are now being excluded from global AIDS agendas. 

“From the epidemic’s beginning, gay men and lesbians have been at the forefront of advocacy around HIV,” said Collins. “And that advocacy has been aimed to advance the whole HIV agenda to address multiple populations.” 

“But gay HIV advocacy has also had a price all over the world. Advocacy efforts have at times resulted in significant backlash and many activists have been beaten, arrested, and killed when they’ve come forward demanding their rights. And for every arrest and death that we know about, there are surely hundreds that we don’t know about…And yet gay people remain generally underrepresented in making decisions…We need better epidemiological studies and donors need to be sponsoring that. We also need transparency about where the money’s going.” 

Collins’ call to action is a strong appeal for more detailed research, more gay people involved in HIV policy-related decision-making, and targeted donations support for HIV among MSM. “We know there has been gross underinvestment in the HIV-related needs of gay people in countries all over the world,” Collins said. “And that goes for donor investments, which have, until recently, largely ignored the needs of gay people.” 

“The science is now teaching us that the expanding HIV epidemic among MSM, and their disproportionately higher rates of infection, is not solely about individual risk behaviors but also biological dynamics that place MSM at significantly higher risk of infection than heterosexual men and women,” said Collins. “It’s imperative that we do much better at reaching MSM with anti-retroviral prevention and treatment, and develop new tools to turn the epidemic around in MSM.”