Stahlman, S., Beyrer, C., Sullivan, P.S., et al. AIDS and Behavior (April 2016), e-publication ahead of print.
The authors gave an overview of the drivers of the HIV epidemic and the relevance of these drivers to the global and local epidemics, including concentrated and generalized epidemics in high- and low-income settings. They posited that engaging and retaining gay men and other MSM in treatment and prevention services is critical to controlling the HIV epidemic worldwide. The article described how drivers of HIV risk among MSM could accelerate the spread of the virus:
Individual: condomless anal intercourse with serodiscordant and viremic sexual partners, high frequency and lifetime number of casual partners, drug use (injection and non-injection, and before and during sex)
- Network: social and peer-group norms, condomless sex, high prevalence of HIV and other sexually transmitted infections within networks
- Community: societal and internalized homophobia that limits the provision and uptake of HIV prevention, treatment, and care services
- Structural: administrative policies such as criminalization of same-sex practices and exclusion of MSM from national surveillance programs and HIV responses.
Universal HIV treatment, HIV self-testing, and daily oral pre-exposure prophylaxis have emerged as integral to the prevention of HIV transmission, the authors said. They urged immediate expansion of these approaches to address HIV among MSM and other populations that are disproportionately affected by HIV.