Van Griensven, F., Guadamuz, T.E., de Lind van Wijngaarden, J.W., et al. Sexually Transmitted Infections (June 2017), 93:356-362, doi: 10.1136/sextrans-2016-052669.
This paper examined biomedical prevention strategies, national prevention policies and guidelines, and HIV cascade data for men who have sex with men (MSM) to understand evidence for treatment for prevention (TFP) for MSM in the Asia-Pacific Region. TFP is a common prevention intervention in this region, despite a lack of evidence on its use among MSM. The authors found no evidence of TFP efficacy among MSM. Countries' guidelines and policies were largely based on evidence available from heterosexual intercourse, which does not reflect the increased risk of HIV transmission during anal intercourse, particularly during acute HIV infection, which has been shown to be the period when MSM are likely to acquire and transmit HIV. Pre-exposure prophylaxis (PrEP) is an important prevention mechanism for MSM because they are likely to have acquired HIV by the time TFP takes effect. However, national guidelines in Asia-Pacific countries do not include or prioritize PrEP for MSM. The authors urged prioritizing PrEP for HIV prevention among MSM, and presented a double-sided protocol which included both a care and a prevention cascade, including PrEP. International donors and governments need to include prevention for MSM within the HIV care cascade and national policies.