The persistent and evolving HIV epidemic in American men who have sex with men.

TitleThe persistent and evolving HIV epidemic in American men who have sex with men.
Publication TypePublication
Year of Publication2021
AuthorsMayer KH, Nelson LR, Hightow-Weidman L, Mimiaga MJ, Mena L, Reisner S, Daskalakis D, Safren SA, Beyrer C, Sullivan PS
Date Published2021 Mar 20
KeywordsAcquired Immunodeficiency Syndrome, Adolescent, Adult, Anti-Retroviral Agents, Comorbidity, COVID-19, HIV Infections, Homosexuality, Male, Humans, Incidence, Male, Middle Aged, Minority Groups, Pre-Exposure Prophylaxis, Risk Factors, SARS-CoV-2, Sexual and Gender Minorities, Sexual Behavior, Sexual Partners, Transgender Persons, United States, Young Adult

<p>Men who have sex with men (MSM) in the USA were the first population to be identified with AIDS and continue to be at very high risk of HIV acquisition. We did a systematic literature search to identify the factors that explain the reasons for the ongoing epidemic in this population, using a social-ecological perspective. Common features of the HIV epidemic in American MSM include role versatility and biological, individual, and social and structural factors. The high-prevalence networks of some racial and ethnic minority men are further concentrated because of assortative mixing, adverse life experiences (including high rates of incarceration), and avoidant behaviour because of negative interactions with the health-care system. Young MSM have additional risks for HIV because their impulse control is less developed and they are less familiar with serostatus and other risk mitigation discussions. They might benefit from prevention efforts that use digital technologies, which they often use to meet partners and obtain health-related information. Older MSM remain at risk of HIV and are the largest population of US residents with chronic HIV, requiring culturally responsive programmes that address longer-term comorbidities. Transgender MSM are an understudied population, but emerging data suggest that some are at great risk of HIV and require specifically tailored information on HIV prevention. In the current era of pre-exposure prophylaxis and the undetectable equals untransmittable campaign, training of health-care providers to create culturally competent programmes for all MSM is crucial, since the use of antiretrovirals is foundational to optimising HIV care and prevention. Effective control of the HIV epidemic among all American MSM will require scaling up programmes that address their common vulnerabilities, but are sufficiently nuanced to address the specific sociocultural, structural, and behavioural issues of diverse subgroups.</p>

Alternate JournalLancet
PubMed ID33617771
PubMed Central IDPMC9639667
Grant ListU19 HD089881 / HD / NICHD NIH HHS / United States
P30 MH116867 / MH / NIMH NIH HHS / United States
K24 DA040489 / DA / NIDA NIH HHS / United States
P30 AI042853 / AI / NIAID NIH HHS / United States
P30 AI060354 / AI / NIAID NIH HHS / United States