HIV prevention with MSM in the developing world

Several sessions at the conference took a long-overdue look at the HIV epidemics occurring among men who have sex with men (MSM) in the developing world. In some parts of the world such as south-east Asia, there is evidence of a quite recent and sudden increase in HIV prevalence among gay and male-desiring men. For instance, Fritz van Griensven reiterated the news from a survey published last December that showed, using careful sampling in many different kinds of gay meeting place, that HIV prevalence among MSM in Bangkok had increased from 17.3% in 2003 to 28.3% in 2005.
Van Griensven was also involved in a Bangkok survey that showed that, despite being at higher risk of HIV, receptive gay men (‘bottoms’) had something in common with women, in that they had a harder time enforcing condom use than insertive men. Receptive men were very significantly more likely than insertive men to report not using condoms: insertive men were twice as likely as average to have safer sex and receptive men 60% less likely.
Altogether, 22% of men who identified as gay and 29% of transsexuals reported not using condoms during their last sex.
Back in Africa, however, HIV is still largely considered to be a heterosexual matter. There was one poster from, of all countries, Sudan, looking at the lives and HIV risks of young receptive MSM in Khartoum. This stigmatised and hard-to-reach population was contacted through ‘snowballing’, i.e. using one contact to contact friends. The 713 men surveyed were young (50% school age) and 9.3% had HIV.
Unsurprisingly, three-quarters were involved in commercial sex and although 47% had used a condom at last sex, only one in 30 did so consistently. Alarmingly, 53% – perhaps the same ones who didn’t use condoms – did not know that anal sex was an HIV risk. The researcher comments: “The study revealed that MSM are part of the Khartoum…community, though marginalised and undignified.”
from AIDSMap

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