AIDS epidemic remains "markedly higher" among MSM population

Chris Beyrer, MD, MPH

Indeed, the trajectory of AIDS is "markedly higher" among men who have sex with men (MSM) compared to all other populations throughout the world, and the disparity is especially high among black MSM and it shows no signs of narrowing.

Chris Beyrer, director of the Johns Hopkins Center for AIDS Research, outlined the state of the epidemic before a capacity audience Thursday in Winslow Auditorium during a Dean's Lecture. His talk came two days before World AIDS Day.

"There's a great deal of work to do in this field if we are going to turn this around," said Beyrer, adding that a number of factors are contributing to the disparity, and new approaches are needed if the epidemic is going to be effectively addressed.

Part of the explanation is biological; there is a much higher risk (18 times) of transmitting the virus through homosexual sex than through heterosexual sex. This risk is compounded by a number of social, political and economic barriers that include stigma against homosexuality, a shortage of health care workers in regions of the world where the disease is pronounced, a lack of health insurance that leads to people being undiagnosed and untreated and even attempts in some parts of the world to criminalize and punish homosexuality.

"What are we going to do about it?" Beyrer asked. "This has been a longstanding fight and it is not over."

Still, there is reason for optimism. Beyrer said there are new and emerging tools in place that could reduce infections among MSM by 25 percent within 10 years. For instance, a new generation of microbicides is being tested. "Stay tuned," he said. "[This] is an incredibly important area."

There are also political and social leaders who are emerging to address the epidemic among MSM in different areas of the world. Beyrer cited U.S. Secretary of State Hillary Clinton for her progressive leadership on the issue. He also cited the recently passed Yogyakarta Principles, which, among other things, call for marriage equality and access to health care; and South African Archbishop Desmond Tutu, who has spoken out on behalf on LGBT youth, telling them to never allow anyone to make them feel inferior "for being themselves."

"Someone like Bishop Tutu is our best defense," Beyrer said.