MSM are playing with fire

A lack of HIV prevention efforts and an increase in risky sexual behaviours among men who have sex with men are fuelling an increase in new HIV diagnoses among the group. So claim Kevin De Cock, director of the World Health Organization's HIV/AIDS Department; Ronald Valdiserri of the U.S. Department of Veterans Affairs; and Harold Jaffe, a public health professor at the University of Oxford, in a commentary in the Nov. 28 issue of the Journal of the American Medical Association, the Washington Times reports.

According to the commentary, the number of HIV/AIDS cases among U.S. MSM increased by 13% - from 16,167 to 18,296 - between 2001 and 2005. Syphilis cases also increased 10-fold among MSM (Wetzstein, Washington Times, 11/28). In addition, recent surveys have found an increase in risky sexual behaviour among MSM who do not know their partners' HIV status, the authors write (Jaffe et al, JAMA, 11/28).

According to the authors, a lack of awareness about HIV and a decrease in HIV prevention efforts are fuelling the increase. HIV/AIDS is "not as frightening as it was" when the epidemic first surfaced because antiretroviral drugs have allowed HIV-positive people to live longer, the authors write. In addition, younger MSM are unfamiliar with the effects of HIV among U.S. MSM in the 1980s, the commentary says.

The authors called on public health and community leaders to increase HIV prevention efforts and education about safer-sex behaviours to help curb the spread of the virus. Leaders also "must call for the end of stigma toward MSM, which may mitigate the internalization of homophobia leading to sexual risk behaviour," the authors write.

They add that leaders also should "advocate for legal domestic partnerships as a way to promote stable, longer-term" relationships among MSM (Washington Times, 11/28). In addition, HIV testing rates among MSM should be increased because many members of the group are not aware of their HIV status, the authors write.

"Failure to address" issues such as testing, funding for public health strategies and community leadership "implies that the HIV/AIDS epidemic in MSM must be accepted as inevitable," the authors write, concluding that "this cannot be allowed to happen. The tragedy of the epidemic for an earlier generation of MSM must not be repeated" (JAMA, 11/28).