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Full Enjoyment of Human Rights by All June 9, 2008 Chris Beyrer MD MPH

HIV/AIDS epidemics among men who have sex with men (MSM) in Africa, Asia, Latin America and the Caribbean, and the CIS. Full Enjoyment of Human Rights by All June 9, 2008 Chris Beyrer MD MPH The Center for Public Health and Human Rights Johns Hopkins Bloomberg School of Public Health.

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Full Enjoyment of Human Rights by All June 9, 2008 Chris Beyrer MD MPH

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  1. HIV/AIDS epidemics among men who have sex with men (MSM) in Africa, Asia, Latin America and the Caribbean, and the CIS Full Enjoyment of Human Rights by All June 9, 2008 Chris Beyrer MD MPH The Center for Public Health and Human Rights Johns Hopkins Bloomberg School of Public Health

  2. Introduction • HIV epidemic spread among MSM is occurring in both high and low income settings in 2008 • MSM HIV epidemics are underway in Latin America, Asia, Eastern Europe/FSU, and Africa • Many MSM epidemics are occurring in “hidden” contexts of discrimination, stigma, criminalization, rights abrogation and limited HIV surveillance

  3. HIV prevalence among MSM in Selected settings Source: Wade et al. 2005; Girault et al. 2004; van Grievsven et al. 2005; Action for AIDS Singapore, 2006, Go et al. 2004; Pando et al. 2006; UNAIDS, 2006; Caceres et al, 2005, Strathdee, et al, 2006. CENSIDA, CA State Office of AIDS; Patterson et al, IAS, 2006; Strathdee et al, pers. comm; Viani et al, 2006

  4. HIV prevalence among MSM, Bangkok, Thailand 2003 40 2005 35 30.5 29.7 28.3 30 25 22.3 HIV Prevalence (%) 20.8 20 17.5 17.3 15 12.9 10 5 0 Age (years) ≥29 ≤22 Overall 23-28 N = 194/1,121; 113/399 p-values all < 0.05 Source: Van Griensven, et al, MMWR. 2006

  5. Individual level determinants for HIV among MSM Unprotected anal intercourse ( risk with receptive UAI) High frequency of male partners (>3 sexual contacts/ week) High number of lifetime male partners (>10) Untreated STI (syphilis, HSV-2) Injection drug use Non injection drugs Methamphetamines Possible risk: Lack of circumcision Mediated through increased sexual exposure

  6. Elevated Risk for HIV Infection among MSM in Low and Middle Income Countries 2000-2006: A Systematic Review Stefan Baral, Sifakis F, Cleghorn F, Beyrer C. PLoS Medicine, Dec. 1, 2007

  7. Search Protocol Potentially relevant studies identified and abstracts screened for retrieval from international conference searches (n=779) Potentially relevant studies identified and abstracts screened for retrieval from literature Searches (n=1395) Duplicates excluded (n=255) Reports excluded based on abstract due to lack of quantitative data, geographical context, sample size, self-reported HIV status. n=1280 Abstracts excluded based on abstract due to lack of quantitative data, geographical context, sample size, self-reported HIV status. (n=475) Full texts retrieved for further analysis (n=115) Conference abstracts retrieved for further analysis (n=49) Reports excluded based on lack of HIV prevalence data, inability to calculate country population HIV prevalence (n=93) Abstracts excluded based on inability to find background data on specific country HIV prevalence, inability to find further information on statistical methods (n=6) Studies retrieved that were coordinated by EuroHIV and commissioned by European Union (n=16) Unique studies retrieved from US Census Bureau Database for HIV/AIDS (n=2) 83 studies from 58 unique reports describing data from 38 countries used in meta-analysis

  8. Results Total of 83 publications from 38 countries on HIV in MSM US Bureau of Census and UNAIDS data to estimate general population levels of HIV in adults aged 15-49 Total sample: 63,538 individual men Pooled OR for HIV infection in MSM: 19.3 In very low HIV Prevalence settings (<1/1000 adults with HIV) Pooled OR for MSM was 58.4 In high prevalence settings (> 1/20 infected) Pooled OR for MSM was 9.6

  9. Asia Prevalence

  10. Africa

  11. Latin America

  12. Systematic Review of HIV among MSM in Low and Middle Income Countries Source: Baral. et al, 2007, PLOS Medicine.

  13. What do these data tell us? Why are we seeing such high HIV rates in MSM in 2008?

  14. Implications • MSM understudied in many emerging HIV epidemic contexts: MSM not included in national HIV surveillance in majority of low and middle income countries • Africa most markedly understudied region • Urgent need to include MSM risks in national HIV/AIDS surveillance, in STI measures, and particularly where culturally difficult • Evidence based and rights based approaches to HIV both mandate that there be non-discrimination in services, access,and funding

  15. Responses: HIV, sexual health and human rights among MSM in Southern Africa Center for Public Health and Human Rights, OSISA (Open Society Institute Southern Africa,) SHARP (The Sexual Health and Rights Project of OSI) and LGBT partner organizations in 4 Southern African States Epi-Probe study of HIV prevalence, sexual health, and experience of human rights abrogation N= 200/country Botswana, Namibia, Malawi, South Africa (2 other countries may join soon)

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