Volume 14 Number 1 2017
What the Future Holds for Men who have Sex with Men in 2020
SH162202020, sexually transmissible infections and HIV in gay, bisexual and other men who have sex with men
This editorial accompanies a series of papers dealing with this watershed period for HIV and sexually transmissible infections (STI) infections in gay, bisexual and other men who have sex with men (GBM). We are delighted to share with you the views of some international opinion leaders on what the future may hold and what challenges lie ahead. In this issue of the Journal, authors describe current HIV and STI incidence among GBM and predict the future.
SH16070HIV incidence among gay men and other men who have sex with men in 2020: where is the epidemic heading?
This paper reviews the recent trend in HIV incidence among men who have sex with men (MSM), which is now increasing in many low- and high-income settings with young, adolescent, and racial/ethnic minority MSM being among those at highest risk. We discuss the risk factors that are potentiating the epidemic including individual-, network-, and structural-level factors such as stigma and lack of access to pre-exposure prophylaxis and antiretroviral treatment as prevention. Finally, we call for a concerted effort to integrate all evidence-based interventions to proximally decrease HIV acquisition and transmission risks, together with structural interventions to support improved coverage and retention in care.
SH16104As through a glass, darkly: the future of sexually transmissible infections among gay, bisexual and other men who have sex with men
Sexually transmissible infections (STI) among men who have sex with men (MSM) appear to be increasing globally. We explore the history of STI among MSM before the emergence of HIV, how STI incidence may have decreased as a result of the HIV pandemic and discuss factors potentially contributing to recent STI increases. Looking ahead to the next decade, we conclude that STIs may continue to increase among MSM for a variety of reasons and discuss the implications for MSM sexual health.
A systematic review on hepatitis C virus transmission in gay and bisexual men shows substantially higher HCV prevalence in HIV-positive than in HIV-negative men, and injecting drug use remains the major risk factors. Of longitudinal studies, the pooled incidence remains very low in HIV-negative men. Since the early 2000s, cases-series reports increasingly point to the importance of sexual transmission of HCV in mainly HIV-positive men.
SH16080The future of drugs: recreational drug use and sexual health among gay and other men who have sex with men
Sexualised drug use is associated with a range of problems, including sexual risk-taking dependence, mental health issues, accident and overdose. For gay men, there are complex historical connections between sexual minoritisation and desires to chemically alter bodily experience. Drug and alcohol use can be a creative or experimental response to social marginalisation – and not necessarily a problematic one in every instance. This article outlines some of the conditions most likely to mediate drug futures among gay and other men who have sex with men in the medium term.
Travel shapes the social and sexual networks and, consequently, the HIV and sexually transmissible infection (STI) acquisition risks of gay men and other men who have sex with men (MSM). Four factors associated with travel that could potentiate HIV transmission are different patterns of sexual risk behaviours during travel; the growth of online tools to meet sex partners more efficiently; the global heterogeneity of HIV strains; and the potential for diassortative mixing of men from high- and low-HIV prevalence areas. Addressing these shifting risk contexts from increased connectedness through travel and online social networking platforms requires innovation in HIV and STI prevention and treatment interventions for gay men and other MSM, and mobile applications and social networking platforms that can provide HIV-related resources and information tailored to the local risk environment and to the individual may have valuable potential.
In this review we illustrate mental health challenges facing men who have sex with men (MSM) primarily in the US, related to HIV and sexually transmissible infection prevention and across the HIV care cascade, including HIV diagnosis, engagement and retention in care, and antiretroviral adherence. We also describe disparities among MSM including racial and ethnic, age, and structural barriers associated with HIV prevention and treatment, as well as current interventions. As access to prevention and treatment strategies expand, and new breakthroughs continue to emerge, behavioural strategies will continue to be needed to reduce risk and increase uptake and engagement among MSM most at risk through 2020 and beyond.
SH16072Adapting behavioural surveillance to antiretroviral-based HIV prevention: reviewing and anticipating trends in the Australian Gay Community Periodic Surveys
This article describes the adaptation of a behavioural surveillance system, the Gay Community Periodic Surveys, to the introduction of HIV pre-exposure prophylaxis (PrEP) and treatment as prevention. National trends in key indicators during 2000–15 are reviewed, showing increases in HIV testing, treatment and condomless sex with casual partners. Two scenarios anticipating the effect of PrEP highlight the need to target gay and bisexual men who engage in receptive condomless sex while also sustaining condom use at a population level.
HIV testing should be the primary focus of behaviour change to reduce HIV transmission. There is a need for transparency in describing the HIV testing interventions we develop and evaluate. Interventions should detail the testing technologies they use, the specific behavioural aspects they target, and the specific populations they do and do not serve. Clarity concerning the specificity of HIV testing interventions enables diverse testing interventions to be delivered in parallel, and will limit the widening of health inequalities across men who have sex with men populations.
SH16056Enhanced use of phylogenetic data to inform public health approaches to HIV among men who have sex with men
Using HIV phylogenetic approaches to understand and intervene within social networks at high risk for transmission is a rapidly evolving field with strong promise for informing innovative responses to the HIV epidemic among men who have sex with men (MSM). Here, we argue that viral phylogenetics could become an invaluable tool in the public health response to HIV among MSM that adds value to ongoing HIV surveillance and other public health data sources. We also highlight promising HIV phylogenetic applications for the MSM HIV epidemic and important methodological, ethical and implementation questions for the field.
SH16128Dealing with pre-exposure prophylaxis-associated condom migration: changing the paradigm for men who have sex with men
The advent of pre-exposure prophylaxis (PrEP) necessitates attention to several issues associated with condom migration. One issue is the clear possibility of population-level increases in the incidence of sexually transmissible infections. A second issue pertains to how clinicians can best promote the dual use of PrEP and condoms such that both are used consistently and correctly. A third issue involves accounting for condom use in future efficacy trials of PrEP; a complex task that require intensified measurement protocols.
SH16052Stigma, gay men and biomedical prevention: the challenges and opportunities of a rapidly changing HIV prevention landscape
The potential of new biomedical technologies to reduce HIV transmission and the impact of HIV among GMSM will depend, in part, on the degree to which they challenge prejudicial attitudes, practices and stigma directed against gay men and people living with HIV (PLHIV). HIV research, policy and programs will need to invest in: (1) responding to structural and institutional stigma; (2) health promotion and health services that recognise and work to address the impact of stigma on GMSM’s incorporation of new HIV prevention biotechnologies; (3) enhanced mobilisation and participation of GMSM and PLHIV in new approaches to HIV prevention; and (4) expanded approaches to research and evaluation in stigma reduction and its relationship with HIV prevention.
SH16145Advancing health equity for lesbian, gay, bisexual and transgender (LGBT) people through sexual health education and LGBT-affirming health care environments
Lesbian, gay, bisexual and transgender (LGBT) people face pervasive health disparities and barriers to high-quality care. Clinical training programs and healthcare organisations are well poised to start addressing disparities and affirming LGBT patients through curricula designed to cultivate core competencies in LBGT health as well as health care environments that welcome, include and protect LGBT patients, students and staff. Core concepts, language and positive attitudes can be instilled alongside clinical skill in delivering inclusive sexual health care, through novel educational strategies and paradigms for clinical implementation. Caring for health needs of LGBT patients also involves creation of health care settings that affirm LGBT communities in a manner that is responsive to culturally specific needs, sensitivities and challenges that vary across the globe.
SH16067Human papillomavirus vaccination in men who have sex with men – what will be required by 2020 for the same dramatic changes seen in heterosexuals
This paper addresses the issue of whether men who have sex with men (MSM) will share the spectacular reductions in human papillomavirus (HPV) infection and its associated neoplasia that we are currently witnessing in heterosexuals. On the basis of published data we argue that if MSM are to have the same benefit from HPV vaccination as heterosexuals have enjoyed, boys and not adult MSM will need to be vaccinated.
SH16038Sexually transmissible infection control programs for men who have sex with men – what will they look like in 2020?
The resurgence of sexually transmissible infections among men who have sex with men is a concern for sexual health. Traditional strategies have relied on the promotion of condom use, regular testing, treatment, and partner management. Future sexually transmissible infection control programs must combine current prevention methods with novel approaches that target the providers, patients, and mechanisms of health care delivery.
SH16119Emerging models of clinical services for men who have sex with men: focused versus comprehensive approaches
Over the past few decades, the recognition of infections that were specifically transmitted through male–male intimate contact (e.g. anal intercourse) led to the development of sexual health services that were tailored to gay and other men who have sex with men (MSM). With the spread of HIV among MSM, the need for these services to address other aspects of comprehensive care, including behavioural health, led to further refinements. Some programs have further evolved to become primary care centres for all sexual and gender minority people, including lesbians, bisexuals and transgender persons, while others have refined their model to provide more efficient sexual health services for otherwise healthy individuals. This paper will discuss some of the emerging models of sexual health care.