Staggering HIV Rates Among Men Who Have Sex with Men

By Todd Heywood

Men who have sex with men face an HIV prevalence rate "magnitudes higher" than any other risk group in the U.S., researchers from Emory University have found.

The study, published by the online journal JMIR Public Health and Surveillance, found that 15 percent of MSM in the U.S. were living with HIV in 2012-2013. Just over 11 percent of MSM living with the virus have been diagnosed, the study found.

"The diagnosed HIV prevalence rate among MSM was 57.5 times greater than among other U.S. men," researchers wrote.

The study also found that a significantly higher number of MSM across the South were infected with the virus.

But those national levels hide a deeper, more encompassing county-by-county crisis. While most of the prevalence areas of 30 per 100 MSM infected were in the South, Michigan has one county at that level -- Jackson. But Kent, Kalamazoo, Genesee, Oakland, Wayne and Ingham all have rates between eight and 16 percent.

Researchers evaluated data from 2012-2013. The Michigan Department for Health and Human Services reported about 8,200 men who have sex with men living with HIV in 2013. That included both those men who used injection drugs as well as men who have sex with men.

Until the last year, the state and federal authorities did not track incidence among trans people, particularly transwomen. They were regularly grouped into the men who have sex with men risk category in official government statistics. But a report in 2014 by AmFAR found that transwomen were 49 times more likely to be infected with HIV than any other women in the world.

AIDS service organizations and health officials from Michigan said the numbers point to serious issues related to the ongoing HIV crisis among MSM in the U.S.

Kelly Doyle, executive director of CARES which works with HIV affected communities in southwest Michigan, said the numbers point to a need to expand access to "innovate" prevention programs for MSM.

She pointed out that the study looks at a time when PrEP -- the prescription drug that, if taken daily, is up to 99 percent effective in preventing HIV-negative people from getting infected with the virus -- had barely been approved by the FDA.

"I think PrEP will change the framework," she said. But she added a caveat.

"I think we'll see more and more people protecting themselves with PrEP, but if, and only if, we make it available," she said. "That means not just for people with money who can afford it, or white gay men -- it means for everyone."

The drug is costly -- running about $1,000 a month. However, Gilead -- the company that makes the drug -- provides a generous subsidy for those people with low incomes seeking to use it, said Dwayne Riley, the prevention manager at the Lansing Area AIDS Network.

Despite its promise, PrEP was not widely in use during the years of the study. It is unclear what role, if any, the drug would mean for the epidemic.

Before the impact of PrEP can be measured, it has to be scaled up in the community and that points to another obstacle in HIV prevention -- the ongoing crisis related to obtaining culturally competent and appropriate medical care.

"For instance, in Ingham County, we only have two providers who are willing to write a prescription for this drug," Riley said.

MSM he said, often face difficulty "feeling safe" in certain spaces, particularly in medical settings. Add to that issues around discomfort from both provider and patient in discussing sexual activity, and a major barrier to accessing care is created.

Riley said LAAN has launched a PrEP referral system tied to its HIV testing programs. Since January, when the program was formally launched, the organization has referred over 20 people to doctors who are willing to prescribe the intervention.

Ingham County averages 25 or so new cases of HIV each year, most in the MSM category.

The high prevalence rates among MSM are likely tied in part to decisions made 35 years ago, as a strange new disease began appearing among MSM in California and New York. The new disease would be known first as gay cancer, then Gay Related Immune Deficiency Syndrome (GRIDS) and finally Acquired Immune Deficiency Syndrome (AIDS). The federal government, under then-President Ronald Reagan, was exceedingly slow to respond to the crisis in large part because those impacted were MSM.

Riley said that initial reluctance to address the growing AIDS crisis, and the developed mistrust of healthcare professionals by the MSM community, continues to be an issue. He said that is not the only issue at play however.

"There needs to be culturally competent providers who are willing and able to provide the care," he said. "But that means talking about sex and sexual behavior. Many providers are very uncomfortable with that."

Federal officials said the data was an important new tool in addressing the crisis.

"By pinpointing where HIV strikes the hardest, we have a key piece of the puzzle highlighting the largest disparities within states and the South," says Dr. Jonathan Mermin, director of CDC's National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention. "We hope these data empower local public health officials, community-based organizations and everyone fighting HIV to bring resources to the gay and bisexual men who need them the most."

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