CROI plenary: Without focus on MSM epidemic, “an AIDS-free generation is not going to be achievable”

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Science Speaks is in Atlanta, Georgia this week and will be live-blogging from the 20th CROI — Conference on Retroviruses and Opportunistic Infections from Sunday to Wednesday, covering breaking developments from investigators on cure research, new antiretroviral agents, hepatitis, tuberculosis and treatment as prevention.

ATLANTA, GA—Three decades after the AIDS epidemic was noted first among gay men, and after the toll, activism, contributions and sacrifices of gay men made possible the development of life-saving antiretroviral treatment, structural barriers to accessing that treatment faced by men who have sex with men worldwide continue to cost individuals opportunities to benefit from adances,  to fuel the epidemic,  and remain as an obstacle to turning the trajectory of the epidemic.

That was part of the message brought by Dr. Chris Beyrer to the plenary session Tuesday of the 20th Conference on Retroviruses and Opportunistic Infections in Atlanta.

He reviewed the state of the global burden of the epidemic on men who have sex with men — a term he points out was invented by researchers.

“The pattern is consistent,” he said. “MSM have markedly higher rates in every region.” That includes sub-Saharan Africa and Caribbean, where the impact on men who have sex with men is highest.

“We have to ask ourselves, where in the pandemic it makes sense to ignore MSM,” Beyrer said.

And yet, of course they are ignored, so much so that on much of the map he showed, data on the prevalence of HIV among men who have sex with men is simply not available. Data on incidence – new infections – also is scarce, but what there is shows “rapidly rising rates, particularly in the last five years,” Beyrer noted.

“I think we have to ask ourselves why is this happening,” he added.

The answers would point the way to obstacles and answers to responding to the epidemic among men who have sex with men. “If we can’t do this, an AIDS-free generation is not going to be achievable.”

And yet the challenges to prevention and treatment among individuals and networks of men who have sex with men are only enhanced by structural ones – stigma, discrimination, consequences for sexual orientation codified by law.

Research focusing on pre-exposure prevention and microbicides are among the moves offering hope, as does the new spur to the military’s research program to study means to address the epidemic among men who have sex with men, now that the military’s discrimination against gay service people has been repealed.

While that represents long delayed progress here, Beyrer also pointed to data showing that dollars from the Global Fund to Fight AIDS, Tuberculosis and Malaria aren’t making their way to programs supporting services for sexual minorities.

He also challenged those in the audience, people working in countries where homosexuality is criminalized, and who don’t think to include members of sexual minorities in their research.

The path to progress will lie in supporting community based outreach, culturally competent care, access to condom compatible lubricants, research that informs targeted interventions and attention to structural barriers.

The positive signs now include the growing emergence of sexual minority activists around the world, he said. “We all have the obligation to stand with them.”

 

 

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