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A new report says the rate of HIV infections among men who have sex with men is many times greater than HIV infections in the general population. The report by the American Foundation for AIDS Research, or amfAR, was released this week at the 2008 International AIDS Conference in Mexico City. As VOA's Rosanne Skirble reports, activists are calling for targeted prevention programs and resources, especially in low- and middle- income countries, where the problem is most acute.
The amfAR report looks at the response of 128 countries to a 2006 United Nations initiative promoting universal access to HIV prevention, treatment and care. But the amfAR report focuses on one HIV-infected population group: men who have sex with men, better known by the acronym MSM. The term describes this group's sexual behavior, and does not imply a homosexual lifestyle.
Report co-author and Johns Hopkins University epidemiologist Chris Beyrer says a review of all published HIV data shows that MSM makes up a large and growing portion of the AIDS epidemic in every region of the world.
"In Latin America, the odds ratio, the elevated risk compared to the general population, was 33 times. That was the most extreme that we saw."
Beyrer says in Asia, men who have sex with men "are 18 times more likely to have HIV infection, and in Sub-Saharan Africa, where general population rates (of HIV infection) are the highest, men who have sex with men were still more than three times more likely to have HIV than adults in the reproductive age population."
amfAR CEO Kevin Frost says criminalization of male-with-male sexual activities is driving the MSM epidemic in many countries, making it "enormously difficult" to reach the population.
Frost says 86 countries criminalize sex between men. In seven of those countries it is a capital offense. "That kind of institutionalized homophobia makes it very difficult to address the AIDS epidemic in those men."
The amfAR report links MSM prevalence to the failure of many countries to launch any kind of MSM-targeted response, as described in the U-N's 2006 call-to-action on HIV-AIDS programs. The report found that nearly half of all countries did not provide any data on MSM in response to the U.N. initiative. Among those nations that did, 71 percent have not launched any MSM-specific programs.
AmfAR's Kevin Frost says that must change. "History, if it has taught us anything about this epidemic, it has taught us that if we are going to be effective in our response, our response has to be comprehensive," Frost says, "meaning it has to address all the populations at risk, whether that is men who have sex with men or drug users or sex workers."
The report concludes that despite the upward trend in MSM-related HIV infections, resources to deal with them are scarce.
In Latin America, for example, where the AIDS conference is being held, MSM represents 25 percent of the people living with HIV. But MSM programs get less than one percent of total spending on HIV/AIDS prevention.
Co-author Chris Beyrer says it's essential that funding priorities be adjusted and is using the data to advocate for resources. "When you find this kind of a problem and you have the evidence, you want evidence-based approaches to prevention for these men: increased surveillance, health care access, antiretroviral therapy, condoms, and lubricants. And that has to be paid for."
Beyrer calls for stepped up efforts in this area by national governments and major donors like the Global Fund to Fight AIDS, Tuberculosis and Malaria; the World Bank; and the U.S. President's Emergency Plan for AIDS Relief, or PEPFAR.
"The epidemiology has told us this is the most at risk group, and when we look at the services we see that they are ... among the most underserved groups."
Beyrer says failure to provide health care, prevention and treatment for the MSM population amounts to nothing less than a denial of basic human rights to health care and, ultimately to life itself.