Failure to achieve reduction in the incidence of human immunodeficiency virus among men who have sex with men: A worrisome global concern.

Sir,

Over the years, the trends of surveillance have time and again suggested that men who have sex with men (MSM) have a higher risk of acquiring the infection by human immunodeficiency virus (HIV) than the general population.[12] In-fact, the MSM has almost 20 times additional risk of being infected with HIV in comparison with the general population, especially in low and middle income nations.[2] Further, it is important to note that even though a decline in the incidence of HIV across the world has been observed, the scenario among MSM is altogether different, as either incidence of HIV has remained same or even increased in nations like the United States.[12] It is really worrisome that despite the existence of various behavioral prevention initiatives such as measures to enhance the access and utilization of condoms and lubricant, facilities for early diagnosis of infection, the existence of a mechanism to ensure quick linkage with sustained care and supportive services, and availability of an effective antiretroviral therapy (ART), the scenario is not as expected.[13]

Now, the question arises as to why we have failed to reduce the incidence of HIV among MSM while we are at least on the right track for the general population.[2] This is predominantly because of the paucity of key information in the MSM sub-population (viz. no clear global or region-wise estimates available about their sexual behavior, condom use, psychological health, prevalence of other sexually transmitted infections [STIs], etc.).[3] However, the stigma and discrimination associated with MSM have played a crucial part and significantly influenced the opportunity to diagnose HIV infection, augmented the unmet needs for prevention, and discouraged them from utilizing HIV testing services and even prompted them to conceal their sexuality or sexual behavior from their family, friends, neighbors, and healthcare professionals.[4] Further, defects in the current service delivery models in most of the settings (viz. either the health workers have never approached due to the associated stigma or failure to establish a sense of trust) has also negatively affected.[4] At the same time, limited monetary allocation or lack of resources in the national HIV programs has also interfered with the progress/sustaining the achievements.[5]

In order to effectively protect the global community from the re-emerging HIV epidemics in MSM worldwide, there is a definitive need to strengthen, improve (and, in some cases, to start), and implement holistic, effective, and customized HIV prevention measure specific to MSM in heterogeneous settings.[26] In-fact, to reduce the incidence of HIV among MSM, the World Health Organization in collaboration with the multiple other partners, has formulated guidelines to improve the HIV programs.[6] The ultimate aim of the guideline is to enable the implementation of an evidence-based approach for the prevention and treatment of HIV/STIs and simultaneously establish a mechanism to monitor the performance and impact of its implementation.[6]

It advocates for the implementation of various measures like the empowerment of community, including MSM (as it is an indispensable element in rationale planning, implementation and monitoring); addressing the issues of violence/stigma/discrimination/breach of human rights; giving special attention to ensure uniform accessibility, availability, and utilization to condoms/lubricants; building linkages with private sector; utilizing different modes of information and communication technology, including social networking sites for the advocacy, communication and social mobilization activities; strengthening of the different aspects of the program; and implementing consistently health care service delivery services (viz. sexual and risk reduction, maintenance of anal health, encourage voluntary HIV testing and counseling/pre- and post- exposure prophylaxis/ART, and treatment of STIs and of co-infections).[34567]

To conclude, in order to significantly reduce the incidence of HIV and associated mortality among MSM the key is to ensure that services are easily accessible, implemented in an effective manner and finally delivered in close partnership with their intended beneficiaries.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest