A New Trend in the HIV Epidemic Among Men Who Have Sex With Men, San Francisco, 2004–2011
In San Francisco, men who have sex with men (MSM) have historically comprised 90% of the HIV epidemic. It has been suggested that given the ongoing HIV transmission among this population, there is the possibility of a high-level endemic of HIV into the future. We report on the possibility of another phase in the HIV epidemic among MSM in San Francisco.
Behavioral surveillance systems monitor HIV prevalence, HIV incidence, and behaviors among populations at high risk for HIV infection. Among MSM, time-location sampling is used to obtain samples for standardized behavioral surveys, HIV-antibody and incidence testing. We analyzed National HIV Behavioral Surveillance data from MSM sampled in 2004, 2008, and 2011.
Three hundred eighty-six, 521, and 510 MSM were enrolled in each of the waves. Only slight changes were seen in demographics over time. We detected significant declines in unrecognized HIV infection and methamphetamine use, a significant increase in HIV testing in the past 6 months, and no changes in HIV prevalence, history of gonorrhea infection, or having multiple sex partners. Among HIV-infected men, current antiretroviral treatment (ART) use seems to have risen from 2008 to 2011.
The trends of the last 7 years point to stable HIV prevalence as rising ART coverage results in improving survival coupled with decreasing incidence as ART use achieves viral load suppression at levels more than sufficient to offset ongoing sexual risk behavior. "Treatment as prevention" may be occurring among MSM in San Francisco.
- "Unprotected sex among men who have sex with men (MSM) is the main route of HIV transmission in many countries and regions that were first affected by the HIV/AIDS epidemic, such as North America, Western Europe, and Australia . Over the past years, HIV infection rate among MSM is on the decline in some cities in the United States . On the contrary, HIV infection rate is increasing obviously among MSM in China [3, 4]. "
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This study was to characterize the continuously changing trends of HIV prevalence, risks, sexual behaviors, and testing behaviors among men who have sex with men (MSM) in Chongqing, China.
Five consecutive cross-sectional surveys were conducted among MSM in 2006, 2008, 2010, 2012, and 2013. Testing for HIV and syphilis was performed, and HIV risks, sexual behavior, prevention, and HIV testing behavior were collected using the same questionnaire.
HIV prevalence increased from 13.0% to 19.7% from 2006 to 2013 (P = 0.004), with an increase of 1.0% per year. Syphilis prevalence peaked in 2008 with a positive rate of 11.6% and then experienced a sharp drop to 2.8% in 2012 and 2.9% in 2013. Percentage of those who ever received HIV testing in the last year increased from 17.0% to 43.3% (P < 0.001); condom use at the last anal intercourse and reported consistent condom use in the last 6 months increased from 51.8% to 71.0% (P < 0.001) and from 24.7% to 47.9% (P < 0.001), respectively.
HIV continued to spread among MSM in Chongqing even when a decline in prevalence of syphilis and increase in awareness rate, condom use, and HIV testing seeking behaviors seemed to occur.
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ABSTRACT: Gay, bisexual, and other men who have sex with men (MSM) have been disproportionately affected by HIV and AIDS since the beginning of the epidemic in the United States and in many other parts of the world. The HIV epidemic is inextricably tied to other health problems that disproportionately affect gay, bisexual, and other MSM including psychological comorbidities, substance use, sexual victimization, stigmatization, and multiple forms of discrimination. These interrelated health problems and social issues can be characterized as a syndemic of mutually reinforcing conditions or epidemics. Moreover, the syndemic is directed by biological, behavioral, psychosocial, and structural determinants. Addressing HIV within the context of a larger syndemic will require a more holistic approach to HIV prevention and treatment that recognizes the interplay between biological, behavioral, psychosocial, and structural factors that affect the health and well-being of sexual minority men. (PsycINFO Database Record (c) 2013 APA, all rights reserved).
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