While improvements in approaches to HIV prevention have been made over the 30 years since the start of the AIDS epidemic, HIV among MSM is far from eradicated. Despite more than two decades of prevention efforts focused toward MSM, the rates of HIV infection in this population continue to rise.
What is the state of the HIV/AIDS epidemic among men who have sex with men (MSM) in the U.S.?
A 2008 report released by the Centers for Disease Control and Prevention (CDC) showed that MSM accounted for 46% of all new HIV infections and HIV infection rates among young MSM increased at a rate of about 12% each year between 2001 and 2006. This report further noted that MSM were the only risk group who experienced an increase i n infection rates during this time. In fact, according to a recent study by researchers at the University of Pittsburgh, even if the rate of HIV infection among MSM remains at the current level, by the time a group of young MSM (18 years old) reach the age of 40, 41% of them will be HIV-positive. We cannot make any progress in fighting the HIV/AIDS epidemic in the U.S. unless we find ways to lower rates of HIV transmission among MSM.
How do other health disparities among MSM relate to risk for HIV/AIDS?
A growing set of recent scientific papers had shown that health problems among MSM are interconnected and function as a group to increase HIV risk in this population. Because they are sexual minorities, gay, bisexual, and other MSM experience massive minority stress and social marginalization (for example, widespread bullying, gay-bashing, and other forms of violent harassment). Studies suggest that these negative experiences increase a person’s risk for multiple health issues, including depression, anxiety, drug use, and sexual risk behaviors. This process happens over time as people are exposed to discrimination and social marginalization. These experiences cause stress to the individual, resulting in lowered self-esteem, increased emotional distress, and a sense of social isolation, all of which cause a person to be more vulnerable to serious emotional and physical health problems.
According to the CDC, a syndemic is, “Two or more afflictions, interacting synergistically, contributing to excess burden of disease in a population.” In other words, negative health conditions are thought to interact to form a syndemic: synergistic epidemics that, together, can lower a person’s overall health and make him or her more susceptible to disease. For example, health problems such as drug use, depression, and domestic violence have been found to interact so that their impact on the overall health of the person is greater than what we might expect from looking at each affliction separately.
While many studies involving MSM have shown interconnections between health problems, such as drug use and high-risk sex, two recent studies have focused on syndemic conditions in samples of adult MSM and young MSM. These two studies showed that as the number of psychosocial conditions (such as depression, anxiety, and experience of abuse) a person has increases, so will his likelihood of having unprotected anal sex, as well as his likelihood of becoming infected with HIV. It has been suggested that this set of co-occurring psychosocial health problems operating together as a syndemic may actually be driving the HIV epidemic among MSM, while also working to raise the levels of other health problems among MSM.
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