This presentation, given at the Global Forum on MSM and HIV Preconference in Vienna in 2010, contains these key findings related to HIV prevention among MSM: (1) MSM-specific prevention interventions can have an impact on the rate of new infections in the general population but must include access to antiretrovirals for MSM; (2) where people who inject drugs play a major role in the epidemic, needle-exchange programs and substitution therapy programs can have a major impact on the rate of new infections in the general population; and (3) human rights–based approaches and science are in agreement. The presentation provides a detailed overview of four distinct epidemic scenarios, recognizing that HIV epidemics among populations of MSM occur together with those affecting other exposed groups (i.e., people who inject drugs, heterosexuals).

This review considers behavioral interventions as a means for reducing risk for sexual transmission of HIV among MSM. It analyzes 44 studies evaluating 58 interventions, including small group-, individual-, and community-level approaches. Interventions reviewed include individual counseling, peer education, group counseling, and interventions in community areas, among others. The review found that behavioral interventions can lead to significant reduction in risk for HIV transmission among MSM; however, it highlights the need for further analysis to understand in greater detail which interventions are most effective for which groups. One interesting finding is that interventions that included greater than 25 percent non–gay-identifying MSM were more effective than those that did not. This suggests that, when they can be reached, these men may be more responsive to risk reduction efforts.

MSM in low- and middle-income countries in Asia, Africa, Latin America, and the former Soviet Union experience high levels of HIV transmission. The authors examined the relationship between HIV prevalence among MSM to that of the general population in countries with low to high HIV prevalence overall. After conducting a meta-analysis of studies in low- and middle-income countries, the authors found that HIV prevalence among MSM was 58 times as high as the general population in nations with very low prevalence. In medium-high prevalence settings, HIV prevalence among MSM remained high, at nine times that of the general population. MSM from low- and middle-income countries are in urgent need of prevention and care, and appear to be both understudied and underserved, due in part, say the authors, to the criminalization of sex between consenting adult men in 85 countries as of 2007.

This study of 537 men is the first cross-sectional study establishing MSM as a high-risk group for HIV infection and human rights abuses in the countries of Malawi, Namibia, and Botswana. In these contexts, a significant proportion of men identified as either heterosexual or bisexual, and were married or had at least one female partner in the previous six months. An important finding of the study establishes the Internet as the predominant tool used by MSM to find male sexual partners. This is especially true in contexts like Malawi, Namibia, and Botswana, where homosexuality is criminalized and there is no safe, legal space for MSM to congregate. The authors suggest the Internet may represent a powerful tool for efficiently reaching and delivering prevention messages to MSM.

The researchers describe discordance between self-described sexual identity and behavior among MSM and the relationship between self-described sexual identity and risk behaviors. Of New York City men reporting a sexual identity, 12 percent reported sex with other men. MSM who self-identified as heterosexual were more likely than their gay-identified counterparts to belong to minority racial or ethnic groups, to be foreign-born, to have lower education and income levels, and to be married. Heterosexual or “straight-identified” MSM were more likely to report having only one sexual partner in the previous year than gay-identified MSM, but were less likely to have been tested for HIV and were less likely to have used condoms during their last sexual encounter. The authors conclude that medical providers cannot rely on patients' self-reported identities and that public health messages should target risky sexual activities rather than a person's sexual identity.

Studies of the impact of the HIV epidemic among African-American MSM have largely neglected men who self-identify as heterosexual but who engage in same-sex behavior. These men, commonly referred to as “men on the down low,” pose formidable challenges to researchers conducting prevention studies. The authors discuss the benefits and drawbacks of various sampling methods to identify these hard-to-reach MSM and describe a novel approach to reaching these men. Instead of relying on self-identified gay men or gay establishments, the researchers successfully used three recruiters who frequented known cruising areas (a park and the Internet) to find men who would meet the general classification of men on the down low.

This policy brief succinctly argues that MSM shoulder a disproportionate burden of HIV globally, and therefore countries need to increase their commitment to and coverage of MSM populations. It identifies the following strategic areas for increased work, with specific action recommendations for each: (1) increased investment in effective HIV treatment, care, and support for MSM; (2) expanded coverage of quality services for MSM; (3) increased MSM-related knowledge through research; (4) decreased violence, stigma, and discrimination against MSM; and (5) strong MSM networks linked to MSMGF. Quotes from MSM activists throughout the world are included.

This article is a meta-analysis that assesses factors associated with disparities in HIV infection in black MSM in Canada, the United Kingdom, and the United States from 1981 to 2011. The authors base their findings on aggregated data from racial comparative studies with outcomes associated with HIV risk or infection from seven studies from Canada, 13 from the United Kingdom, and 174 from the United States. It looks at data related to a number of factors, including seropositivity, drug use, structural barriers, and access to prevention services, among others. The study finds that there are similar racial disparities in terms of HIV status, STIs, and ART initiation among MSM in the United Kingdom and the United States. The study concludes that elimination of these disparities cannot be accomplished unless structural barriers to clinical care access are addressed.

This article makes the important argument that the successful integration of structural and biomedical approaches to HIV prevention depends on biomedical and social scientists working together. It compares successful and unsuccessful prevention interventions/programs, and highlights the importance of structural factors in determining HIV risk. For HIV prevention programs to be effective, the focus must include both behavioral and structural factors. The article concludes that multidisciplinary teams provide a good starting place for the development of effective prevention programs that take combination approaches.

As part of the President's Emergency Plan for AIDS Relief's (PEPFAR's) second five-year strategy, this technical document provides specific information to assist country teams in the development of HIV prevention programs for MSM that respond comprehensively and effectively to specific epidemic scenarios. The document highlights the importance of combination prevention, which combines structural, biomedical, and behavioral approaches, and provides in-depth information on community-based outreach; condom distribution; HIV counseling and testing; active linkages to health care and antiretroviral therapy; targeted information, education, and communication; and sexually transmitted infection prevention, screening, and treatment. The guidance document also recommends a set of best program practices to ensure the effectiveness of HIV prevention programs among MSM (i.e., MSM involvement; confidentiality; staff training; strategic information; linking, integrating, and collocating services; and incorporating research advances and new technologies).

The goal of this comprehensive report is to evaluate the impact of legislation that criminalizes same-sex sexual practices on two key outcomes: (1) the efficiency of multilateral funding sources for HIV programming and (2) the effectiveness of programming for MSM. It also analyzes the evidence for the positive impact decriminalizing same-sex sexual practices can have on the delivery of comprehensive HIV programs for MSM. It is comprised of analysis of country case studies; in-country consultations with a wide range of stakeholders; and data from the UN General Assembly Special Session on AIDS (UNGASS), PEPFAR, and the Global Fund. Countries of focus include China, Ethiopia, Guyana, India, Mozambique, Nigeria, Ukraine, and Vietnam.

This action framework seeks to go beyond "business as usual" approaches to articulate UNAIDS' specific commitments to MSM and transgender (TG) communities worldwide. It provides direction for enhanced action by the UNAIDS Secretariat and UNAIDS Cosponsors. The framework is intended to serve as a foundation for articulating specific workplans and recommendations for better-coordinated action. It focuses on these key objectives: (1) improving human rights for MSM and TG populations; (2) strengthening and promoting the evidence base related to MSM, TG, and HIV; (3) promoting partnerships and ensuring better, broader responses for MSM and TG populations; (4) outlining roles, responsibilities, and partnerships within the UN related to MSM and TG groups; and (5) developing a monitoring, evaluation, and review plan.

This policy briefing was developed as an elaboration of Advancing the Sexual and Reproductive Health and Human Rights of People Living with HIV: A Guidance Package, published jointly by the GNP+, the International Community of Women with AIDS, EngenderHealth, the International Planned Parenthood Federation, and UNAIDS in 2009. It is a set of principles, based on the original guidelines, specific to the needs and priorities of MSM living with HIV. The recommendations are intended for program managers and policy makers, sexual health advocates and health care workers, and community and civil society organizations.

This 82-page report discusses the vulnerability to HIV of MSM in Asia. Many Asian countries focus on such high-risk groups as female sex workers and injecting drug users, while ignoring MSM despite increasing HIV prevalence in the region. MSM may be overlooked because many are married and do not self- identify as gay or bisexual. Studies found HIV prevalence as high as 28 percent among MSM in Bangkok, Thailand; 14 percent in Phnom Penh, Cambodia; and 16 percent in Andhra Pradesh, India. MSM in Asia are often not organized, are hidden from society, and are persecuted by police. Sex between men is illegal in 11 of the countries examined. Many MSM have multiple partners, have sex with women, fail to use condoms, and have high rates of sexually transmitted diseases. This in-depth report provides research findings, country profiles, recommendations for politicians and non-governmental organizations, a directory of organizations, and extensive appendices for reference.

The Internet and other technologies are increasingly used by MSM for a variety of purposes, including meeting sexual partners. This article reports the results of an expert consultation led by the U.S. Centers for Disease Control and Prevention (CDC) on the potential role of the Internet in delivering HIV prevention messaging to MSM. The report summarizes group discussion around how use of specific channels, technologies, and websites differed between groups; characterizes the strengths and weaknesses of those channels in terms of their potential for delivering HIV prevention messages; and discusses how online tools might be developed to help reduce HIV risk and promote overall health for MSM.

This article looks at the epidemiological drivers of the global epidemic in MSM and why it continues unchecked. It is based on a review of available data for HIV prevalence, incidence, risk factors, and the molecular epidemiology of HIV in MSM from 2007 to 2011, and on an agent-based simulation that is used to model the dynamics of HIV transmission. The article shows that unprotected anal intercourse plays a central role in explaining the disproportionate disease burden in MSM, that HIV can be transmitted through MSM networks with speed and efficiency, and that prevention strategies that lower biological risks, such as ART, offer promise for controlling the expanding epidemic in MSM. It also finds that the potential effectiveness of ART is limited by structural factors that contribute to low levels of health-seeking behavior in populations of MSM.

This article suggests a detailed conceptual framework for packaging HIV prevention interventions for MSM and modeling the potential effect of scale-up. It contains a review of MSM-focused HIV prevention interventions, and makes a strong case for combination interventions. It underscores the importance of innovative study designs, increased resources for scale-up, and bringing more focus to low- and middle-income countries.

This article examines HIV infection in black MSM across the African diaspora and the extent to which these men report access to HIV prevention and care services, assesses whether these findings are associated with increased susceptibility to HIV infection, examines genetic and biological explanations for disproportionate rates of HIV infection in black communities compared with other populations, and uses meta-analytic methods to assess differences in the prevalence of HIV infection between black MSM and general populations. The authors present recommendations based on study findings.

This resource profiles successful MSM- and TG-community-led HIV-related interventions, all grantees of amfAR's MSM Initiative. The 10 organizations are geographically diverse, and work to promote health and human rights through a number of projects, including (but not limited to) MSM in prisons, leadership development, network building, working in challenging environments, and health. The sections profiling each organization draw on quotes from organization members themselves. The report also surfaces six major themes that community service providers identify as key to program success: addressing basic needs, creating a safe space, establishing and maintaining community trust, providing a range of integrated services, tailoring and revising services on an ongoing basis, and collecting process and outcome indicators.

The Internet is often listed as a tool for targeting MSM for HIV prevention interventions for "hidden" populations; however, there are few examples of concrete ways to use it as a public health tool. This article provides a concrete example of an Internet-based intervention, conducted in Peru, to reach hidden populations who might otherwise not seek care or be targeted for health interventions. It describes a randomized, controlled trial of 272 gay-identified and 187 non-gay-identified MSM, who were selected to receive a text or video intervention. The study suggests that video-based online interventions can improve HIV testing uptake among non-gay-identified MSM.

This technical report and set of recommendations came out of a meeting of the UNAIDS Reference Group on Estimates, Modeling and Projections held in Amsterdam, the Netherlands, December 9-10, 2008. The goal of the meeting, which brought together 29 experts, was to draft recommendations on the topic of population size and HIV prevalence estimation for sex workers, people who inject drugs, and MSM. The report provides a detailed list of methods for various epidemic scenarios and risk groups, with accompanying recommendations.

This guide provides a detailed overview of population size estimation for groups at high risk for HIV, and treats MSM populations with specificity and detail. The guide provides a general overview of the importance of size estimation, issues regarding size estimation for high-risk groups, size estimation methods, and methods for selecting the best method. It also contains exercises that allow readers to test their understanding through case examples, which could also be used in a workshop setting. It contains a resource list for further reading.

This toolkit, developed in Vietnam, is intended to guide action on understanding and challenging stigma related to MSM and TG people, with HIV prevention as one goal. It is designed to equip individuals and agencies working in HIV prevention with the knowledge and tools to understand basic issues related to gender, sexuality, and the sexual health of MSM and TG people, and to combat stigma. The toolkit is comprised of four sections: part A includes exercises aimed at building knowledge and skills related to gender and sexuality; part B is designed to increase understanding of MSM- and TG-specific stigma and discrimination; part C guides planning activities geared toward reducing stigma; and the annexes provide concrete ways to use the toolkit in a workshop setting. Although it is Vietnam-specific, the toolkit can be adapted to other contexts, and may serve as a useful tool for groups who are challenging MSM- and TG-related stigma in their particular contexts.

This 61-page publication, one of the Key Population series, gives an overview of the issues for MSM related to HIV and other sexually transmitted infections. The report is designed primarily to support policymakers, donors, and nongovernmental organization support programs that are planning to work in communities in developing countries where few or no organizations already work with MSM. Drawing on experiences of the Alliance's partner organizations in countries such as India and Costa Rica, the report addresses issues such as why and how men have sex with men, and presents strategies for developing prevention and care programs for men.

This guidance document was developed for both researchers and CBOs in rights-constrained environments. It is intended to help both groups to better design and conduct meaningful research on HIV among MSM in challenging social, political, and human rights contexts. It provides a checklist of factors for researchers and CBOs to consider in the design, conduct, and implementation of research studies, and offers lessons learned from case studies of research and community partnerships, recent successes, and challenges. It contains a user-friendly set of appendices with questions for researchers and CBOs to ask as they engage in MSM-focused research to ensure that they are on the right track.

This set of guidelines provides guidance in planning, monitoring, and evaluating programs for MSM, sex workers, and TG people for national, sub-national levels (volume I), and service delivery (volume II) levels. The first volume is intended for country- and national-level bodies and donor agencies, while the second is intended for networks, NGOs, and other civil society groups. The guidelines are organized using the "eight steps" model for HIV prevention, and contain summary information, methods and tools, and resource lists.

This document offers a set of tools to assist planning and implementation of MSM-oriented health promotion and health care activities in Latin America and the Caribbean (LAC) region. It reflects recommendations emerging from the expert Regional Consultation on Health Promotion and the Provision of Care to Men Who Have Sex with Men (MSM) in Latin America and the Caribbean, held July 14-16, 2009, in Panama City. The document contains a compendium of management algorithms, or step-by-step procedural diagrams, that encompass the essential elements of a variety of approaches to MSM health, such as first clinical evaluation, HIV risk and infection, ano-rectal health, substance use, sexual concerns, emotional and mental health, consequences of violence, and community-clinic interaction. Although developed for the LAC region, it is a tool that can inform health care provision in other contexts.

This 250-page document is intended as a practical guide to legal reform to enable effective action against HIV. It seeks to alert those working on HIV strategies and projects to opportunities for legal and policy reform and to provide them with tools to undertake these challenges. The guide identifies key issues, discusses the pertinent legal and policy considerations for each issue, and provides at least one good practice example for each, as well as resources for continued research and reading. An MSM-focused section discusses gender orientation in general antidiscrimination statutes, sexual offenses, vague or overbroad criminal statutes and police harassment, and rights of association and expression.