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Turning the Tide Together for HIV among Men who have Sex with Men

Turning the Tide Together for HIV among Men who have Sex with Men. Paul Semugoma Chris Beyrer, Stefan Baral. Overview. Gay men and other MSM Burden of HIV Clinical Care and HIV Prevention Barriers to Progress Case Studies: Senegal, Uganda Call to Action Moving Forward.

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Turning the Tide Together for HIV among Men who have Sex with Men

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  1. Turning the Tide Together for HIV among Men who have Sex with Men Paul Semugoma Chris Beyrer, Stefan Baral

  2. Overview • Gay men and other MSM • Burden of HIV • Clinical Care and HIV Prevention • Barriers to Progress • Case Studies: Senegal, Uganda • Call to Action • Moving Forward

  3. Men who have Sex with Men Exist E V E R Y W H E R E Source: Beyrer, Baral, van Griensven, Goodreau, Chariyalertsak, Wirtz, Brookmeyer, The Lancet, 2012

  4. Patient who Changed my Life • Gay • Bisexual Practices • Recently diagnosed with HIV • ‘One of my lovers must have slept with a woman.’ • ‘How do I protect my lovers?’

  5. Ignorance, Denial • We DO NOT discriminate • We do NOT ask about Sexual Orientation • Q. Is Sexual Orientation/Sexual Behaviour Important?

  6. An AIDS Free Generation? Not Without Including MSM

  7. Global prevalence of HIV in MSM compared with regional adult prevalence in 2010 Source: Beyrer, Baral, van Griensven, Goodreau, Chariyalertsak, Wirtz, Brookmeyer, The Lancet, 2012

  8. HIV Prevalence Among Black MSM vs. Black Populations Across Diaspora • HIV prevalence disparities among black MSM vs. general populations • U.S. 72x more likely to be HIV+ • Canada 73x more likely to be HIV+ • UK111x more likely to be HIV+ Source: Greg Millett, et al. The Lancet, 2012

  9. Disparities Persist Between Black and White MSM Throughout Treatment Cascade Undiagnosed HIV OR, 6.38 (4.33-9.39) HIV Detection Diagnosed HIV+ OR, 2.59 (1.82-3.69) Health insurance coverage OR,0.47 (0.29-0.77) ART utilization/ access OR, 0.56 (0.41-0.76) >200 CD4 cells/mm3 before ART initiation OR, 0.40 (0.26-0.62) ART adherence OR, 0.50 (0.33-0.76) HIV suppression OR, 0.51 (0.31-0.83) Viral Suppression Source: Greg Millett, et al. The Lancet, 2012

  10. Culturally Competent Care • Sub-optimal care, Reticent to disclose because of fears of stigmatization • Health care providers unaware of diversity of MSM and differences • Health Care Providers uniquely placed Gate-Keepers • Culturally-competent care is essential for optimal clinical management Source: Ken Mayer, et al. The Lancet, 2012

  11. Drivers of HIV Transmission among MSM and Targets for Prevention Source: Patrick Sullivan , et al. The Lancet, 2012

  12. Interventions to Decrease HIV Risk among MSM Condoms ART HIV testing nPEP Condom Distribution GLI NLI ILI PrEP • ILI: Individual-level behavior change intervention; NLI: Network-level behavior change Intervention; GLI: Group level Behavior change intervention. • Size of bubble is proportional to strength of evidence. • Blue: Behavior change; Green: Biomedical; Orange: Structural Source: Patrick Sullivan , et al. The Lancet, 2012

  13. Geography of HIV Intervention Studies for MSM Source: Patrick Sullivan , et al. The Lancet, 2012

  14. The Relationship between Criminalization of Same Sex Practices and Targeted Expenditures for MSM Source: amfAR, JHU. Achieving an AIDS-Free Generation for Gay Men and other MSM, 2011

  15. HIV Prevalence Disparities among Black MSM (vs. General Populations) by Anti-Homosexual Criminalization Policies in Africa and Caribbean Source: Greg Millett, et al. The Lancet, 2012 (Millett et al. 2012)

  16. Case Study- Senegal • Concentrated epidemic • Comprehensive outreach in place for MSM • ICASA 2008 held in Dakar and MSM mentioned • 9 outreach worker arrested and prosecuted • Released April, 2009

  17. Study in 2008 DG Statement, Arrests of Activists Difficulty in Recruitment of Respondents Background of fear Comparative studies in Kenya, TZ, Zanzibar Case Study - Uganda Source: Hladik, et al. Plos One, 2012

  18. Uganda, 2012 Source: http://edition.cnn.com/2012/06/20/world/africa/uganda-agencies-ban/index.html

  19. Independent Associations with HIV among MSM in Uganda Source: Hladik, et al. Plos One, 2012

  20. A Call To Action Count us! End invisibility in epidemiology, service delivery, decision making Source: Beyrer, Sullivan, Sanchez, Dowdy, Altman, Trapence, Collins, Katabira, Kazatchkine, Sidibe, Mayer. The Lancet. 2012.

  21. Back to the Basics USD $134 million for condoms and lubricant to avert 25% of global MSM infections in the next 10 years Source: Beyrer, Sullivan, Sanchez, Dowdy, Altman, Trapence, Collins, Katabira, Kazatchkine, Sidibe, Mayer. The Lancet. 2012.

  22. The Strategy to END AIDS among MSM Source: Beyrer, Sullivan, Sanchez, Dowdy, Altman, Trapence, Collins, Katabira, Kazatchkine, Sidibe, Mayer. The Lancet. 2012.

  23. Conclusion • MSM an important part of the HIV epidemic • We cannot achieve an AIDS Free Generation without including MSM • We need to address Structural Challenges • Fight Stigma, Ignorance with Data, Information • A Multi-Stakeholder effort is necessary-Governments, Researchers, Service providers, and Communities of MSM

  24. Price of Advocacy Advocates Beaten, Arrested, and Killed Including Alim Mongoche in Cameroon Steve Harvey in Jamaica David Kato in Uganda Thapelo Makutle in South Africa Many stories untold, unreported. Tough to achieve Comprehensive HIV prevention and treatment in these contexts But, they have tried. And, we continue to try.

  25. My Life and My Partner

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