MSM: The Global Perspective
MSM: The Global Perspective session began with a study examining testing behaviour in Thai MSM by Tim Holtz. This was followed by a presentation outlining the historical disparities in HIV incidence in Black MSM living in King County by Galant Au Chan. Ashley Grosso spoke about the potential issues associated with exclusion and inclusion of MSM aged under 18 years in epidemiological research. And finally Christen Khosropour and my colleague, Ben Bavinton spoke about seroadaptive behaviours in MSM in Seattle and in Australia, Brazil, and Thailand respectively.
Some findings of this session were:
- Only about one fifth of individuals attending a busy MSM clinic in Bangkok, Thailand met the current Thai national guidelines for HIV testing (every 6-12 months) Messages to improved repeat testing are needed.
- Historical examination of trends in HIV incidence showed HIV incidence increased in birth cohorts from 1940s to 60s then declined 65% but has since plateaued. These trends have been the same in both black and white MSM, and there is evidence of significantly higher incidene in black MSM almost since the beginning of the epidemic. Disparities and absence of progression in recent birth cohorts in concerning
- A significant proportion of MSM reported having had sex with a man under the age of 18yrs across different settings in Africa, estimates ranged from 15-65%. Most also reported non-disclosure of orientation to family and stigma experienced as a result of family members knowing their orientation suggesting that parental consent for <18 years of age is unlikely to encourage participation in this setting. We may be overlooking an important group of MSM in our epidemiological research, innovative ways of involving MSM under the age of 18 while considering ethical considerations in this group are required.
-There is evidence that HIV testing frequency and ART use impacts sexual behaviour decision-making among MSM in Seattle. Results on incidence are not conclusive as there were few seroconversion however there was some suggestion effects of this nuanced behaviour may lead to protection from HIV.
- HIV-ve MSM were twice as likely to have condomless anal sex when they perceived their partners viral load was undetectable in Australia, but not in Thailand or Brazil. Optimism about TasP were found to be associated with condomless anal sex in all three settings.