A/Prof Mark Bloch

Mark has been working in the field of HIV medicine since 1983; he was a doctor at Sydney Hospital and Albion St AIDS clinic prior to being a director at Holdsworth House. He has completed his Masters in Medicine, HIV and Sexual Health from University of Sydney, and he is a past President of the Sexual Health Society of NSW. He is the director of clinical trials at Holdsworth House and actively involved in clinical research in HIV and STIs, co-joint lecturer at University of NSW, and a member of medical advisory boards.

MSM and HIV - Global Issue

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CROI Tues am (session 21 - Abs #71) plenary speaker Prof Chris Beyrer from Johns Hopkins gave a clear, evidence-based, passionate and excellent summary of HIV in MSM (Men who have Sex with Men) (see also Lancet special issue 2012)

This presentation is well recommended to view from CROI website.

Key points:

1. Globally in first, middle income and third world countries, Global burden of HIV is stabilising or declining in most populations - MSM in all these regions is the exception.

2. MSM are disproportionately affected - eg USA 2010 - MSM 1-1.5% of population - 60% of diagnoses

3. WHY? - even in this era of ART?
Higher prevalence drives risk of acquisition, untreated STIs, unprotected receptive anal intercourse 18x greater risk than vaginal sex
Also clustering of population, "bursts" of transmission in primary infection
Structural issues - stigma & discrimination affects access to treatment and care, leads to depression and substance use
(Ironically MSM contributed so greatly to development of HIV treatments and are in many cases denied treatment and care in too many countries)

4. Achieving the end of HIV for everyone has to include MSM in all countries

5. Take home messages - applicable for our care in Australia - we need to combine all these:
 - Treat all MSM with HIV (treatment as prevention)
 - Test for HIV and test frequently
 - Condom protection for anal sex
 - PrEP for some, PEP
 - Test, diagnose and treat STIs
 - Access to care that's culturally sensitive
 - Address homophobic stigma, discrimination (legal and social) - the responsibility of all of us as health care workers, at work and at home


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