The Global HIV Epidemic Among MSM and Key Populations: Time to Act
Saturday, November 23, 2013
2:45 pm - 4:15 pm
Chris Beyrer, MD, MPH
Chris Beyrer MD, MPH, is a professor of epidemiology, international health, and health, behavior, and society at the Johns Hopkins University Bloomberg School of Public Health. He serves as director of the University’s Center for Public Health and Human Rights and as associate director of the Centers for AIDS Research and of Global Health. He is the President- Elect of the International AIDS Society, a member of the scientific advisory panel of the U.S. President’s Emergency Plan for AIDS Relief, and Co-Chairs the U.S. National Institutes of Health Office of AIDS Research Planning Committee on Epidemiology and Natural History. Beyrer is the author of more than 170 scientific papers, and author or editor of six books, including War in the Blood: Sex, Politics and AIDS in Southeast Asia, and Public Health and Human Rights: Evidence-Based Approaches. He has served as a consultant and adviser to numerous national and international institutions, including the National Institutes of Health, the World Bank, and the Open Society Foundations. Dr. Beyrer received a BA in History from Hobart and Wm. Smith Colleges, his MD from SUNY Downstate in Brooklyn, NY, and completed his residency, public health training, an MPH and a ID Fellowship at Johns Hopkins University in Baltimore. He received an honorary Doctorate in Health Sciences from Chiang Mai University in Thailand, in 2012, in recognition of his 20 years of HIV research in Thailand.
Time to Act - Epidemics of HIV in men who have sex with men (MSM) continue to expand in most low, middle and upper income countries in 2013. HIV burdens are disproportionate among other key populations as well, including sex workers and Transgender persons (TG) High rates of new infection are consistently found among young MSM and TG women globally. A review of HIV prevalence and incidence, individual and network level risks for HIV, and of prevention and care options, suggests that the high probability of transmission per act through receptive anal intercourse, and sex role versatility among MSM, play central roles in explaining disproportionate disease burdens among MSM. HIV can be transmitted through large MSM networks at great speed. Molecular epidemiologic data show marked clustering of HIV in MSM networks, and higher rates of dual and multiple variant infection in these men than in heterosexual networks in the same populations. Prevention strategies which lower biological transmission and acquisition risks, including those based on use of antiretrovirals, offer promise for epidemic control, but are limited by structural factors including discrimination, criminalization, and barriers to health care access for MSM, TG and Sex Workers which much also be addressed. Sub-epidemics, including among minority MSM and TG in the US and UK, are particularly severe and will require targeted efforts. Community leadership, engagement, and empowerment are likely to be key to success. To address the expanding epidemics of HIV in key populations will require continued research, political will, structural reform, community engagement, and strategic planning and programming, but it can and must be done.