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Citing ‘exploding’ HIV epidemic, WHO says all gay men should consider taking antitretroviral drugs

Antiretroviral medication. (Photo Illustration by Justin Sullivan/Getty Images)

At the height of the AIDS epidemic in the 1980s, images of gaunt victims flooded publications and television, igniting a global awareness campaign that would eventually help winnow the annual number of new infections by one-third in the past decade. But those victories have also lulled the general population into a sense of complacency, the World Health Organization warned late last week.

“We are seeing exploding epidemics,” said Gottfried Hirnschall, who leads WHO’s HIV department, according to Agence France-Presse.

Those at the most at risk of being infected — transgender people, men who have sex with men, prisoners, sex workers and people who inject drugs — account for nearly half of new HIV infections worldwide. And because of social or legislative discrimination, they’re also often the least likely to access HIV prevention and treatment centers.

“None of these people live in isolation,” Hirnschall said. “Sex workers and their clients have husbands, wives and partners. Some inject drugs. Many have children. Failure to provide services to the people who are at greatest risk of HIV jeopardizes further progress against the global epidemic and threatens the health and well-being of individuals, their families and the broader community.”

So now, for the first time, the WHO is strongly recommending that men who have sex with other men consider antiretroviral medications to help prevent HIV infection. The approach, called pre-exposure prophylaxis, calls for the noninfected to take a preventive pill every day.

With such treatment, the United Nations organization predicts HIV incidence among gay men would ultimately fall by as much as 25 percent — and avert close to 1 million infections over the next decade. “Rates of HIV infection among men who have sex with men remain high almost everywhere and new prevention options are urgently needed,” the WHO said on Friday.

The likelihood a gay man will become infected is approximately 19 times greater than the general population, the agency reported. But this is not the only at-risk demographic. Female sex workers, WHO estimates, are 14 times more likely to have HIV than other women. And the most high-risk groups are transgender women and intravenous drug users, who are 50 times more likely to be infected than the general population.

Among the biggest problems with plans to combat HIV: They’re not targeted enough. “There are significant gaps in addressing [high-risk group] needs in national HIV plans,” WHO said. It reported 30 percent of countries don’t have any policies to address the risk gay men face — and the same goes for transgender people, who often don’t even warrant a mention in some countries.

Many related problems are rooted in discrimination. Being gay is criminal in 77 countries. Many of those nations — 38 — are in Africa, where large swaths of some populations are already infected with HIV. For instance, homosexuality is against the law in Botswana, where a staggering 23 percent of residents aged 15 to 49 are suffering from HIV.

“Bold policies can deliver bold results,” said Rachel Baggaley of the WHO’s HIV Department. “Data show that where a combination of effective HIV prevention and treatment services for people who inject drugs are available, HIV transmission among people who inject drugs is minimal.”

Terrence McCoy covers poverty, inequality and social justice. He also writes about solutions to social problems.



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