HIV epidemics in MSM : Does Gender matter ?

In  his  article  in the  Executive  summary  of  the  Lancet 2012  Professor  Beyrer  described  the  HIV  epidemics  among  MSM  as  unique because  of  the capacity  of  males  within  the  network  to  practise  role  reversal .

 Professor  Beyrer  stated  in that  document  that  the combination  of  anal  penetration  and role  reversal  in MSM  networks  accounted  for  98%  of  the  difference  in HIV  rates  between  MSM  and  heterosexuals.   

Women are  unable  to  penetrate  men after  being  themselves  penetrated  but  a  male  may  be  penetrated  and  subsequently  penetrate  another  male.


In  the  article  in the  Jamaica Gleaner  below  he  he  does  not  refer  to  his  comments on  role  reversal  in MSM  networks, addresses  only  receptive  anal  penetration  and claims  that  gender  does  not  matter .


Why  has  the  Professor  ignored  his  clear  statements made  in the  Lancet  in July 2012  on the uniqueness  of  HIV epidemics  in  MSM  and  not  commented  on   the  consequences   of   role  reversal  (due  to  the   differences  between  males  and  females)    in  making  these  epidemics  unique ?  

Why  did  the  Professor   give  only  one  aspect  of  the  transmission  of  the virus   and  not    the  whole  truth  including  the  difference  in  the   dynamics  of  HIV  epidemics  between  MSM  and  heterosexuals ?


Global epidemiology of HIV infection in men who have sex with men Chris Beyrer et al.

In 2012, HIV epidemics in MSM are expanding in countries of all incomes. Availableincidence data from Thai, Chinese and Kenyan samples of MSM suggest those epidemics are in rapid expansion phases.

 HIV infection rates among MSM are substantially higher than those of general population adult males in every epidemic assessed. A comprehensive review of the burden of HIV  disease in MSM worldwide found that pooled HIV prevalence ranged from a low of 3% in the Middle East and North Africa to a high of 25.4% of MSM in the Caribbean.

Biological and behavioral factors make the dynamics of the MSM epidemic different than for general population

The disproportionate HIV disease burden in MSM is explained largely by the high per- act and per-partner transmission probability of HIV transmission in receptive anal sex.

Modeling suggests that If the transmission probably of receptive anal sex was similar
to that associated with unprotected vaginal sex, five year cumulative HIV incidence in MSM would be reduced by 80-90%.

o Many MSM practice both insertive and receptive roles in sexual intercourse, which
helps HIV spread in this population. Were MSM limited to one role, HIV incidence in
this population over five years would be reduced 19-55% in high-prevalence

o Taking both factors (per act transmission probability and role versatility) into  account explains 98% of the difference between HIV epidemics among MSM  and heterosexual populations—behavioral differences account for 2% of the difference.

Yes, Do Tell Gay Men The Truth!

Published: Friday | July 26, 201317 Comments

Chris Beyrer, Guest Columnist
Chris Beyrer, Guest Columnist

By Chris Beyrer, Guest Columnist

As a public-health physician in residency training, I had the privilege of living and working in Kingston, Jamaica with the excellent Expanded Program on Immunisation on polio and measles eradication efforts, now more than 20 years ago. I have fond memories of the welcome and kindness of my Jamaican colleagues and also of the great traditions of public health and medicine in the country. So it has been with real concern and personal sadness that I’ve seen the recent work of myself and my colleagues on HIV among men who have sex with men (MSM) both misunderstood and misused by professionals in Jamaica. In the interest of scientific rigour and of the rights of all Jamaicans to benefit from the outcomes of scientific progress, I would like to clarify the findings of our work (published in The Lancet in 2012.)


Perhaps most importantly we did find that HIV infection rates are high among gay, bisexual, and other MSM worldwide. But we also found a clear and compelling relationship between HIV risks among these men and stigma, discrimination, and criminalisation. The bad news here is that the Caribbean region has the highest rates of HIV among MSM of any region worldwide, and also, I am sorry to say, some of the most discriminatory laws and practices for sexual and gender minorities. That is not a coincidence. We’ve documented these challenges in many countries, and the reasons why stigma, homophobia, and discrimination can drive HIV rates are quite clear. People who are afraid and feel threatened avoid health care, do not seek or get HIV testing or other services which can help reduce risks, and are less likely to be treated for HIV if they are living with the virus. Punitive and hostile policies do not reduce HIV risks – they increase them.


There has also been a misuse of the biological argument we have made in our work. To say that HIV is spread efficiently through unprotected (condomless) anal sex is, simply, true. It is also true that this has nothing to do with gender – the risks are similar for women and men when they are the receptive partners, which we also reported. And data from a number of countries makes clear that heterosexual couples do commonly engage in this practice, sometimes to reduce pregnancy risks and sometimes for pleasure. To argue that because this practice can lead to HIV infection it is inherently ‘unnatural’ or should be subject to criminal penalty is the same as arguing that vaginal sex is ‘unnatural’ since it can efficiently transmit syphilis, gonorrhea, chlamydia or the human papilloma virus, the cause of most cervical cancers in women. What matters, of course, is reducing risks for all sexually transmitted infections (STI) for men and women. And the science tells us how to do this. By making condoms and lubricants widely available and cheap, by treating STI in settings of dignity, safety, and quality of care, so that people at risk will seek and use the services they need. And by listening to patients, being non-judgemental, and helping them reduce their real risks – which they will not disclose if they are afraid.

We called for comprehensive services for MSM to reduce HIV risks, not discriminatory laws, policies, and practices which drive them underground and away from compassion and health care. That is true for sexual and gender minorities in Jamaica, as it is true anywhere else.

Chris Beyrer, MD, MPH, is a professor at Johns Hopkins Bloomberg School of Public Health. Email feedback to

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