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!
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.)
HIGH RATE OF INFECTION
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.
NOTHING TO DO WITH GENDER
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 firstname.lastname@example.org.