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Challenges and emerging opportunities for the HIV prevention, treatment and care cascade in men who have sex with men in Asia Pacific.

Abstract In Asia Pacific, most countries have expanded HIV treatment guidelines to include all those with HIV infection and adopted antiretroviral treatment for prevention (TFP) as a blanket strategy for HIV control. Although the overall epidemic development associated with this focus is positive, the HIV epidemic in men who have sex with men (MSM) is continuing unperturbed without any signs of decline or reversal. This raises doubt about whether TFP as a blanket HIV prevention policy is the right approach. This paper reviews currently available biomedical HIV prevention strategies, national HIV prevention policies and guidelines from selected countries and published data on the HIV cascade in MSM. No evidence for efficacy of TFP in protecting MSM from HIV infection was found. The rationale for this approach is based on assumptions about biological plausibility and external validity of latency-based efficacy found in heterosexual couples. This is different from the route and timing of HIV transmission in MSM. New HIV infections in MSM principally occur in chains of acutely HIV-infected highly sexually active young men, in whom acquisition and transmission are correlated in space and time. By the time TFP renders its effects, most new HIV infections in MSM will have already occurred. On a global level, less than 6% of all reports regarding the HIV care cascade from 1990 to 2016 included MSM, and only 2.3% concerned MSM in low/middle-income countries. Only one report originated from Asia Pacific. Generally, HIV cascade data in MSM show a sobering picture of TFP in engaging and retaining MSM along the continuum. Widening the cascade with a preventive extension, including pre-exposure prophylaxis, the first proven efficacious and only biomedical HIV prevention strategy in MSM, will be instrumental in achieving HIV epidemic control in this group.
PMID
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Authors

Mayor MeshTerms

Homosexuality, Male

Keywords

HIV

acquired Immunodeficiency syndrome

antiretroviral therapy

pre-exposure prophylaxis

prevention and control

sexual behavior

Journal Title sexually transmitted infections
Publication Year Start




PMID- 28729520
OWN - NLM
STAT- MEDLINE
DA  - 20170721
DCOM- 20170807
LR  - 20170807
IS  - 1472-3263 (Electronic)
IS  - 1368-4973 (Linking)
VI  - 93
IP  - 5
DP  - 2017 Aug
TI  - Challenges and emerging opportunities for the HIV prevention, treatment and care 
      cascade in men who have sex with men in Asia Pacific.
PG  - 356-362
LID - 10.1136/sextrans-2016-052669 [doi]
AB  - In Asia Pacific, most countries have expanded HIV treatment guidelines to include
      all those with HIV infection and adopted antiretroviral treatment for prevention 
      (TFP) as a blanket strategy for HIV control. Although the overall epidemic
      development associated with this focus is positive, the HIV epidemic in men who
      have sex with men (MSM) is continuing unperturbed without any signs of decline or
      reversal. This raises doubt about whether TFP as a blanket HIV prevention policy 
      is the right approach. This paper reviews currently available biomedical HIV
      prevention strategies, national HIV prevention policies and guidelines from
      selected countries and published data on the HIV cascade in MSM. No evidence for 
      efficacy of TFP in protecting MSM from HIV infection was found. The rationale for
      this approach is based on assumptions about biological plausibility and external 
      validity of latency-based efficacy found in heterosexual couples. This is
      different from the route and timing of HIV transmission in MSM. New HIV
      infections in MSM principally occur in chains of acutely HIV-infected highly
      sexually active young men, in whom acquisition and transmission are correlated in
      space and time. By the time TFP renders its effects, most new HIV infections in
      MSM will have already occurred. On a global level, less than 6% of all reports
      regarding the HIV care cascade from 1990 to 2016 included MSM, and only 2.3%
      concerned MSM in low/middle-income countries. Only one report originated from
      Asia Pacific. Generally, HIV cascade data in MSM show a sobering picture of TFP
      in engaging and retaining MSM along the continuum. Widening the cascade with a
      preventive extension, including pre-exposure prophylaxis, the first proven
      efficacious and only biomedical HIV prevention strategy in MSM, will be
      instrumental in achieving HIV epidemic control in this group.
CI  - (c) Article author(s) (or their employer(s) unless otherwise stated in the text
      of the article) 2017. All rights reserved. No commercial use is permitted unless 
      otherwise expressly granted.
FAU - van Griensven, Frits
AU  - van Griensven F
AD  - Department of Epidemiology and Biostatistics, University of California San
      Francisco, San Francisco, California, USA.
FAU - Guadamuz, Thomas E
AU  - Guadamuz TE
AD  - Department of Society and Health, Mahidol University, Nakorn Pathom, Thailand.
FAU - de Lind van Wijngaarden, Jan Willem
AU  - de Lind van Wijngaarden JW
AD  - Department of Public Health Sciences, Burapha University, Bang Saen, Thailand.
FAU - Phanuphak, Nittaya
AU  - Phanuphak N
AD  - Prevention Department, Thai Red Cross AIDS Research Center, Bangkok, Thailand.
FAU - Solomon, Sunil Suhas
AU  - Solomon SS
AD  - Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland, USA.
FAU - Lo, Ying-Ru
AU  - Lo YR
AD  - HIV, Hepatitis and STI Unit, Regional Office for the Western Pacific, World
      Health Organization, Manila, Philippines.
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20170720
PL  - England
TA  - Sex Transm Infect
JT  - Sexually transmitted infections
JID - 9805554
SB  - IM
MH  - Acquired Immunodeficiency Syndrome/*drug therapy/epidemiology/*prevention &
      control/*therapy
MH  - Asia/epidemiology
MH  - HIV Infections/*drug therapy/epidemiology/*prevention & control
MH  - Health Knowledge, Attitudes, Practice
MH  - *Homosexuality, Male
MH  - Humans
MH  - Male
MH  - Poverty
MH  - Pre-Exposure Prophylaxis
MH  - Risk Factors
MH  - Risk-Taking
MH  - Young Adult
OTO - NOTNLM
OT  - HIV
OT  - acquired Immunodeficiency syndrome
OT  - antiretroviral therapy
OT  - pre-exposure prophylaxis
OT  - prevention and control
OT  - sexual behavior
COI - Competing interests: None declared.
EDAT- 2017/07/22 06:00
MHDA- 2017/08/08 06:00
CRDT- 2017/07/22 06:00
PHST- 2016/12/27 [received]
PHST- 2017/04/19 [revised]
PHST- 2017/06/03 [accepted]
AID - sextrans-2016-052669 [pii]
AID - 10.1136/sextrans-2016-052669 [doi]
PST - ppublish
SO  - Sex Transm Infect. 2017 Aug;93(5):356-362. doi: 10.1136/sextrans-2016-052669.
      Epub 2017 Jul 20.