Literature Review

Introduction
In every country across the globe there is Men Who Have Sex With Men (MSM)1. In
many places outside of Western countries, many men who see themselves as heterosexual who
have sex with men. There are numerous reasons why men may have sex with men: physical
attraction to the same sex, curiosity, societal or cultural norms, environment (ex. being
incarcerated) or for financial gains1. Sex between men is significant because it may involve anal
sex----a sex practice that when used without protection carries a higher risk for HIV
transmission, verses having vaginal intercourse3. In the United States, MSM accounts for the
largest group affected by HIV. Black MSM are affected by HIV has and AIDS2. Gay, bisexual,
and other MSM accounts for 2% of the US population, but are the population most affected by
HIV. Young MSM ages 13-24 accounted for 72% of new HIV infections among all MSM3.
Approximately 500,022 MSM at the end of 2011 were living with an HIV diagnosis in the US1.
In some cities, the prevalence of HIV has been as high as 46% among MSM2.
There are many different groups of MSM that are affected by HIV/AIDS, African American
MSM especially those who are younger are disproportionately affected by HIV more than any
1 Avert. Men Who Have Sex With Men and HIV/AIDS. http://www.avert.org/men-whohave-sex-with-men-msm-hiv-aids.html. Accessed: May 30, 2015
2 Caster, Alexandra M, Wiegand, Ryan E, Sionean, Catlainn et. al. Understanding
disparities in HIV infection between black and white MSM in the United States. AIDS:
Epidemiology and Social. 2011;25(8): 1103-1112.
Doi:10.1097/QAD.06013E328347efa.
3 Centers for Disease Control and Prevention. HIV among gay and bisexual men.
http://www.cdc.gov/hiv/risk/gender/msm/facts/index/html Last update: March 18,
2015. Accessed: May 29, 2015.

other racial group3. According to the CDC, there was a recent research conducted that found
African American MSM had a 19% increase in self-reported sex without condoms3. The
epidemic of HIV among MSM, particularly African American men is becoming more,
problematic. In 2010 approximately 10,600 new cases of HIV was reported among African
American MSM1. In the same year, approximately 11,200 new cases of HIV were reported
among white MSM, and approximately 6,700 reported case of Hispanic/Latino MSM infected
with the HIV virus1. African American men accounted for the largest percent of MSM affected
by AIDS 40%, followed by White MSM 32%, and Hispanic/ Latino MSM at 23%3.
The purpose of the Stop the Stigma program is to address factors that contribute to the
HIV/AIDS epidemic among MSM but particularly African American MSM. Raising awareness
of HIV statistics that plague MSM is essential in the fight on the war against HIV/AIDS.
Preventative efforts can reduce if not eliminate the HIV/AIDS epidemic. Some of the Stop the
Stigma goals are to put an end to the stigma and discrimination that MSM face and to address
some of the issues that are plaguing MSM such as: socioeconomic factors that affect minority
MSM, lack of knowledge of HIV status, having intercourse with older men, inconsistent condom
usage, and the discrimination, stigma, and homophobia that MSM often face1. Stop the Stigma
plan to implement initiatives to address the HIV/AIDS epidemic through advocacy, offering free
literature, hosting HIV/AIDS seminars were HIV testing will be offered.
The following articles that were utilized in the following body of evidence conducted
various types of studies through various methods that focus on the effects of the stigma,
discrimination, lack of medication adherence has had on MSM. The issues that the articles focus
on make it evident how there is a great need of advocacy and education for the MSM population,

particularly the African American MSM population. If the issues that are plaguing the MSM
population arent reduced the war on HIV/AIDS will never cease.
That Body of Evidence:
A study was conducted by Oster et al. to evaluate different hypotheses for disparities in
HIV transmission between black and white MSM in the United States. Some of the hypotheses
were evaluated were: being incarcerated, partner HIV status, circumcision, sexual networks, and
duration of infectiousness. The hypotheses were tested by interviewing MSM and testing them
for HIV infection2. MSM that were infected with HIV were questioned about the duration of
their infection2. The results proved that the biggest risk factor to Black MSM was not knowing
their partner HIV status2. It was also determined that black MSM were unlikely to be on
antiretroviral therapy (ART)2. This study proved that the lack of knowledge of partner HIV status
and lower antiretroviral therapy use among Black MSM may somewhat explain the differences
in HIV infection between black and white MSM. Initiatives that encourage discussions about
HIV status between MSM and their partners can reduce barriers to ART provisions among Black
MSM, which may lead to a reduction in HIV transmissions2.
In a study conducted by Beyrer et. al. it was found that MSM are often excluded,
sometimes systematically from HIV services because stigma, discrimination, and
criminalization4. In order to stop the HIV/AIDS epidemic these issues must be addressed. In the
public health and human rights spectrum, expanding HIV prevention efforts, treatments and care
to MSM should be of great importance4. Condom and lubricant access should be made readily
4 Beyrer C, Sullivan P, Sanchen G, Dowdy D, Altmen D, Trapence G, et al. A call to
action for comprehensive HIV services for men who have sex with men.
2012;380(12):424-438. Doi: http://dx.doi.org/10.1016/50140-6736(12)61022-8.

accessible and it is also cost effective4. To combat the HIV epidemic in MSM more research is
needed, community engagement, and structural reform must be conducted4.
In an article wrote by Rodrigquez et al. it was stated that the Centers for Disease Control and
Prevention stated that stigma and homophobia may have a profound impact on the lives of MSM
and could persuade them to engage in HIV risky behaviors5. In order to understand the
complexity of related HIV risk behaviors among young MSM, transforming traditional
individual behavior oriented views in order to create a more comprehensive approach5. Stigma
was also a major factor acknowledged in the study conducted by Beyrer et al.
Scientific data provides proof that current trends in HIV/AIDS vulnerability among MSM is due
to unprotected anal intercourse, lack of knowledge about HIV risk, and negative attitudes
towards safer sex practices5. It was found that there has been little research on the experiences of
MSM who are living with HIV in sub-Saharan Africa6. In a study conducted by Kennedy et al. it
was found that MSM stated they suffered from multiple forms of stigma and discrimination due
to their sexuality and HIV status6. The stigma and discrimination that MSM has had to face has
caused them to not disclose their identities, have a lack of social support for medication
adherence, late care seeking, and travel to clinics that are further away, and missed opportunities
for appropriate services6. Study participants also reported being victimized and had a lack of

5 Rodriguez M, Mader S, and Diaz N. Stigma and Homophobia: persistent challenges

for HIV prevention among young MSM in Puerto Rico. Revista de ciencias sociales.
Published: 2013. Accessed: May 30, 2015.
6 Kennedy CE, Baral SD, Fielding-Miller R, et al. They are human beings, they are
swazi: intersecting stigmas and positive health, dignity and prevention needs of
HIV-positive men who have sex with men in Swaziland. Journal of the International
AIDS Society. 2013;16(4suppl3):18749. Doi:10.7448/IAS.16.4.18749.

police protection and mental health challenges. This study proves that interventions to decrease
stigma is imperative along with reducing discrimination and acts of violence against MSM6.
Awareness of HIV status is imperative to reduce risk of transmission and increase antiretroviral
therapy7. MSM who are unaware of their HIV status are more likely to participate in sexual
activity that places their partner at risk of contracting HIV7. A questionnaire and HIV/STI test
was given in a study conducted that compared three groups of MSM: MSM who prostituted for
cash in the last three months, MSM who did not prostitute for cash, and MSM who have
experienced traumatic life events such as: being raped, incarcerated, homeless, or had a low
literacy rate8. The study found that the HIV transmission was highest among MSM prostitutes,
followed by MSM who had experienced traumatic life events. The study signifies the importance
of social vulnerability in fueling the HIV epidemic8. The study also points to a need to empower
young MSM, to decrease social vulnerability and other barriers such as stigma and
discrimination in this vulnerable population in order to reduce HIV transmission8.
Factors that contribute to the disproportionate rate of HIV among African American MSM are
not fully understood. Mayer et al. conducted a study by enrolling Black MSM in six major cities
to evaluate the many different prevention intervention methods9. The reason for the intervention
analysis was to evaluate different factors plaguing MSM by comparing their prevalence among
participants who were recently diagnosed with HIV at enrollment, in order to gain knowledge of
7 Wejnert C, LeB, Rose C, et al. HIV infection and awareness among men who have
sex with men20 cities United States 2008 and 2011. PLOS ONE. 2013. Doi:
10.1371/journal.pone0076878.
8 Figueroa J, Cooper C, Edwards J, et al. Understanding the high prevalence of HIV
and other sexually transmitted infections among socio-economically vulnerable
men who have sex with men in Jamaica. PLOS ONE. 2015. Doi:
10.1371/journal.pone.0117686.

the potentiates of the disproportionate spread of HIV among Black MSM9. The study found that
Black MSM that were recently diagnosed with HIV were more likely to be unemployed, have
STIs, and engage in anal intercourse than other Black MSM9. This study further suggests the
need for increased care, STI screenings, in conjunction with safer sex prevention interventions to
reduce further transmission among MSM9.
It has been found that the stress from multiple types of discrimination has a major effect in the
health outcomes in MSM. In a study conducted by Bogart et al., 348 HIV positive Black and
Latino men were given computer based interviews10. It was revealed through the study that
African American participants who were victims of discrimination were less likely to have a high
CDC4 count, detectable viral loads, and more likely to visit the emergency departments10. These
men were more likely to have increased AIDS symptoms.
Conclusion:
All of the studies that were examined in the literature review suggest that there is a great need for
more initiatives aimed at reducing the stigma, discrimination, and increase knowledge of status
of self and partner along with medication adherence in MSM particularly African American
MSM. There is a great need for the Stop the Stigma program to address issues plaguing
particularly African American MSM but all MSM. Stop the Stigma plans to reach MSM

9 Mayer K, Wang L, Koblin B, et al. Concomitant socioeconomic, behavioral, and

biological factors associated with the disproportionate HIV infection burden among
black men who have sex with men in 6 US cities. PLOS ONE. 2014. Doi:
10.1371/journal.pone.0087298.
10 Bogart L, Landrine H, Galvan R, Wagner G, and Klein D. Percieved discrimination
and physical health among HIV positive black and latino men who have sex with
men. AIDS Behavior. Jan. 8, 2013. Doi: 10.1007/s10461-012-0397-5.

through advocacy, education, and community building. The war on HIV/AIDS will be lost if
greater initiatives are not taken to increase knowledge, and awareness of this dreadful disease.

References:
1. Avert. Men Who Have Sex With Men and HIV/AIDS. http://www.avert.org/men-whohave-sex-with-men-msm-hiv-aids.html. Accessed: May 30, 2015
2.

Caster, Alexandra M, Wiegand, Ryan E, Sionean, Catlainn et. al. Understanding

disparities in HIV infection between black and white MSM in the United States. AIDS:
Epidemiology and Social. 2011;25(8): 1103-1112. Doi:10.1097/QAD.06013E328347efa.

3. Centers for Disease Control and Prevention. HIV among gay and bisexual men.
http://www.cdc.gov/hiv/risk/gender/msm/facts/index/html Last update: March 18, 2015.
Accessed: May 29, 2015.
4.

Beyrer C, Sullivan P, Sanchen G, Dowdy D, Altmen D, Trapence G, et al. A call to action

for comprehensive HIV services for men who have sex with men. 2012;380(12):424-438.
Doi: http://dx.doi.org/10.1016/50140-6736(12)61022-8.

5.

Rodriguez M, Mader S, and Diaz N. Stigma and Homophobia: persistent challenges for
HIV prevention among young MSM in Puerto Rico. Revista de ciencias sociales.
Published: 2013. Accessed: May 30, 2015.

6. Kennedy CE, Baral SD, Fielding-Miller R, et al. They are human beings, they are
swazi: intersecting stigmas and positive health, dignity and prevention needs of HIVpositive men who have sex with men in Swaziland. Journal of the International AIDS
Society. 2013;16(4suppl3):18749. Doi:10.7448/IAS.16.4.18749.
7. Wejnert C, LeB, Rose C, et al. HIV infection and awareness among men who have sex
with men20 cities United States 2008 and 2011. PLOS ONE. 2013. Doi:
10.1371/journal.pone0076878.
8. Figueroa J, Cooper C, Edwards J, et al. Understanding the high prevalence of HIV and
other sexually transmitted infections among socio-economically vulnerable men who
have sex with men in Jamaica. PLOS ONE. 2015. Doi: 10.1371/journal.pone.0117686.
9.

Mayer K, Wang L, Koblin B, et al. Concomitant socioeconomic, behavioral, and

biological factors associated with the disproportionate HIV infection burden among black
men who have sex with men in 6 US cities. PLOS ONE. 2014. Doi:
10.1371/journal.pone.0087298.

10. Bogart L, Landrine H, Galvan R, Wagner G, and Klein D. Perceived discrimination and

physical health among HIV positive black and latino men who have sex with men. AIDS
Behavior. Jan. 8, 2013. Doi: 10.1007/s10461-012-0397-5.