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The Ongoing Risk of HIV/AIDS Among Men Who Have Sex With Men

The Ongoing Risk of HIV/AIDS Among Men Who Have Sex With Men

Acquired Immune Deficiency Syndrome (HIV/AIDS) has progressed to become a serious global health challenge since 1981, when it first emerged. It had been estimated that by 2011, there would be 34.2 million people, both adults, and children globally, having HIV/AIDS, hence resulting in 1.7 million deaths. AIDS was first diagnosed in male heterosexuals. Men who have sex with men (MSM) often have multiple sex partners, as well as a higher proportion of unprotected sex than non-MSM males, which indicates that they are at a higher risk for HIV transmission. Such research is aimed to describe how homosexual orientation puts individuals at risk for various infections when there is a lack of knowledge.

At Risk-Population

Men having sex with other men are at risk for HIV infection. In 2010, an estimation was given to show that 1.1 million individuals in the US aged 13 years and older had HIV infection. Most of the people living with HIV at the time, 76%, were male and had sex with men (MSM), accounting for most of the new as well as existing infections among men. Regarding ethnicity or race, black men have recorded the highest rates of new infections than men from other groups. Among MSM, white men were the majority, followed by black men and Latino/Hispanic men. Similarly, between 2009 and 2013, male-to-male sexual transmission accounted for between 58 and 65% of the human immunodeficiency virus (HIV) diagnoses in the United States. Men having sex with other men are at risk population for HIV infection.

In the theory of social networks, it is reported that social network strongly influences the behavior of their members. Usually, social influence is characterized by internal and external dynamics. People with common interests, attributes, and similar activities tend to associate. Therefore, the commonalities form the basis for creating networks and how such networks influence members’ views, norms, and even behaviors. In the field of HIV, members belonging to the same network form similar views and attitudes regarding risks and have shared levels of risky sexual practices. Among MSM, norms on safer sex are shared within safely guarded networks, and odds for higher risks are influenced by the type of network or neighborhood. The norms determine the sexual activity beliefs among members.

Nowadays, there are varying knowledge and beliefs among MSM regarding HIV infection. Pando et al. conducted a study to assess the knowledge and beliefs of 500 men who have sex with men in Buenos Aires regarding HIV infection. The data used in this study were analyzed using SPSS. The study showed that men still have many misconceptions regarding HIV, as about 60% of the questions included in the study were not answered correctly, while only less than 3% of the study participants could give correct answers to the questions that were asked. The implication is that men know about HIV, but misconceptions, such as condom use, continue to manifest. The misconception may result in the use of ineffective strategies for risk reduction. Other misconceptions the study revealed included the belief that washing genitals, use of antibiotics, withdrawing before ejaculation, and having oral or anal sex reduce the risk of HIV transmission.

Furthermore, 20% of the study participants believed there is a vaccine for HIV, while 40% reported that symptoms show immediately after infection. Also, 60% of the participants believed that HIV could be transmitted through coughing, and 24% claimed it could be transmitted by sharing a swimming pool. The study concluded that men who have sex with men continue to have misconceptions regarding the transmission and prevention of HIV, which increases their risk for infection.

MSM often have the perception that they are not at risk of getting HIV even when they involve in sex with other men. Nel, Yi, Sandfort, and Rich conducted another study to assess the factors contributing to MSM’s perception that they are not at risk for HIV. In this study, data were analyzed using SPSS version 15.0. The study participants were 280 untested MSM between the ages of 16 and 74, with a mean age of 26.7 years. Data revealed that the majority of the men, 87%, were attracted to men only, reported being sexually active, and knew people with minority sexual orientations who live with HIV/AIDS. In the bivariate analysis, 77% of white MSM, along with 69% of men belonging to the high socioeconomic status, were found to be more likely to perceive themselves as not being at risk for HIV than other racial groups and men with low socioeconomic status.

Regarding fear of being tested for HIV, the study showed that MSM who prefer feminine gender expression were more unlikely to go for testing than those expressing masculine gender, at 68% and 44%, respectively. Besides, being sexually active was found to be correlated with fear of going for the test. The investigators concluded that fear of going for an HIV test would likely continue among untested MSM considered more vulnerable to HIV and sexually transmitted infections.

It is worth noting that various parameters raise the risk of HIV among MSM. Zhang et al. assessed the prevalence of HIV infection and the factors that put people at risk of HIV infection among MSM within Harbin, China. The variables in the study included AIDS knowledge, demographics, homosexual behavior, and intervention status in MSM. Multivariate analyses, as well as logic regression, were conducted using SPSS version 13.0. From the analysis, 57.6% of MSM were reported to never use or seldom use condoms during sexual activity, with 86.6% claiming to have had anal sex, while 74.1% reported oral sex with male sexual partners.

Similarly, 5.8% of the participants reported having purchased sex from male partners or sold it to them in the past six months. In the univariate analysis, the risk for HIV was found to be higher among individuals at 35 years old or higher. Importantly, participants with more than 10 sexual partners were found to be 5.6 times more likely to contract HIV. The study concluded that HIV infection among men having sex with men has been on a rapid increase in the study locality. The high knowledge about AIDs awareness, intensive coverage by a chosen intervention, and low use of protection during sexual activity often occurs simultaneously among MSN in Harbin. In this way, the MSM population is at risk for infection with HIV/AIDS.

Potential Obstacles that may Hinder the Implementation of the Prevention and Health Promotion Activities

There are scarce resources, criminalization of MSM individuals, prejudice, and lack of recognition for MSM communities. Prejudice, threats, as well as violence, meted out against MSM people subvert HIV prevention, care, as well as treatment. When MSM individuals are criminalized, they do not come out openly, especially if they fear for their safety. The men cannot disclose having male sex partners. Men might not want to seek services from healthcare providers if they fear or have experienced violence owing to their sexual orientation. Therefore, it might not be easy to know the challenges that they go through. Introducing health promotion interventions that might be appropriate for them also becomes difficult.

Similarly, governmental agencies and ethics institutions’ legal prohibition prohibits research on the most effective ways of delivering appropriate and effective preventive services. Prohibitive laws mean that any attempts to intervene in the challenges of MSM are not likely to succeed. Besides, guidelines describing ethical and not ethical sex mean that MSM would always conceal their identities to avoid potential embarrassment for going against cultural and societal norms.

Costs for pre-exposure prophylaxis (PrEP) medications for MSM can be prohibitive. Without a doubt, the costs to individuals and healthcare systems are critical in implementing PrEP. Long funding lists and large segments of individuals without insurance hinder the implementation.

Stakeholders, Individuals, and Agencies to Collaborate with

Drug manufacturers are important stakeholders. I would collaborate by informing them of the need to manufacture cost-effective drugs. The other stakeholders are the insurance companies that should consider providing coverage for health conditions arising from MSM activities. Lastly, the counselors could provide counseling services to the MSM and educate them on the dangers they are exposed to.


The MSM population remains at risk of being infected with HIV. Despite the knowledge and information available to the population already, the existing social networks can influence the beliefs and norms of the members. Existing data from various sources indicate that while the population continues to face the challenge of HIV infection, nurses can play an important role in providing nursing care through counseling and education to help minimize the risks.

📎 References

1. Amirkhanian, Y. (2014). Social networks, sexual networks and HIV risk in men who have sex with men. Curr HIV/AIDS Rep., 11(1), 81–92. https://doi.org/10.1007/s11904-013-0194-4
2. Centers for Disease Control and Prevention (CDC). (2017). HIV among men in the United States. Retrieved from https://www.cdc.gov/hiv/group/gender/men/index.html
3. Grey, J.A., Bernstein, K.T., Sullivan, P.S., Purcell, D.W., Chesson, H.W., Gift, T.L., & Rosenberg, E.S. (2016). Estimating the population sizes of men who have sex with men in US states and counties using data from the American community survey. JMIR Public Health and Surveillance, 2(1), e14. https://doi.org/10.2196/publichealth.5365
4. Mansergh, G., Koblin, B.A., & Sullivan, P.S. (2012). Challenges for HIV Pre-exposure prophylaxis among men who have sex with men in the United States. PLoS Med, 9(8): e1001286. https://doi.org/10.1371/journal.pmed.1001286
5. Nel, J.A., Yi, H., Sandfort, T.G.M., & Rich, E. (2013). HIV-untested men who have sex with men in South Africa: Perception of not being at risk and fear of being tested. AIDS Behav., 17(0 1), 51–59. https://doi.org/10.1007/s10461-012-0329-4
6. Pando, M.A., Balan, I., Marone, R., Dolezal, C., Barreda, V., Dieguez, A.C., & Avilla, M.M. (2013). HIV knowledge and beliefs among men who have sex with men (MSM) in Buenos Aires, Argentina. AIDS Behav, 17(4), 1305-1312. http://doi.org/10.1007/s10461-012-0404-x
7. Sullivan, P. S., Carballo-Dieguez, A., Coates, T., Goodreau, S.M., McGowan, I., Sanders, E.J., Smith, A., Goswami, P., & Sanchez, J. (2012). Successes and challenges of HIV prevention in men who have sex with men. Lancet, 380(9839), 388–399. https://doi.org/10.1016/S0140-6736(12)60955-6
8. Tucker, J.S. et al. (2012). Social network and individual correlates of sexual risk behavior among homeless young men who have sex with men. J Adolesc Health., 51, 386–392.
9. Zhang, L., Zhang, D., Yu, B., Wang, S., Liu, Y., Wang, J., Li, X., Shang, X., & Li,H. (2013). Prevalence of HIV infection and associated risk factors among men who have sex with men (MSM) in Harbin, P. R. China. PLoS ONE, 8(3), e58440. https://doi.org/10.1371/journal.pone.0058440