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Feature HIV and AIDS

The invisible epidemic

BMJ 2008; 337 doi: (Published 26 November 2008) Cite this as: BMJ 2008;337:a2566

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  1. Bob Roehr, freelance medical journalist
  1. 1Washington, DC
  1. BobRoehr{at}

    Lack of recognition of homosexuality in many countries is hampering efforts to reduce HIV transmission among men who have sex with men. Bob Roehr reports

    Men who have sex with men are at the core of the HIV epidemic in every country in the world. But social and governmental denial, stigma, and violence against those who transgress sexual norms have helped to hide this fact and impede efforts to prevent new HIV infections.

    At one extreme are Iraq and Iran, where religious fundamentalists have hunted down and killed hundreds of people whom they believe to be gay. Further along the spectrum are scores of nations where draconian sodomy laws are aggressively enforced, with penalties that include years in prison. Political and religious leaders in Botswana even tried to quash research into the subject, claiming that same sex activity did not exist in that country.

    Men who have sex with men (MSM)

    Epidemiologists created the term men who have sex with men because a substantial portion of men who engage in that activity do not identify themselves as gay and often do not respond to HIV prevention interventions designed to reach members of the gay community. The term applies to populations within developed nations and especially in developing countries, where there often is little or no open gay community.

    “General population heterosexual transmission is the major source in only two regions, Africa and the Caribbean,” says David Wilson, lead health specialist of the global HIV/AIDS programme at the World Bank. But even in these regions, men who have sex with men are about four times more likely than heterosexuals to be infected with the virus, according to the scant data that are available.

    A literature review published last year found that globally, men who have sex with men are 19 times more likely to be infected with HIV …

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