Is Canada Reaching The Global 90
The Joint United Nations Programme on HIV/AIDS and the World Health Organization have established a global health sector strategy on HIV to help eliminate AIDS as a public health threat by 2030. Canada has endorsed this strategy. The strategy can be encapsulated in the phrase 90-90-90 and consists of the following targets for the year 2020:
- 90% of people with HIV know their infection status
- 90% of people diagnosed with HIV receive HIV treatment
- 90% of people taking treatment have an undetectable viral load
Canada is approaching the 90% goal for awareness of HIV status and the 90% goal for treatment and has surpassed the 90% goal for achieving viral suppression. Of the estimated 62,050 people with HIV in Canada in 2018, an estimated:
- 87% were diagnosed and aware they had HIV
- 85% of those who were diagnosed were on treatment
- 94% of those on treatment had achieved viral suppression
This means that 70% of all Canadians with HIV had achieved viral suppression in 2018. If all 90-90-90 measures had been reached, 73% of all Canadians with HIV would have achieved viral suppression.
What Cdc Is Doing
a The term male-to-male sexual contact is used in CDC surveillance systems. It indicates a behavior that transmits HIV infection, not how individuals self-identify in terms of their sexuality. This web content uses the term gay and bisexual men to represent gay, bisexual, and other men who reported male-to-male sexual contact.b Unless otherwise noted, data in this web content are for adults and adolescents aged 13 and older.
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How Did We Achieve This
Because the decline in annual incidence started in 2013 when few men were taking PrEP, the remarkable decline in infections appears largely to be due to treatment as prevention, or what is often called ‘U=U’ when applied to individuals. Two factors made all the difference.
The first was a big increase in the number and frequency of HIV tests. The number of HIV tests in gay men at STI clinics nearly tripled from 60,000 in 2010 to 160,000 in 2018, and the average number of times gay men tested in a year increased from 1.4 to 1.8, thanks partly to a recommendation in 2012 that gay men at risk of HIV should test every three months rather than every six months.
The lesson for other high-income countries is that amplified testing and treatment as prevention have controlled the HIV epidemic in England.”
Probably even more crucial was the widespread adoption of immediate ART on diagnosis. In the first decade of this century treatment was not recommended until the CD4 count fell below 200 and as a result the proportion of people who had started treatment within six month of diagnosis stayed at around 30-35%. The CD4 threshold was changed to below 350 cells in 2008 and treatment for all was recommended in 2015. In 2018, 91% of diagnosed gay men started treatment within six months, with an average post-diagnosis wait of only 2-3 weeks.
With additional large-scale implementation of PrEP, elimination of HIV transmission is likely to be within reach by 2030.
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Stigma Discrimination And Violence
Gender norms in many cultures sanction the ill-treatment of men who have sex with men. As a result, a large proportion of men who have sex with men worldwide have reported experiencing violence due to their sexual orientation. This is especially evident in particularly machismo cultures and patriarchal societies.99
In some areas, public officials, police and healthcare workers are committing these offences. The fear of being identified as homosexual deters many men from accessing HIV services, avoiding healthcare check-ups and treatment in order to keep their orientation secret.100101
Evidence is also emerging that, in some settings, a high proportion of men who have sex with men are also experiencing intimate partner violence . A UK study among men who have sex with men involved in a trial for PrEP found around 45% had been a victim of IPV and around 20% had been a perpetrator.102
What Factors Put Gay And Bisexual Men At Risk For Hiv Infection
The high percentage of gay and bisexual men who are living with HIV means that, as a group, they have a greater risk of being exposed to HIV.
Other factors may also put gay and bisexual men at risk for HIV infection:
- Anal sex. Most gay and bisexual men get HIV from having anal sex without using condoms or without taking medicines to prevent or treat HIV. Anal sex is the riskiest type of sex for getting HIV or passing it on to others .
- Homophobia, stigma, and discrimination. Negative attitudes about homosexuality may discourage gay and bisexual men from getting tested for HIV and finding health care to prevent and treat HIV.
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Hiv/aids In The United States
|Rates of HIV Diagnoses in the US, 2017|
|New HIV Infections by Race and Transmission Group|
|HIV Diagnosis Trends in the U.S. and Dependent Areas, 20122016|
|The estimated number of U.S. HIV/AIDS Cases, in 2007 by transmission category|
The AIDS epidemic, caused by HIV , found its way to the United States as early as 1960, but was first noticed after doctors discovered clusters of Kaposi’s sarcoma and pneumocystis pneumonia in homosexual men in Los Angeles, New York City, and San Francisco in 1981. Treatment of HIV/AIDS is primarily via a “drug cocktail” of antiretroviral drugs, and education programs to help people avoid infection.
Initially, infected foreign nationals were turned back at the U.S. border to help prevent additional infections. The number of U.S. deaths from AIDS has declined sharply since the early years of the disease’s presentation domestically. In the United States in 2016, 1.1 million people aged over 13 lived with an HIV infection, of whom 14% were unaware of their infection.Gay and bisexual men, African Americans, and Latinos remain disproportionately affected by HIV/AIDS in the U.S.
In 5 Gay/bi Men Have Hiv Nearly Half Don’t Know
CDC Study Shows Gay/Bisexual African-Americans, Young Adults Least Aware of HIV Status
Black gay/bi men and under-30 gay/bi adults are least likely to know of their HIV infections.
The findings show that HIV infection rates remain strikingly high among gay and bisexual men, says Kevin Fenton, MD, PhD, director of the CDC’s center for HIV/AIDS, viral hepatitis, STD, and TB prevention.
“The number of new HIV infections each year is increasing among men who have sex with men , while remaining stable or decreasing in other groups,” Fenton said in a statement. “Currently, MSM account for nearly half of the more than 1 million people living with HIV in the United States.”
To get these numbers, CDC teams visited bars, dance clubs, and other venues frequented by gay and bisexual men in the 21 cities with the highest number of AIDS cases. They interviewed 8,153 self-identified gay and bisexual men who agreed to undergo HIV testing.
- 19% of the men tested positive for HIV, the virus that causes AIDS.
- 28% of black, 18% of Hispanic, and 16% of white men tested positive for HIV.
- 44% of the men who tested positive for HIV had been unaware of their infection.
- 59% of black, 46% of Hispanic, and 26% of white men who tested positive for HIV were unaware of their infection.
- 63% of the HIV-positive men age 18-29 were unaware of their infection.
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What It Means To Live With Hiv: Constrained Futures And Unrealised Possibilities
So far, we have seen how rare it was for the men and clinicians to talk with one another about the possibility of having children. We have suggested that the lack of conversations about potential parenting desires or intentions could be partly explained by what clinicians assumed about what mattered to their patients. Assumptions aside, sometimes practitioners had good reasons for not asking men about parenthood if a man looked at them as if they were from outer space, it was understandable to conclude that they didnt need to have that conversation. Some men also suggested that it was not necessary for clinicians to initiate such conversations with their patients:
If a person is actually wanting to explore that fatherhood avenue, I think then that person should be really wanting to open that avenue with their consultant. I dont really think it should be a rule for every gay man that comes into the clinic. But you could put some signs out that say, well, if there ever is such a need then you know who to actually speak to.
dont have the luxury of time to give that much information So I dont think that this needs to be sort of included in the healthcare, you know, like part of your routine check-up. I think what should be provided is a little bit of, look, if you have questions about this, you can search this webpage.
Men Who Have Sex With Men Hiv And Aids
- There are biological, behavioural, legal, and social and cultural factors which put men who have sex with men 27 times more at risk of HIV compared with the general population.
- Many countries have made significant progress in recognising the rights of LGBTQ people, while in other countries punitive laws and homophobia create additional barriers for men who have sex with men when accessing HIV prevention, testing and treatment services.
- Despite growing evidence of the effectiveness of PrEP in preventing new infections among men who have sex with men, access remains limited.
- Globally, more funding is required to support targeted HIV prevention, testing and treatment programmes for men who have sex with men.
Explore this page to find out more about what factors put men who have sex with men at risk of HIV, prevention programmes, testing initiatives, using technology, access to antiretroviral treatment, barriers to prevention and the way forward for men who have sex with men.
Globally, gay men and other men who have sex with men are 27 times more likely to acquire HIV than the general population.1 New diagnoses among this group are increasing in some regions – with a 17% rise in Western and Central Europe and a rise of 8% in North America between 2010 and 2014.2
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List Of Estimated Hiv Infection Rates By Country
Disclaimer: estimated HIV rates can be inaccurate. For example, UNAIDS reported that the HIV rate among MSM in Australia was 18.1%, but the actual rate reported by The Australian Federation of AIDS was 7.3%. This is due to the fact UNAIDS relied on a convenience sample of men who were more at risk to HIV, and thus did not capture an accurate representation of the MSM population.
Anal Sex Without A Condom
HIV can be transmitted through sex without a condom or other barrier method.
The chance of transmission is higher during anal sex without a condom or other barrier method than vaginal sex without a condom or other barrier method.
This is because the skin around the anus is thinner than the skin around the vagina, so small tears are more likely to occur during anal sex.
Someone without HIV is more likely to contract the virus during anal sex if they are the receptive partner .
Early diagnosis and treatment for HIV are important. Treatment with antiretroviral therapy prevents progression to AIDS. It can also reduce the virus to undetectable levels, at which point it cant be transmitted to others.
The CDC recommends that MSM get tested for HIV at least once a year. People at higher risk of HIV may benefit from more frequent testing, such as every 3 to 6 months.
Not all MSM follow these recommendations. As a result, some may have HIV without realizing it. This can lead to delays in treatment and increase the chances of transmission.
As of 2018, approximately 1 in 6 MSM with HIV in the United States didnt know they had the virus, reports the . In that same year, per the CDC, only 65 out of 100 gay and bisexual men with HIV in the United States received some HIV care.
Some MSM dont seek testing or treatment due to homophobic stigma or fear of discrimination.
Medications are available to reduce your likelihood of acquiring HIV.
In 2017, the CDC reported, PrEP was taken by:
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Its Much Easier To Get Hiv From Anal Sex
Its been scientifically proven that anal sex is riskier than vaginal sex when it comes to HIV. Eighteen times riskier to be exact. There are two reasons for this. First, the cells in the ass are much more susceptible to HIV than cells in the vagina. Second, both semen and rectal mucosa carry more HIV than vaginal fluid. Combine this with the fact that gay and bi guys have much more anal sex than straight guys, and youve got yourself a lot more risk right there.
What Steps Can Gay And Bisexual Men Take To Prevent Hiv Infection
Gay and bisexual men can take the following steps to reduce their risk of HIV infection:
Choose less risky sexual behaviors.Receptive anal sex is the riskiest type of sex for getting HIV. Insertive anal sex is less risky for getting HIV than receptive anal sex . In general, there is little to no risk of getting or transmitting HIV from oral sex.
Limit your number of sex partners.The more partners you have, the more likely you are to have a partner with poorly controlled HIV or to have a partner with a sexually transmitted disease . Both factors can increase the risk of HIV transmission.
Use condoms correctly every time you have sex.
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Hiv And Health Risks Among Lesbian And Bisexual Women Are Worsened By Invisibility
One reason that some lesbian and bisexual women may be at risk for HIV is their relative invisibility in male-dominated HIV messaging. For instance, as discussed above, a queer woman who has sex with a man and contracts HIV is statistically counted as a heterosexual woman by the CDC.
In addition, many doctors who speak to women about their sex life may not even ask about sex with women if the person indicates that she has had sex with a man, making queer female sexuality even more invisible.
A 2018 report even found that the U.S. Office of Womens Health removed from its website a link to a factsheet about bisexual and lesbian womens health. A page on the website titled Lesbian and Bisexual Health that had previously been listed as a health topic was no longer there as of June 2020.
How Mental Health Issues Can Worsen Hiv Among Bisexual People
Bisexual people often also have worse mental health outcomes, often as a result of biphobia and bisexual erasure. For instance, many bisexual people deal with being told that their sexuality is either nonexistent or invalid. This includes being told that bisexuals are greedy, confused, or sexually promiscuous.
Bisexual people have a number of measurably worse mental health outcomes than their straight and gay counterpartseach of which can lead to increased HIV risk and poorer health while living with HIV.
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Hiv Prevention Programmes For Men Who Have Sex With Men
It is evident that prevention strategies are failing to reach this group due to high HIV prevalence in communities around the world. For example, HIV infections among men who have sex with men in Asia are rising and prevalence is 5% or higher in 10 countries in the region. The countries reporting the highest prevalences among MSM are Indonesia , Malaysia and Australia . Rates among younger men who have sex with men are especially high.40
In Africa, the Middle East, Eastern Europe and Central Asia, government-run HIV services for men who have sex with men are extremely limited, yet hostile legal, policy and social environments sometimes make it difficult for NGOs to fill the service gap.41
Reports from 20 countries between 2009 and 2013 show that the percentage of men who have sex with men reached by HIV prevention programmes fell from 59% to 40%. However, access varies greatly between regions and within countries. For example, men who have sex with men on a higher income are more likely to be able to afford, and therefore access, prevention initiatives than those on a low income.42
When men who have sex with men are targeted by HIV prevention campaigns they can be extremely effective. It is important that a combination of prevention programmes are available.
Hiv Among Bisexual People In The Us
Despite making up the largest part of the LGBTQ community, bisexual people continue to be erased in many ways. And, as weve discussed above, invisibility and erasure often lead to worse health outcomes.
The CDC does not include data specific to bisexuals in its HIV data. Although men, women, and people of all genders can identify as bisexual, data about sexual HIV transmission is often recorded as either heterosexual or male to male, even if one or both people involved in the transmission are bisexual. Because data is aggregated by mode of transmission and not a persons identity, bisexual people are often unseen within HIV data.
Bisexual people are much less likely than gay men or lesbians to disclose their sexual orientation to their sexual health care providersnot because they dont want to, but because they often feel like their sexuality is misunderstood or because providers may assume that they are either exclusively straight or exclusively gay. One 2013 study found that 39% of bisexual men and 33% of bisexual women did not disclose their bisexuality to their health care provider, compared to only 13% of lesbians and 10% of gay men.
Along with creating barriers to health care, biphobia among the general population can often lead to compromised sexual health for bisexual people, as well.
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