Τρίτη, 15 Απριλίου 2014

HIV Among Gay, Bisexual, and Other Men Who Have Sex With Men

Picture of gay male couple 

Gay, bisexual, and other men who have sex with men (MSM))a represent approximately 2% of the United States population, yet are the population most severely affected by HIV. 

In 2010, young MSM (aged 13-24 years) accounted for 72% of new HIV infections among all persons aged 13 to 24, and 30% of new infections among all MSM. 

At the end of 2010, an estimated 489,121 (56%) persons living with an HIV diagnosis in the United States were MSM or MSM-IDU.

The Numbers

New HIV Infectionsb

  • In 2010, MSM accounted for 63% of estimated new HIV infections in the United States and 78% of infections among all newly infected men. From 2008 to 2010, new HIV infections increased 22% among young (aged 13-24) MSM and 12% among MSM overall.
  • Among all MSM, white MSM accounted for 11,400 (38%) estimated new HIV infections in 2010. The largest number of new infections among white MSM (3,300; 29%) occurred in those aged 25 to 34.
  • Among all MSM, black/African American MSM accounted for 10,600 (36%) estimated new HIV infections in 2010. The largest number of new infections among black/African American MSM (4,800; 45%) occurred in those aged 13 to 24. From 2008 to 2010 new infections increased 20% among young black/African American MSM aged 13 to 24.
  • Among all MSM, Hispanic/Latino MSM accounted for 6,700 (22%) estimated new HIV infections in 2010. The largest number of new infections among Hispanic/Latino MSM (3,300; 39%) occurred in those aged 25 to 34.

Estimates of New HIV Infections in the United States for the Most-Affected Subpopulations, 2010

Shown here is a horizontal bar chart entitled,
Source: CDC. 
HIV Surveillance Supplemental Report 2012;17(4). 
Subpopulations representing 2% or less of the overall US epidemic are not reflected in this chart. Abbreviations: 
MSM, men who have sex with men; IDU, injection drug user.
 

HIV and AIDS Diagnosesc and Deaths

  • In 2011, in the United States, MSM accounted for 79% of 38,825 estimated HIV diagnoses among all males aged 13 years and older and 62% of 49,273 estimated diagnoses among all persons receiving an HIV diagnosis that year.
  • At the end of 2010, of the estimated 872,990 persons living with an HIV diagnosis, 440,408 (50%) were MSM. Forty-seven percent of MSM living with an HIV diagnosis were white, 31% were black/African American, and 19% were Hispanic/Latino.
  • In 2011, MSM accounted for 52% of estimated AIDS diagnoses among all adults and adolescents in the United States. Of the estimated 16,694 AIDS diagnoses among MSM, 39% were in blacks/African Americans; 34% were in whites; and 23% were in Hispanics/Latinos.
  • By the end of 2010, an estimated 302,148 MSM with an AIDS diagnosis had died in the United States since the beginning of the epidemic, representing 48% of all deaths of persons with an AIDS diagnosis.

Prevention Challenges

The large number of MSM living with HIV means that, as a group, gay, bisexual, and other MSM have an increased chance of being exposed to HIV. 

Results of HIV testing conducted in 20 cities as part of the National HIV Behavioral Surveillance System indicated that 18% of MSM tested in 2011 were HIV-positive and that HIV prevalence increased with increasing age. 

In this study, the overall percent of gay and bisexual men with HIV who knew of their HIV infection increased from 56% in 2008 to 66% in 2011. 

Among those infected, 49% of young MSM aged 18 to 24 years knew of their infection, whereas 76% of those aged 40 and over were aware of their HIV infection. 

Fifty- four percent of black/African American MSM knew of their infection, compared with 63% of Hispanic/Latino MSM and 86% of white MSM. 

Persons who don’t know they have HIV don’t get medical care and can unknowingly infect others. 

The Centers for Disease Control and Prevention (CDC) recommends that all MSM get tested for HIV at least once a year. Sexually active MSM might benefit from more frequent testing (e.g., every 3 to 6 months). 

Sexual risk behaviors account for most HIV infections in MSM. Anal sex without a condom (unprotected anal sex) has the highest risk for passing HIV during sex. 

It is also possible to become infected with HIV through oral sex, though the risk is significantly less than for anal or vaginal sex. 

For sexually active MSM, the most effective ways to prevent HIV are to limit or avoid anal sex, or for MSM who do have anal sex, to correctly use a condom every time. 

Gay men are at increased risk for sexually transmitted infections (STIs), like syphilis, gonorrhea, and chlamydia, and CDC recommends that all sexually active MSM be tested annually for these infections. 

Alcohol and illegal drug use increases risk for HIV and other STIs. Using substances such as alcohol and methamphetamines can impair judgment and increase risky sexual behavior. 

Homophobia, stigma, and discrimination may place gay men at risk for multiple physical and mental health problems and affect whether they seek and are able to obtain high-quality health services. 

What CDC Is Doing

Guided by the National HIV/AIDS StrategyExternal Web Site Icon for the United States, CDC and its partners are pursuing a high-impact prevention approach to reducing new HIV infections by using combinations of scientifically proven, cost-effective, and scalable interventions directed to the most vulnerable populations in the geographic areas where HIV prevalence is highest. 

As part of high-impact prevention, CDC is aligning surveillance and program activities more closely

For example, while linkage to care soon after HIV diagnosis is relatively high, more people living with HIV should receive continuous care and antiretroviral treatment, and a greater proportion of persons infected with HIV should have a suppressed HIV viral load—the most important goal for maximizing a person’s health as well as reducing the risk of transmission. 

By increasing the reporting of CD4 and viral load data across the country, CDC will aid health departments and clinicians in monitoring treatment progress toward viral load suppression. Currently, CDC estimates that only 25% of the 1.1 million individuals with HIV have their viral loads adequately suppressed.
 
CDC is also encouraging MSM and their healthcare providers to take advantage of biomedical approaches to HIV prevention.  

Pre-exposure prophylaxis (PrEP), which involves taking antiretroviral medications prior to becoming exposed to HIV, can reduce the risk of HIV infection in individuals at very high risk of infection. 

Post-exposure prophylaxis, which involves taking antiretrovial medications soon after possible exposure to HIV, also plays a role in HIV prevention, but should be not be considered a primary means of HIV prevention. 

Also, while HIV treatments can dramatically improve the health of HIV-positive persons who are treated, they also have prevention benefits: individuals whose HIV viral loads are suppressed have a greatly reduced chance of transmitting the virus to their partners (Treatment as Prevention).

CDC continues to focus on HIV testing
To expand HIV prevention services for young gay and bisexual men of color, transgender youth of color, and their partners, CDC awarded $55 million over 5 years to 34 community-based organizations with strong links to these populations. 

This funding will be used to provide HIV testing to more than 90,000 young gay and bisexual men and transgender youth of color, with a goal of identifying more than 3,500 previously unrecognized HIV infections and linking those who are HIV-infected to care and prevention services. 

Additionally, CDC’s MSM Testing Initiative seeks to identify at least 3,000 MSM with HIV who were previously unaware of their infection and link at least 85% to care. 

Through its Act Against AIDS campaigns and other collaborative activities, CDC aims to provide MSM with effective and culturally appropriate messages about HIV prevention. 
The REASONS/RAZONES testing campaign features Latino gay and bisexual men sharing their reasons for getting an HIV test, while Testing Makes Us StrongerExternal Web Site Icon campaign encourages black gay and bisexual men to get tested for HIV. 
Let’s Stop HIV Together focuses on raising awareness of HIV and AIDS and simultaneously combatting complacency and stigma by increasing support for people living with the disease.
CDC also funds state and local health departments and community-based organizations to support HIV prevention services for MSM. Through the Diffusion of Effective Behavioral Interventions (DEBI) project, CDC supports various behavioral interventions and other high-impact prevention strategies. 



For more background information view the bibliography and other references used in this factsheet.

a The term men who have sex with men (MSM) is used in CDC surveillance systems. 
It indicates the behaviors that transmit HIV infection, rather than how individuals self-identify in terms of their sexuality. 

b New HIV infections refer to HIV incidence, or the estimated number of people who are newly infected with HIV each year. 

c HIV and AIDS diagnoses are the number of persons diagnosed with HIV infection and the number of persons diagnosed with AIDS, respectively, during a given time period. 
The terms do not indicate when the persons were infected.

Who's at Risk for HIV?

Because the most common ways HIV is transmitted is through anal or vaginal sex 

or sharing drug injection equipment with a person infected with HIV, 

it is important to take steps to reduce the risks associated with these.

Risk People 
 
 Risk Behavior photo of two people kissing

In the United States, HIV is spread mainly by having anal or vaginal sex without a condom or by sharing drug-use equipment with an infected person.

Substance use can contribute to these risks indirectly because alcohol and other drugs can lower people’s inhibitions and make them less likely to use condoms. 

This section provides information on the various risk behaviors and what you can do to lower your risk.

Living With HIV


doctor talking to patient about medication

Today, an estimated 1.1 million people are living with HIV in the United States. 

Thanks to better treatments, people with HIV are now living longer—and with a better quality of life—than ever before. 

If you are living with HIV, it’s important to make choices that keep you healthy and protect others.

Stay healthy.

It’s very important for you to take your HIV medicines exactly as directed. 

Not taking medications correctly may lower the level of immune system defenders called CD4 cells and cause the level of virus in your blood (viral load) to go up. 

The medicines then become less effective when taken. 

Some people report not feeling well as a reason for stopping their medication or not taking it as prescribed. 

Tell your doctor if your medicines are making you sick. 

He or she may be able to help you deal with side effects so you can feel better. 

Don’t just stop taking your medicines, because your health depends on it.  

Do tell.

two men in a cafe 

Be sure that your partner or partners know that you have HIV. Then they will know it’s important to use condoms for all sexual activity and to be tested often for HIV. 

Health departments offer Partner Services to help you tell your partners about their exposure. Partner Services provides many free services to people with HIV or other STDs and their partners. 

Through Partner Services, health department staff help find sex or drug-injection partners to let them know of their risk of being exposed to HIV or another sexually transmitted disease (STD) and provide them with testing, counseling, and referrals for other services. 

Partner Services will not reveal your name unless you want to work with them to tell your partners.

Don’t take risks.

HIV is spread through body fluids such as blood, semen (cum), vaginal fluids, and breast milk. 

n the United States, HIV is most commonly passed from one person to another through unprotected anal or vaginal sex and through sharing needles or other drug equipment. 

In addition, a mother can pass HIV to her baby during pregnancy, during labor, through breastfeeding, or if by pre-chewing her baby’s food. 

Viral load can range from undetectable levels of 40 to 75 copies per milliliter of blood to millions of copies. 

The higher your viral load, the greater the risk of spreading HIV to others. 

Protect your partners by keeping yourself healthy. 

Take all of your medicines and get tested and treated for other STDs. 

If you have HIV plus another STD or hepatitis, you are 3 to 5 times more likely to spread HIV than if you only have HIV.  

Your viral load goes up and your CD4 count goes down when you have an STD.

Although having a low viral load greatly decreases your chance of spreading HIV, some risk remains, even when your viral load is lower than 3,500 copies per milliliter. 

You can avoid spreading the virus to others by making sure they do not come into contact with your body fluids. 

image of a couple in bed 
  • Abstinence (not having sex) is the best way to prevent the spread of HIV infection and some other STDs. If abstinence is not possible, use condoms whenever you have sex—vaginal, anal, or oral.
  • Do not share drug equipment. Blood can get into needles, syringes, and other equipment. If the blood has HIV in it, the infection can be spread to the next user.
  • Do not share items that may have your blood on them, such as razors or toothbrushes.
Read more on HIV and opportunistic infections (infections that are more frequent or more severe because of immunosuppression in HIV-infected persons). 

For other patient brochures about living with HIV visit the Act Against AIDS site.

HIV Among Youth

Teen Couples in a corridor 
Youth in the United States account for a substantial number of HIV infections. 
Gay, bisexual, and other men who have sex with men* account for most new infections in the age group 13 to 24; black/African American** or Hispanic/Latinoa gay and bisexual men are especially affected. 
Continual HIV prevention outreach and education efforts, including programs on abstinence, delaying the initiation of sex, and negotiating safer sex for the spectrum of sexuality among youth—homosexual, bisexual, heterosexual, and transgender—are urgently needed for a new generation at risk.

* Referred to as gay and bisexual in this fact sheet.
** Referred to as black in this fact sheet.

The Numbers

New HIV Infectionsb Among Youth (Aged 13–24 Years)

  • In 2010, youth made up 17% of the US population, but accounted for an estimated 26% (12,200) of all new HIV infections (47,500) in the United States.
  • In 2010, young gay and bisexual men accounted for an estimated 19% (8,800) of all new HIV infections in the United States and 72% of new HIV infections among youth. These young men were the only age group that showed a significant increase in estimated new infections—22% from 2008 (7,200) through 2010 (8,800).
  • In 2010, black youth accounted for an estimated 57% (7,000) of all new HIV infections among youth in the United States, followed by Hispanic/Latino (20%, 2,390) and white (20%, 2,380) youth.

Estimates of New Infections Among Youth Aged 13-24 Years, by Race/Ethnicity and Sex, United States, 2010


In 2010, among 13- to 24-year-olds, there were 5600 new HIV infections in African American males, 2100 new HIV infections in Hispanic/Latino males, 2100 new HIV infections in white males, 1400 new HIV infections in African American females, 290 new HIV infections in Hispanic/Latino females, and 280 new HIV infections in white females.
Source: CDC. Estimated HIV incidence in the United States, 2007-2010 Adobe PDF file. HIV Surveillance Supplemental Report 2012;17(4).

HIV and AIDS Diagnosesc and Deaths Among Youth (Aged 13-24)

  • An estimated 10,456 youth were diagnosed with HIV infection in the United States and six dependent areas in 2011, representing 21% of an estimated 50,199 people diagnosed during that year. Seventy-eight percent (8,140) of these diagnoses occurred in those aged 20 to 24, the highest number and population rate of HIV diagnoses of any age group (36.3 new HIV diagnoses/100,000 people).
  • By the end of 2010, of the estimated 39,035 youth living with diagnosed HIV infection in the United States and 6 dependent areas: An estimated 27,621 HIV diagnoses were among young men. Of these, 77% of HIV diagnoses were attributed to male-to-male sexual contact and 13% to perinatal exposure.
  • An estimated 11,413 HIV diagnoses were among young women. Of these, 56% were attributed to heterosexual contact and 34% to perinatal exposure.
  • In 2011, an estimated 3,004 youth in the United States and six dependent areas were diagnosed with AIDS, a number that has increased 29% since 2008.
  • By the end of 2010, an estimated 11,731 youth with an AIDS diagnosis had died in the United States and six dependent areas since the HIV epidemic began.

Prevention Challenges

  • Low perception of risk. A majority of 15- to 24-year-olds in the United States responding to a Kaiser Family Foundation survey said they were not concerned about becoming infected with HIV, which means they may not take measures to protect their health.
  • Low rates of testing. It is estimated that in 2010, almost 60% of youth aged 13 to 24 with HIV in the United States were unaware of their infection, compared to 16% for all ages. In a 2011survey, only 13% of high school students (22% of those who had ever been sexually active), and in a 2010 survey, only 35% of adults aged 18 to 24 had been tested for HIV.
  • Low rates of condom use. In a 2011 survey in the United States, of the 34% of high school students reporting sexual intercourse in the previous 3 months, 40% did not use a condom.
  • High rates of sexually transmitted infections (STIs). Some of the highest STI rates in the United States are among youth aged 20 to 24, especially those of minority races and ethnicities. The presence of an STI greatly increases a person’s likelihood of acquiring or transmitting HIV.
  • Older partners. Young gay and bisexual men are more likely to choose older sex partners than those of their own age, and older partners are more likely to be infected with HIV.
  • Substance use. Nearly half (47%) of youth aged 12 to 20 reported current alcohol use in 2011, and 10% of youth aged 12 to 17 said they were current users of illicit drugs. Substance use has been linked to HIV infection because both casual and chronic substance users are more likely to engage in high-risk behaviors, such as sex without a condom, when they are under the influence of drugs or alcohol. 
  • Homelessness. Runaways, homeless youth, and youth who have become dependent on drugs are at high risk for HIV infection if they exchange sex for drugs, money, or shelter.
  • Inadequate HIV prevention education. Young people are not always reached by effective HIV interventions or prevention education—especially young gay and bisexual men, because some sex education programs exclude information about sexual orientation.
  • Feelings of isolation. Gay and bisexual high school students may engage in risky sexual behaviors and substance abuse because they feel isolated and lack support.

What CDC Is Doing

  • CDC uses a multifaceted approach to meet the goals of the National HIV/AIDS Strategy:
  • In 2011, CDC awarded $55 million over 5 years to 34 community-based organizations (CBOs) to expand HIV prevention services for young gay, bisexual, and transgender youth of color.
  • CDC funds health departments and CBOs to deliver effective behavioral interventionsExternal Web Site Icon.
  • CDC’s Division of Adolescent and School Health collects and reports data on youth health risk behaviors, and supports many other projects. For example:
    • Funding 19 state and 17 local education agencies helps districts and schools deliver exemplary sexual health education emphasizing HIV and other STD prevention, increase adolescent access to key sexual health services, and establish safe and supportive environments for students and staff.
    • To reach sexual minority youth outside of schools, Advocates for Youth trains and works with staff at LGBT-specific CBOs to pilot and/or implement evidence-based HIV prevention programs specific to black and Latino teen gay and bisexual men.
    • The American Psychological Association provides science-based workshops for school counselors, nurses, psychologists, and social workers on how to reach lesbian, gay, and transgender youth with HIV prevention messages in a safe and supportive school environment.
  • Through its Act Against AIDS campaigns, CDC aims to provide effective messages about HIV prevention and to reduce stigma, especially for high-risk groups. Let’s Stop HIV Together, for example, fights stigma by showing that people with HIV are real people—including young people.
View the bibliography.

Additional Resources

CDC-INFO
1-800-CDC-INFO (232-4636)

CDC HIV Website

CDC Act Against AIDS Campaign


a Hispanics/Latinos can be of any race.
b New HIV infections refer to HIV incidence, or the number of people who are newly infected with HIV within a given time frame (for example, 1 year), whether or not they are diagnosed.
c HIV and AIDS diagnoses indicate when a person is diagnosed with HIV infection or AIDS, but do not indicate when the person was infected.

United Nations Convention against Transnational Organized Crime and the Protocols Thereto

Conference of the Parties to the United Nations Convention against Transnational Organized Crime

The United Nations Convention against Transnational Organized Crime, adopted by General Assembly resolution 55/25 of 15 November 2000, is the main international instrument in the fight against transnational organized crime. 
It opened for signature by Member States at a High-level Political Conference convened for that purpose in Palermo, Italy, on 12-15 December 2000 and entered into force on 29 September 2003. 

The Convention is further supplemented by three Protocols, which target specific areas and manifestations of organized crime: 
-the Protocol to Prevent, Suppress and Punish Trafficking in Persons, Especially Women and Children;
-the Protocol against the Smuggling of Migrants by Land, Sea and Air; and 
-the Protocol against the Illicit Manufacturing of and Trafficking in Firearms
their Parts and Components and Ammunition. 

Countries must become parties to the Convention itself before they can become parties to any of the Protocols.

The Convention represents a major step forward in the fight against transnational organized crime and signifies the recognition by Member States of the seriousness of the problems posed by it, as well as the need to foster and enhance close international cooperation in order to tackle those problems

States that ratify this instrument commit themselves to taking a series of measures against transnational organized crime, including the creation of domestic criminal offences (participation in an organized criminal group, money laundering, corruption and obstruction of justice); 
the adoption of new and sweeping frameworks for extradition, mutual legal assistance and law enforcement cooperation; and the promotion of  training and technical assistance for building or upgrading the necessary capacity of national authorities. 


The Protocol to Prevent, Suppress and Punish Trafficking in Persons, especially Women and Children, was adopted by
palermo conference General Assembly resolution 55/25. 

It entered into force on 25 December 2003. 
It is the first global legally binding instrument with an agreed definition on trafficking in persons. 
The intention behind this definition is to facilitate convergence in national approaches with regard to the establishment of domestic criminal offences that would support efficient international cooperation in investigating and prosecuting trafficking in persons cases. 
An additional objective of the Protocol is to protect and assist the victims of trafficking in persons with full respect for their human rights.


The Protocol against the Smuggling of Migrants by Land, Sea and Air, adopted by General Assembly resolution 55/25, entered into force on 28 January 2004. 
It deals with the growing problem of organized criminal groups who smuggle migrants, often at high risk to the migrants and at great profit for the offenders. 
A major achievement of the Protocol was that, for the first time in a global international instrument, a definition of smuggling of migrants was developed and agreed upon.
The Protocol aims at preventing and combating the smuggling of migrants, as well as promoting cooperation among States parties, while protecting the rights of smuggled migrants and preventing the worst forms of their exploitation which often characterize the smuggling process.


The Protocol against the Illicit Manufacturing of and Trafficking in Firearms, their Parts and Components and Ammunition was adopted by General Assembly resolution 55/255 of 31 May 2001. 
It entered into force on 3 July 2005. 
The objective of the Protocol, which is the first legally binding instrument on small arms that has been adopted at the global level, is to promote, facilitate and strengthen cooperation among States Parties in order to prevent, combat and eradicate the illicit manufacturing of and trafficking in firearms, their parts and components and ammunition. 

By ratifying the Protocol,  
States make a commitment to adopt a series of crime-control measures and implement in their domestic legal order three sets of normative provisions: the first one relates to the establishment of criminal offences related to illegal manufacturing of, and trafficking in, firearms on the basis of the Protocol requirements and definitions; the second to a system of government authorizations or licensing intending to ensure legitimate manufacturing of, and trafficking in, firearms; and the third one to the marking and tracing of firearms.

Full text of the Convention and its Protocols:

  • United Nations Convention against Transnational Organized Crime
  • Protocol to Prevent, Suppress and Punish Trafficking in Persons, Especially Women and Children, supplementing the United Nations Convention against Transnational Organized Crime
  • Protocol against the Smuggling of Migrants by Land, Sea and Air, supplementing the United Nations Convention against Transnational Organized Crime
  • Protocol against the Illicit Manufacturing and Trafficking in Firearms, Their Parts and Components and Ammunition, supplementing the United Nations Convention against Transnational Organized Crime

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General Assembly resolutions

In its resolution 55/25 of 15 November 2000, the General Assembly adopted the United Nations Convention against Transnational Organized Crime and two of its supplementary Protocols namely: the Protocol to Prevent, Suppress and Punish Trafficking in Persons, Especially Women and Children and the Protocl against the Smuggling of Migrants by Land, Air and Sea
Arabic Chinese English French Russian Spanish

In its resolution 55/255 of 31 May 2001, the General Assembly adopted the Protocol against the Illicit Manufacturing of and Trafficking in Firearms, Their Parts and Components and Ammunition, supplementing the United Nations Convention against Transnational Organized Crime
Arabic Chinese English French Russian Spanish