The Global HIV Epidemics among Men Who Have Sex with Men (MSM)

DIRECTIONS IN DEVELOPMENT
Human Development
The Global HIV Epidemics
among Men Who Have Sex
with Men
Chris Beyrer, Andrea L. Wirtz, Damian Walker, Benjamin Johns,
Frangiscos Sifakis, and Stefan D. Baral The Global HIV Epidemics among
Men Who Have Sex with MenThe Global HIV Epidemics
among Men Who Have
Sex with Men
Chris Beyrer, Andrea L. Wirtz, Damian Walker, Benjamin Johns,
Frangiscos Sifakis, and Stefan D. Baral© 2011 The International Bank for Reconstruction and Development / The World Bank
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ISBN: 978-0-8213-8726-9
eISBN: 978-0-8213-8727-6
DOI: 10.1596/978-0-8213-8726-9
Library of Congress Cataloging-in-Publication data has been requested
Cover painting: “Untitled” by Raimundo Rubio, 1998. Oil on canvas, 52 by 52 in., World
Bank Art Collection.
Cover design: Naylor Design.Contents
Acknowledgments xv
Abbreviations xix
Executive Summary xxi
Chapter 1 Introduction 1
Note 3
References 4
PART I Epidemic Scenarios and Focus Countries 5
Chapter 2 Introduction to the Epidemic Scenarios 7
Methods 9
Results 13
Bibliography 23
Chapter 3 Scenario 1 Country Studies: Brazil and Peru 31
Brazil: Early Interventions, Early Successes 31
Peru: A Country with Complex Subgroups
and Networks 36
References for Brazil 54
References for Peru 56
vvi Contents
Chapter 4 Scenario 2 Country Studies: Russian Federation
and Ukraine 61
Russian Federation: An Expanding HIV Epidemic
among MSM 61
Ukraine: Hidden HIV Epidemic among MSM 69
References for Russian Federation 75
References for Ukraine 78
Chapter 5 Scenario 3 Country Studies: Kenya, Malawi,
and Senegal 81
Kenya: Developing the Evidence Base for
Effective HIV Prevention among MSM 81
Malawi: Characterizing HIV Risk among MSM
in a Generalized Epidemic 89
Senegal: An HIV Epidemic among MSM
That Is Not Linked to That of the General
Population 96
References for Kenya 105
References for Malawi 108
References for Senegal 109
Chapter 6 Scenario 4 Country Studies: India and
Thailand 111
India: Complex Taxonomies of MSM with
Multifaceted Epidemics of HIV 111
Thailand: High HIV Prevalence and Incidence
among Gay Men, other MSM, and
Transgenders (Katoey) 121
References for India 129
References for Thailand 132
Chapter 7 Middle East and North Africa 135
Egypt 137
Lebanon 138
Morocco 139
Pakistan 139
Sudan 141
Tunisia 142
References 142Contents vii
PART II Combination HIV Prevention Interventions 147
Chapter 8 Combination HIV Prevention Interventions for
MSM: An Umbrella Review of the Evidence
and Recommendations 149
Methods 151
Findings 156
Discussion: Implications of Diversity
and Consistency 193
References 196
PART III Modeling 217
Chapter 9 Modeling MSM Populations, HIV Transmission,
and Intervention Impact 219
Adapting and Using the Goals Model to
Estimate HIV Prevalence and Incidence 220
Methods 221
Results 226
References 236
Chapter 10 Modeling Cost and Cost-Effectiveness 241
Methods 242
Results for Kenya, Peru, Thailand, and Ukraine 258
Annex 10.A 273
Notes 282282
PART IV A Broader Policy Perspective 299
Chapter 11 Policy and Human Rights 301
The UN Family, PEPFAR, and Rights and
Policies Relating to MSM 305
Current Legal Status of MSM in LMICs 306
Focus Countries 308
Modeling the Effect of Enabling Policy
Environments 310
Policy Findings 312
Policy Contexts and Programming 313viii Contents
The Human Rights Framework and MSM
Programming 314
References 315
Appendix A Price Tag for a Comprehensive Prevention
and Treatment Program for MSM 317
Methods 317
Results 324
Discussion 324
References 329
Appendix B Extension of the Cost Analysis to Additional
Selected Countries 331
Reference 335
Index 337
Box
8.1 Theories Supporting Behavior-Change Interventions 161
Figures
ES.1 Algorithm Describing the Development of the
Epidemic Scenarios xxiv
ES.2 HIV Epidemic among MSM in LMICs According
to Epidemic Scenario xxvi
ES.3 Projections of the Number of New HIV Infections
with Implementation of Three Intervention Scenarios
for MSM, Peru, 2008–15 xxxix
ES.4 Expansion Path for Incremental Addition of
Interventions in Peru xliii
2.1 Search Protocol and Results: Systematic Review of
Published and Unpublished Literature on the HIV
Epidemic among MSM in LMICs 10
2.2 Algorithm Describing the Development of the
Epidemic Scenarios 12
2.3 HIV Epidemic among MSM in LMICs According
to Epidemic Scenario 18
9.1 Percentage of New HIV Infections Attributed to
MSM Behavior in Selected Countries, 2015 227