HIV among gay and other men who have sex with men in Latin America and the Caribbean: a hidden epidemic?
OBJECTIVE
To assess the epidemiological and social/cultural context of, and the social response to, the HIV epidemic among gay and other men who have sex with men (MSM) in Latin America and the Caribbean.


METHODS
A review of epidemiological surveillance reports to the Pan American Health Organization/UNAIDS; published studies on HIV prevalence/incidence among MSM in the region; social/cultural studies on homosexuality; documents analysing risk and vulnerability among MSM and publications documenting the social response to the MSM epidemic.


RESULTS
The regional HIV epidemic is concentrated in MSM populations in most urban centres (HIV prevalence 5-20%). Incidence rates (1.5-3.3 in Brazil and Peru) are still moderately high, and call for continued programmatic action. Transmission from bisexual men to women is increasingly observed, demonstrating that the neglect of intervention will fuel co-existent epidemics. MSM in the region are culturally diverse, with mediation of social class, sex, and ethnicity. Around core gay subcultures, non-gay identified MSM interact with them and frequently exchange sex for goods. Examples are shown of sexual meanings affecting prevention messages focused on individual risk, as well as of the role of structural vulnerability on potential exposure to infection, calling for programmes beyond individual rational decision-making. The social response to the AIDS epidemic has, in most countries, included programmes oriented to MSM, usually from civil society organizations, and has strengthened gay organizing.


CONCLUSIONS
Renewed, imaginative efforts are needed from governments and community organizations to strengthen culturally sensitive prevention work, and integrate it into community empowerment and the promotion of sexual rights.
Cáceres
Carlos F
CF
School of Public Health, Cayetano Heredia University, Miraflores, Lima, Peru. ccaceres@upch.edu.pe
D001727:Bisexuality / Q000523:psychology / Q000706:statistics & numerical data; D017691:Caribbean Region / Q000453:epidemiology; D003140:Communicable Disease Control / Q000458:organization & administration; D005783:Gender Identity; D015658:HIV Infections / Q000453:epidemiology* / Q000517:prevention & control / Q000635:transmission; D015528:HIV Seroprevalence; D006293:Health Promotion / Q000458:organization & administration; D018451:Homosexuality, Male / Q000523:psychology / Q000706:statistics & numerical data*; D006801:Humans; D007398:Interpersonal Relations; D007843:Latin America / Q000453:epidemiology; D008297:Male; D011159:Population Surveillance; D012307:Risk Factors; D012309:Risk-Taking; D021841:Safe Sex