When plagues don't end

The syndemic of AIDS and STDS among MSM

The spread of HIV and other STDs among men who have sex with men (MSM) has been labeled a syndemic because in this population a number of different and interrelated health problems have come together and interact with one another. The various elements of the syndemic have an additive effect, each one intensifying the others. These factors include the number of infectious diseases endemic in this population, the high rate of substance abuse problems and psychological disorders, and the significant percentage of MSM who have experienced childhood sexual abuse and other adverse events. While MSM are disproportionately affected by HIV, syphilis, and other STDs, health activists from the gay community have systematically resisted the application of the full range of public health strategies traditionally used to prevent their spread. In the more than three decades since the beginning of the HIV/AIDS epidemic, there have been substantial advances in testing and treatment, yet the infection rate among MSM, and particularly young MSM, remains high, even as it has been dropping among other risk groups. This paper deals with the history of the syndemic, the failure of various risk reduction strategies, and treatment as prevention.

Barebacking websites: electronic environments for reducing or inducing HIV risk

Barebacking, or intentional unprotected anal intercourse (UAI), among men who have sex with men (MSM) has been a growing concern for the public health community because of UAIs link to HIV incidence and sexually transmitted infections (STIs). Men who bareback have created online spaces through websites that host thousands of profiles throughout the US and world. Adapting two domains from person-environment theory, this study contrasted the health messages surrounding the risks of UAI within two mainstream US-based barebacking websites. One website developed intensive systems to promote harm reduction, such as encouraging frequent HIV-testing, discussing STIs with partners, and limiting the number of partners. In contrast, the other site analysed negated the seriousness of HIV and STIs, which can have clear negative outcomes for patrons whom relied on this information. This analysis implicates the need to explore electronic environments as viable tools for HIV prevention and programme development.