Department of Epidemiology, Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205, USA.
Clin Infect Dis. 2010 May 15;50 Suppl 3:S108-13. doi: 10.1086/651481.
The global epidemiology of human immunodeficiency virus (HIV) infection among men who have sex with men (MSM) suggests both reemergent spread among men in resource-sufficient countries since 2000 and emerging epidemics among MSM in resource-limited countries. Both epidemic contexts are evidence of the current limits of prevention of HIV infection in MSM. A range of evidence-based preventive interventions exist, but few new interventions have shown efficacy among MSM. Circumcision has not been investigated for MSM. New interventions are needed. Trials of preexposure prophylaxis are pending and may markedly alter the prevention landscape. For MSM in developing countries, basic services for prevention of HIV infection have yet to reach the large majority of men. Homophobia and discrimination limit access of MSM to prevention services and markedly increase vulnerability, as does criminalization of same-sex behavior. Decriminalization of same-sex behavior is a structural intervention for prevention of HIV infection and has recently been embraced by a nonbinding statement from the United Nations.
全球男男性行为人群（MSM）中人类免疫缺陷病毒（HIV）感染的流行病学表明，自 2000 年以来，资源充足国家的男性中出现了重新流行，而资源有限国家的 MSM 中也出现了新的流行。这两种流行情况都表明，目前男男性行为人群预防 HIV 感染的方法存在局限性。存在一系列基于证据的预防干预措施，但很少有新的干预措施在 MSM 中显示出疗效。针对 MSM 的割礼尚未进行研究。需要新的干预措施。暴露前预防的试验正在进行中，可能会显著改变预防的格局。在发展中国家，预防 HIV 感染的基本服务尚未普及到大多数男性。对 MSM 的恐同和歧视限制了他们获得预防服务的机会，并显著增加了他们的脆弱性，因为对同性性行为的定罪也增加了这种脆弱性。同性性行为的非刑事化是预防 HIV 感染的一种结构性干预措施，最近也被联合国的一项不具约束力的声明所接受。
