Should doctors warn against MSM?

Thursday, September 09, 2010

Dear Editor,

On August 30, 2010, Science News published the article, "UN climate panel urged to reform, stick to science" by Louis Charbonneau. The recommendations were made by a group of scientists, under the chairmanship of Princeton University Professor Harold Shapiro. They were reviewing the work of the UN Intergovernmental Panel on Climate Change. The IPCC had been widely criticised for wrongly predicting Himalayan glaciers would vanish by 2035 and overstating how much of the Netherlands is below sea level. The reviewing committee insisted that such firm forecasts should be made "only when there is sufficient evidence".

Could the UN be accused of placing advocacy before science in other areas?

UNAIDS Executive Director Michel Sidibe, speaking at the "Congressional Briefing on HIV, Human Rights and Men who have sex with men" on September 16, 2009, blamed

"homophobia, prejudice, stigma and discrimination" for MSM's lack of universal access to appropriate care for HIV/AIDS and thus the high prevalence of HIV in this group. "These statistics from Asia, Latin America and Africa continue to shock and enrage me," he said, "but I find it even more perplexing that the situation is not so different here in the US." Mr Sidibe welcomed India's repeal of the penal code against sodomy as a "historic victory".

Why is Mr Sidibe perplexed about the US statistics?

Data from the Centres for Disease Control, Eurosurveillance and other sources indicate that since 2000, in both resource-rich and resource-poor countries with or without legalisation of homosexuality, HIV/AIDS epidemics among men who have sex with men have been advancing.

For example, S Le Vu S et al "Population-based HIV incidence in France, 2003 to 2008. Seventeenth Conference on Retroviruses and Opportunistic Infections, abstract 36LB, San Francisco, 2010" reported that the HIV incidence among gay men in France is 59 times the incidence of the general population and that the incidence decreased in all groups except gay men between 2003 and 2008. Further, I Jansen et al in "Increasing trend among young men who have sex with men in Amsterdam: a 25-year prospective cohort study. Seventeenth Conference on Retroviruses and Opportunistic Infections, abstract 35, San Francisco, 2010" reported that "HIV incidence in gay men has been increasing steadily since the introduction of highly active antiretroviral therapy (HAART) in the mid-90s". The report stated that "among gay men aged 30 and under, annual HIV incidence, which had been 0.9 per cent in 1997, increased to 3.8 per cent by July 2009". Homosexuality has been legal in the Netherlands and France since 1811 and 1791 respectively.

Why does HIV continue to present this unique challenge to the male homosexual community? Is advocacy trumping science in framing UN policy for HIV in the homosexual community? Is it possible that the activities of MSM, like cigarette smoking, are inherently bad for one's health? Should medical authorities issue a warning similar to that against cigarette smoking on the activities of MSM?

W West

wayne_west@hotmail.com

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Should doctors warn against MSM?