# Presentation: 190286

## ABC in the US:Applicability to MSM

**Mark Thrun, MD**
**Assistant Professor of Medicine**
**University of Colorado Health Sciences Center**
**Medical Director, HIV Prevention**
**Denver Public Health**

## The problem is obvious

**CDC, 2003**

## Higher rates of risky behaviors

**Rietmeijer, STD, 2003**

## Decrease number of sexual contacts

**Delay sexual debut**
**Reduce number of partners**

## Decrease infectiousness of contacts

**Reduce rate of anal/vaginal sex**
**Barriers**
**Microbicides**
**Treatment**
**Serosorting**

## Disclosure

**Sexual partner**
**Life partner**

## MSM can limit numbers of partners

**Werdegar, MMWR, 1987**

## MSM can increase condom use

**Catania, Health Psych, 1991**

## Diagnosis can influence behavior

**Higgenbotham, MMWR, 2000**

**Percentage use of condoms following seroconversion**

## Changes in the past helped lead to reduction in HIV

**CDC, 2003**

## Why are rates increasing currently?

**Apathy**
**Fatigue**
**Medications**
**Youth**
**Unwillingness to disclose**

## Slide 12

## The core problem is lack of communication

**Lack of meaningful discussion about HIV and AIDS outside of small groups of “in the know” persons**

## What discussions need to occur for this to change?

## Discussion with youth

**Reasonable goal is abstinence **
**Must be conscious of MSM/gay or MSM/gay questioning youth **
**Failure to address MSM/gay reality leads to alienation and loss of message on those youth**
**It is not ok to ostracize**

## MSM youth are at higher risk for AIDS

**CDC, 2002**

## Encourage partner reductionthrough adequate knowledge

**Up-to-date risk data must be publicized**
**Assumption that HIV is an easily manageable disease must be combated publicly**

## Slide 18

## Encourage partner reductionthrough individualized risk assessment and counseling

**Medical provider must be knowledgeable about HIV risk**
**Medical providers must be comfortable testing for and counseling about HIV**

## Medical providers don’t currently ask about risk

## Providers can learn to assess risk and counsel

**Prevention in care settings can occur**
**Richardson - Partnership for Health**
**Fisher - Options Project**
**HRSA - SPNS**
**Denver Health/CDC - Positive Steps (Striving to Engage People)**
**Care setting is ideal place for ongoing assessment, counseling, and emphasis on personal responsibility**

## Encourage partner reduction through de-stigmatization of HIV

**Fear based in ignorance**
**Even in out gay communities, it is not easy being HIV positive**

## ...and de-stigmatization of persons at risk for HIV

## De-stigmatize HIV

**“****Fight the disease and not the person” programs are important, but do not go far enough**
**HIV will remain stigmatized until the persons who have HIV are no longer stigmatized/ostracized/alienated**

## Discussions about HIV (and populations at risk) need to occur

**At home**
**At school**
**At church**
**In the community**
**In bed**

**With family**
**With partners**
**With peers**
**With educators**
**With providers**

## Encourage partner reduction through social constructs supporting monogamy

**Committed relationships need to be valued**
**By family**
**By peers**
**By community**
**By legal system**
**It is hypocritical to encourage long-term relationships and oppose them at the same time**

## Condoms need to be encouraged in all high risk settings

**100% abstinence outside of relationships in not a realistic goal**
**It is poor public health policy not to educate people about a potentially life saving intervention**
**Correct and consistent use of condoms should be encouraged outside of long-term monogamous relationship in which both partners are HIV negative**

## Gay men/MSM need to accept responsibility for their actions

**To knowingly expose someone to HIV is inexcusable**
**One is ultimately responsible for their own health**
**Seattle Community Manifesto**
**MSM HIV/STD Prevention Task Force**
**“****Every Gay, Bisexual, or other man who has sex with men is responsible for the health and well-being of the community.”**

## Stress personal responsibility

## Conclusions

**Abstinence for *****ALL***** youth **
**Limitation of discussion to only male/female sexual acts alienates population at highest risk of infection**
**Partner reduction and personal responsibility as cornerstone**
**Condoms can not be dismissed**

## Conclusions

**Society needs to decide if MSM/gay population is a priority**
**Public institutions need to lead the way in de-stigmatizing HIV and populations at risk for HIV**
**Only then will meaningful change occur**

## “You did then what you knew how to do.  When you knew better, you did better.”

**Maya Angelou**