Men who have sex with men of color in the age of AIDS: The sociocultural contexts of stigma, marginalization, and structural inequalities

Abstract

Nearly three decades since the onset of AIDS epidemic in the United States (US), men who have sex with men (MSM) have represented a significant disproportionate number of cases of HIV and AIDS.1 Within this context, MSM refer to gay, bisexually, and heterosexually identified men who engage in sexual behavior with other men. With the advent of HIV antiretroviral therapies (e.g., HAART or highly active antiretroviral therapies), AIDS-related morbidity and mortality in MSM initially decreased during the 1990s.2 Yet, recent epidemiological data have demonstrated that there has been an accelerated increase in rates of HIV and AIDS, as well as other sexually transmitted infections (STIs) in MSM.1 For instance, in 2005, MSM represented 71% of the overall HIV infections among adult and adolescent males in the US; MSM also accounted for the highest HIV transmission category, which yielded 67% of male-to-male sexual contact when compared to 15% for heterosexual transmission and 13% for injection drug use.3 MSM of Color (identified as Asian/Pacific Islander, black, Latino, and Native American/Alaska Native men) have been significantly impacted by AIDS epidemic in the United States.4 - 9 Much of the HIV epidemiological data have demonstrated that black and Latino MSM - in particular - have experienced substantial disproportionate rates of HIV and AIDS in the US, with the rates of black MSM comparable to some of the highest rates observed in some resource-limited countries.10 By race/ethnicity, of the 207,810 MSM cases of HIV/AIDS in 2005, 32% represented black MSM, when compared to 50% for white MSM, 16% for Latino MSM, 1% for Asian/Pacific Islander MSM, and less than 1% for Native American/Alaska Native MSM.3 However, incidence and prevalence rates of HIV/AIDS have been underestimated in specific racial/ethnic groups, including Asian/Pacific Islander and Native American communities, due to inadequate methodological approaches (e.g., research design, measurement, and sampling procedures) including but not limited to misclassification of racial/ethnic groups, surveillance systems not collecting data on specific groups, and failure to disaggregate within-group data to assess specific HIV-related health disparities.8 , 11 , 12 © 2009 Springer-Verlag New York.