Sexual identity, sexual attraction and sexual experience: the Second Australian Study of Health and Relationships.

UNLABELLED: Background Behavioural and other aspects of sexuality are not always consistent. This study describes the prevalence and overlap of same-sex and other-sex attraction and experience and of different sexual identities in Australia. METHODS: Computer-assisted telephone interviews were completed by a representative sample of 20094 men and women aged 16-69 years recruited by landline and mobile phone random-digit dialling with a response rate (participation rate among eligible people) of 66.2%. Respondents were asked about their sexual identity ('Do you think of yourself as' heterosexual/straight, homosexual/gay, bisexual, etc.) and the sex of people with whom they had ever had sexual contact and to whom they had felt sexually attracted. RESULTS: Men and women had different patterns of sexual identity. Although the majority of people identified as heterosexual (97% men, 96% women), women were more likely than men to identify as bisexual. Women were less likely than men to report exclusively other-sex or same-sex attraction and experience; 9% of men and 19% of women had some history of same-sex attraction and/or experience. Sexual attraction and experience did not necessarily correspond. Homosexual/gay identity was more common among men with tertiary education and living in cities and less common among men with blue-collar jobs. Many gay men (53%) and lesbians (76%) had some experience with an other-sex partner. More women identified as lesbian or bisexual than in 2001-02. Similarly, more women reported same-sex experience and same-sex attraction. CONCLUSION: In Australia, men are more likely than women to report exclusive same-sex attraction and experience, although women are more likely than men to report any non-heterosexual identity, experience and attraction. Whether this is a feature of the plasticity of female sexuality or due to lesser stigma than for men is unknown.

The increase in global HIV epidemics in MSM.

Epidemics of HIV in MSM continue to expand in most low, middle, and upper income countries in 2013 and rates of new infection have been consistently high among young MSM. Current prevention and treatment strategies are insufficient for this next wave of HIV spread. We conducted a series of comprehensive reviews of HIV prevalence and incidence, risks for HIV, prevention and care, stigma and discrimination, and policy and advocacy options. The high per act transmission probability of receptive anal intercourse, sex role versatility among MSM, network level effects, and social and structural determinants play central roles in disproportionate disease burdens. HIV can be transmitted through large MSM networks at great speed. Molecular epidemiologic data show marked clustering of HIV in MSM networks, and high proportions of infections due to transmission from recent infections. Prevention strategies that lower biological risks, including those using antiretrovirals, offer promise for epidemic control, but are limited by structural factors including, discrimination, criminalization, and barriers to healthcare. Subepidemics, including among racial and ethnic minority MSM in the United States and UK, are particularly severe and will require culturally tailored efforts. For the promise of new and combined bio-behavioral interventions to be realized, clinically competent healthcare is necessary and community leadership, engagement, and empowerment are likely to be key. Addressing the expanding epidemics of HIV in MSM will require continued research, increased resources, political will, policy change, structural reform, community engagement, and strategic planning and programming, but it can and must be done.

A call to action for comprehensive HIV services for men who have sex with men.

Where surveillance has been done, it has shown that men (MSM) who have sex with men bear a disproportionate burden of HIV. Yet they continue to be excluded, sometimes systematically, from HIV services because of stigma, discrimination, and criminalisation. This situation must change if global control of the HIV epidemic is to be achieved. On both public health and human rights grounds, expansion of HIV prevention, treatment, and care to MSM is an urgent imperative. Effective combination prevention and treatment approaches are feasible, and culturally competent care can be developed, even in rights-challenged environments. Condom and lubricant access for MSM globally is highly cost effective. Antiretroviral-based prevention, and antiretroviral access for MSM globally, would also be cost effective, but would probably require substantial reductions in drug costs in high-income countries to be feasible. To address HIV in MSM will take continued research, political will, structural reform, community engagement, and strategic planning and programming, but it can and must be done.

Rights matter: structural interventions and vulnerable communities / Los derechos importan: intervenciones estructurales y las comunidades vulnerables

This contribution includes a lecture delivered by Dr. Dennis Altman at the International AIDS Conference held in Bangkok, Thailand during the summer of 2004. Its main goal was to recognize Jonathan Mann for his commitment to the struggle against HIV/AIDS. Jonathan Mann is probably best known for his work with the World Health Organization and the publication of the two volume book entitled AIDS in the World. In this address the concept of vulnerability is critically addressed in order to expose how risk behaviours are intimately linked to the environment in which they are manifested. Therefore, structural interventions that take into consideration this context are urgently needed. These structural interventions can serve to reduce the stigma surrounding HIV/AIDS and address the future of the epidemic without blaming those living with the virus.

Esta contribución incluye un mensaje hecho por el Dr. Dennis Altman en la Conferencia Internacional del SIDA llevada a cabo en Bangkok, Tailandia en el verano del 2004. Su objetivo principal fue reconocer a Jonathan Mann y su compromiso con la lucha contra el VIH/SIDA. Jonathan Mann es probablemente mejor conocido por su trabajo en la Organización Mundial de la Salud y la publicación de su libro de dos volúmenes titulado SIDA en el Mundo. En este mensaje el concepto de vulnerabilidad es críticamente abordado para exponer cómo las conductas de riesgo están íntimamente ligadas a los contextos en los cuales se manifiestan. Por lo tanto, intervenciones estructurales que tomen en consideración este contexto son urgentemente necesarias. Estas intervenciones estructurales pueden servir para reducir el estigma que rodea al VIH/SIDA y abordar el futuro de la epidemia sin culpar a las personas que viven con el virus.