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Evidence from a range of studies, reports and surveillance systems suggests that epidemics of sexually transmitted infections (STI), most prominently HIV infection, are underway in 2008 among men who have sex with men (MSM) in a wide range of developing countries. Although a lack of surveillance and research data limit our understanding of too many of these diverse epidemics, what data are available among MSM in south and central America, the Caribbean, Asia, the former Soviet Union and Africa are remarkably consistent in finding MSM at substantial risk.1–6 In a recent systematic review of the literature from 2000 to 2006 on HIV among MSM in low and middle income countries, our group found an overall adjusted odds ratio (OR) of 19.3 (95% CI 18.8 to 19.8) for MSM compared with general population reproductive age adults.1 HIV risks were markedly elevated for MSM in the Americas (OR 33.3, 95% CI 32.3 to 34.2), Asia (OR 18.7, 95% CI 17.7 to 19.7) and for Africa (OR 3.8, 95% CI 3.3 to 4.3).1 The high rates of prevalent and incident STI and HIV reported among gay, bisexual and MSM from the USA, western Europe and Australia have been described as resurgent epidemics—and in some settings, these incidence densities rival or exceed those seen among gay men in the 1980s.7 8 For much of the developing world, however, little work was done among MSM in the 1980–90s and indeed the data remain sparse in 2008. Whether the epidemics we are now seeing among developing country MSM are due to resurgent spread, ongoing spread that has long gone undocumented, or represent newly emerging epidemic patterns is thus difficult to ascertain. Nevertheless, there is enough evidence to assert that epidemic spread of HIV and other STI is occurring in previously …
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