Sexual and gender minorities have been present throughout human history, but recently there has been increased public awareness of their prevalence, because of human rights activism and the recognition of the increased STI and HIV burden among some subpopulations, particularly men who have sex with men (MSM) and transgender women. Behavioral and biological factors explain some of the disparities noted in their higher rates of STI and HIV. The colorectal mucosa has the greatest concentration of cells that can bind HIV in the body, and single layer columnar epithelial cells may be readily traumatised and inflamed during anal intercourse. MSM who are versatile in their sex roles may efficiently acquire HIV/STI by being the receptive partner, and then can readily transmit infections to new partners if they are insertive. STI and HIV potentiate the transmission of each other, and certain venues that enable MSM to meet partners readily, such as saunas and specific internet sites, have been associated with rapid expansion of micro-epidemics. MSM in many parts of the world have been found to have higher rates of many bacterial and viral STIs than demographically matched peers, and may have unique STIs based on specific behaviours (e.g. association of faecal contact and enteric pathogens) and the concentration of new infections within subpopulations (e.g. recent outbreaks of MRSA and LGV). The stigmatisation of homosexuality and gender nonconformity create barriers to effective STI and HIV control, since many MSM may defer seeking health care because of the expectation of receiving insensitive care, and concerns about confidentiality, as well as liability, in many jurisdictions. In order to mitigate the disproportionate rates of STI and HIV among MSM, public health officials and clinicians need to become culturally competent, to develop services that conduct appropriate screening (e.g. rectal NAAT) in a sensitive manner.
- men who have sex with men