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WHO guidelines for HIV/STI prevention and care among MSM and transgender people: implications for policy and practice
  1. Jenny Cohen1,
  2. Ying-Ru Lo2,
  3. Carlos F Caceres3,
  4. Jeffrey D Klausner4,
  5. For the WHO guideline working group
  1. 1Department of Medicine, University of California, San Francisco, California, USA
  2. 2Department of HIV/AIDS, World Health Organization (WHO), Switzerland, Switzerland
  3. 3Universidad Peruana Cayetano Heredia, Peru
  4. 4David Geffen Medical School and Global Health, University of California, Los Angeles, California, USA
  1. Correspondence to Dr Jenny K Cohen, Department of Medicine, University of California, 505 Parnassus Avenue, San Francisco, CA 94114, USA; Jenny.cohen{at}ucsf.edu.

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Rates of sexually transmitted infections (STIs) in men who have sex with men (MSM) peaked in the late 1980s in the developed world and then declined and resurged in the late 1990s.1–3 Several high-income countries responded to those rises in STI rates by enhancing surveillance, expanding community-based treatment services and increasing STI screening programmes.1 ,2 ,4 Although the response has been varied, for the most part, there has not been a similar public health movement around STI control in low-income and middle-income countries. Legal policies in some countries directed against same-sex behaviour discourage safer sex and sexual health promotion among MSM and transgender people.5 Additionally, MSM and transgender people experience profound barriers to quality healthcare due to discrimination and ignorance regarding non-traditional gender identity within the medical community.5 Furthermore, while the literature on the epidemiology of same-sex behaviour and prevalence of STIs in low-income and middle-income countries is scant, evidence suggests that MSM and transgender people have a relatively higher burden of STIs than non-MSM or transgender people.5 ,6

A recent meta-analysis found that MSM in low-income and middle-income countries were 19.3 times more likely to be HIV-infected than the general population.6 Reports show varied but generally higher prevalence of HIV infection among MSM as compared with non-MSM with some of the highest odds of HIV infection among MSM in Bolivia (178.8), Mexico (109.0) and Egypt (108.9).6 Thus, there is an urgent need for improved HIV prevention strategies in low-income and middle-income countries. The early diagnosis and treatment of STIs that may potentiate the spread of HIV infection is one such strategy, particularly in light of the fact that most rectal STIs are asymptomatic and are strongly associated with increased risk for the acquisition of HIV infection.

In 2011, WHO …

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Footnotes

  • Collaborators The guideline working group included (in alphabetical order): Abu S. Abdul-Quader, Centers for Disease Control and Prevention, USA office; Iyanthi Abeyewickreme, WHO—Regional Office for South-East Asia; Soas Aids, the Netherlands; Andrew Anglemyer, University of California at San Francisco, USA; Sam Avrett, UNDP; George Ayala, Global Forum on MSM and HIV, USA; Hana Azman, University of California at San Francisco, USA; George Azzi, HELEM, Lebanon; Rachel Baggaley, WHO—Department of HIV/AIDS; Andrew Ball, WHO—Department of HIV/AIDS; Michael Bartos, UNAIDS; Chris Beyrer, Johns Hopkins School of Public Health, USA; Diane Binson, University of California at San Francisco, USA; Naomi Bock, Centers for Disease Control and Prevention, USA office; Carlos F. Caceres, Universidad Peruana Cayetano Heredia, Peru; Nicolas Clark, WHO—Department of Mental Health and Substance Abuse; Ton Coenen, the Netherlands; Smiljka de Lussigny, WHO—Regional Office for Europe; Kim Dickson, WHO—Department of HIV/AIDS; Martin Donoghoe, WHO—Regional Office for Europe; Andrew Doupe, WHO—Department of HIV/AIDS; Anna Dovbakh, International HIV/AIDS Alliance, Ukraine; Mostafa El Nakib, Minsitry of Pulbic Health, Lebanon; Aids Fonds, the Netherlands; Antonio Gerbase, WHO—Department of HIV/AIDS; Andrew Grulich, University of New South Wales, Australia; Steven Gu, Asia Pacific Coalition on Male Sexual Health, Thailand; John Hassell, UNAIDS; Amy Herick, University of Pittsburgh, USA; Joumana Hermez, WHO—Regional Office for the Eastern Mediterranean; Gottfried Himschall, WHO—Department of HIV/AIDS; Tara Horvath, University of California at San Francisco, USA; Victoria Indrawati, Ministry of Health, Indonesia; Xu Jie, National Center for AIDS Prevention and Control, China; Siroat Jittjang, Family Health International, Thailand; Kamolset Kanggarnrua, Rainbow Sky Association, Thailand; JoAnne Keatley, Center of Excellence for Transgender Health, USA; Caitlin Kennedy, Johns Hopkins School of Public Health, USA; Selma Khamassi, WHO—Department of Safe Injection Global Network; Shivananda Khan, The Naz Foundation Trust, India; Jeffrey Klausner, Centers for Disease Control and Prevention, South Africa office; Els Klinkert, UNAIDS; Kelika A. Konda, Universidad Peruana Cayetano Heredia, Peru; Segundo Leon, Universidad Peruana Cayetano Heredia, Peru; Yng-Ru Lo, WHO—Department of HIV/AIDS; Geoffrey Manthey, UNAIDS; Rafael Mazin, WHO—Regional Office for the Americas; Han Mengjie, National Center for AIDS Prevention and Control, China; Michael Meulbroek, HISPANOSIDA, Spain; Francis Ndowa, WHO—Department of Reproductive Health and Research; Innocent Ntaganira WHO—Regional Office for Africa; Kevin O'Reily, WHO—Department of HIV/AIDS; Robert Oelrichs, World Bank; Pick Billy, USAID/PEPFAR; Maria Cristina Pimenta Oliviera, Brazilian Association for AIDS, Brazil; Mary Poynten, University of New South Wales, Australia; Nunung Pryatani, Ministry of Health, Indonesia; Ferran Pujol, HISPANOSIDA, Spain; Jirair Ratevosian, The Foundation for AIDS Research, USA; Kevin Rebe, Health4Men, South Africa; Gary Reid, WHO—Regional Office for South-East Asia; Michelle Rodolph, WHO—Department of HIV/AIDS; Keith Sabin, WHO—Department of HIV/AIDS; Julia Samuelson, WHO—Department of HIV/AIDS; Alfanso Silva Santisteban, Universidad Peruana Cayetano Heredia, Peru; Andy Seale, The Global Fund to Fight AIDS, Tuberculosis and Malaria, Switzerland; Eddy Segura, Universidad Peruana Cayetano Heredia, Peru; Edmund Settle, UNDP; Charles Shey, Wiysonge, University of Cape Town, South Africa; Jason Sigurdson, UNAIDS; Mariangela Simao, UNAIDS; Nira Singh, AIDS Task Force of Fiji, Fiji; Cynthia Souza, WHO—Department of Research Policy and Cooperation; Susan Timberlake, UNAIDS; Igor Toskin, WHO—Department of Reproductive Health and Research; Cheikh Traore, UNDP; Frits van Griensven, Centers for Disease Control and Prevention, Thailand office; Annette Verster, WHO—Department of HIV/AIDS; Marco Vitoria, WHO—Department of HIV/AIDS; Chongyi Wei, University of Pittsburgh, USA; William Woods, University of California at San Francisco, USA; Wei Xiaoyu, Centers for Disease Control and Prevention, China office; Pengfei Zhao, WHO—Regional Office for Western Pacific; Li Zhijun, Centers for Disease Control and Prevention, China office; Jose M. Zuniga, International Association of Physicians in AIDS Care, USA.

  • Contributors Each of the main authors contributed in at least one of the following domains per ICMJE guidelines (http://www.icmje.org/ethical_1author.html): (1) conception and design, acquisition of data or analysis and interpretation of data: JKC and JDK; (2) drafting the article or revising it critically for important intellectual content: JKC and JDK; and (3) final approval of the version to be published: CFC, YRL, JDK and JKC.

  • Competing Interest None.

  • Provenance and peer review Commissioned; internally peer reviewed.

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