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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}

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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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