Disproportionately High Rates of STDs among Men who Have Sex with Men (MSM)

STDs are an especially important health concern for men who have sex with men (MSM). Compared to heterosexual men, MSM in the U.S. are at disproportionate risk for many STDs, including HIV, gonorrhea, syphilis, HPV, HSV-2, and HHV-8. For example, studies of gonorrhea prevalence among STD clinic attendees show rates of gonorrhea among MSM nearly double rates for heterosexual men. Reasons for disparate STD rates among MSM are multiple and complex, and include physiological factors, partner dynamics, sexual practices, sexual network characteristics, unique developmental circumstances, and alcohol and drug use. A comprehensive approach that encompasses improved surveillance, increased diagnostic and treatment capabilities, strengthened prevention efforts and a vigorous community response would help to substantially narrow these disparities. In addition to summarizing the epidemiology of STD disparities among MSM, this presentation will also review the individual and societal determinants of disparate STD risk, and outline public health research priorities that should be undertaken to reduce these disparities. Among the key research priorities are: improved estimates of STD incidence and prevalence, especially for MSM of color, interventions to improve health care providers' capacity to assess and address the sexual health needs of MSM, new approaches to partner notification, diagnosis and treatment (especially approaches based on social network constructs), and structural interventions to reduce risky sexual behavior in public sex environments. Finally, successful efforts to reduce STD disparities among MSM will require the active engagement of and support by MSM communities in their own vision of what it means to be healthy.