In San Francisco, incidence of the “Gay Bowel Syndrome,” as it was called in medical journals, had increased by 8,000 percent after 1973. herpes simplex virus (HSV) and Chlamydia trachomatis.Īccording to Randy Shilts, who before his death from AIDS covered the epidemic: , or Salmonella enterica intestinal parasites such as Giardia and Entamoeba spp. Infectious agents included Shigella sonnei, Shigella flexneri, Campylobacter spp. In the 1970s, physicians were treating the large number of conditions affecting the lower intestinal tract of MSM under the classification “gay bowel syndrome.” These included viral infections, infectious diarrheal diseases caused by bacteria and parasites, and injuries caused by anal sexual activity. Even before the first MSM was infected with the virus, MSM were already in the midst of an epidemic of STDs. It was not an accident that the AIDS epidemic first struck MSM. MSM are 44 to 86 times more likely to be diagnosed HIV positive than men who don't ( Purcell et al. ( CDC 2013a)Īccording to the CDC, one in five sexually active gays and bisexuals is carrying the AIDS virus and nearly half of those infected don't know it ( CDC 2013b). MSM accounted for 52% of all people living with HIV infection in 2009, the most recent year these data are available. Although MSM represent about 4% of the male population in the United States, in 2010, MSM accounted for 78% of new HIV infections among males and 63% of all new infections. In 2010, the estimated number of new HIV infections among MSM was 29,800, a significant 12% increase from the 26,700 new infections among MSM in 2008. It includes some MSM with AIDS who died of other causes ( Cranor 2013). This includes the transmission category MSM and use injection drugs. In 2009 the last year for which figures are available, the CDC estimated that 8361 MSM with AIDS died. Since then over 302,143 men who have sex with men (MSM) with AIDS have died. In the period October 1980–May 1981, 5 young men, all active homosexuals, were treated for biopsy-confirmed Pneumocystis carinii pneumonia at 3 different hospitals in Los Angeles, California. The first report of what would become the HIV epidemic appeared in MMWR Weekly in June of 1981. This paper deals with the history of the syndemic, the failure of various risk reduction strategies, and treatment as prevention. In the more than three decades since the beginning of the HIV/AIDS epidemic, there have been substantial advances in testing and treatment, yet the infection rate among MSM, and particularly young MSM, remains high, even as it has been dropping among other risk groups. While MSM are disproportionately affected by HIV, syphilis, and other STDs, health activists from the gay community have systematically resisted the application of the full range of public health strategies traditionally used to prevent their spread. These factors include the number of infectious diseases endemic in this population, the high rate of substance abuse problems and psychological disorders, and the significant percentage of MSM who have experienced childhood sexual abuse and other adverse events. The various elements of the syndemic have an additive effect, each one intensifying the others. The spread of HIV and other STDs among men who have sex with men (MSM) has been labeled a syndemic because in this population a number of different and interrelated health problems have come together and interact with one another.
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