Volume 5 • Issue 8 • 1000331 Open Access Research Article J AIDS Clin Res ISSN: 2155-6113 JAR an open access journal Ayala et al., J AIDS Clin Res 2014, 5:8 http://dx.doi.org/10.4172/2155-6113.1000331 AIDS & Clinical Research HIV Treatment Cascades that Leak: Correlates of Drop-off from the HIV Care Continuum among Men who have Sex with Men Worldwide George Ayala 1 *, Keletso Makofane 1 , Glenn-Milo Santos 2,3 , Sonya Arreola 1 , Pato Hebert 1 , Matthew Thomann 4 , Patrick Wilson 5 , Jack Beck 1 and Tri D. Do 5 1 The Global Forum on MSM & HIV (MSMGF), Oakland, California, USA 2 Department of Community Health Systems, University of California, San Francisco, California, USA 3 San Francisco Department of Public Health, San Francisco, California, USA 4 Mailman School of Public Health, Columbia University, New York, New York, USA 5 Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, California, USA *Corresponding author: George Ayala, The Global Forum on MSM & HIV (MSMGF), 436 14th Street, Suite 1500, Oakland, California 94612, USA, Tel: 1 (213) 268-1777; E-mail: gayala@msmgf.org Received June 20, 2014; Accepted July 31, 2014; Published August 08, 2014 Citation: Ayala G, Makofane K, Santos GM, Arreola S, Hebert P, et al. (2014) HIV Treatment Cascades that Leak: Correlates of Drop-off from the HIV Care Continuum among Men who have Sex with Men Worldwide. J AIDS Clin Res 5: 331. doi:10.4172/2155-6113.1000331 Copyright: © 2014 Ayala G, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Keywords: Men who have sex with men; MSM; HIV; HIV diagnosis; Access to care; HIV care continuum; HIV treatment cascade Introduction Men who have sex with men (MSM) are disproportionately afected by the human immunodefciency virus (HIV) compared to the general population in nearly all countries reliably collecting surveillance data [1,2]. MSM have 19.3-fold greater odds of being infected with HIV compared with the general population in low- and middle-income country settings [3]. Te prevalence of HIV among MSM across regions (North, South, and Central America; South and Southeast Asia; and Sub-Saharan Africa) ranges consistently between 14 and 18% [1]. In many high-income countries, the incidence of HIV among MSM remains unchanged over recent years, and in some cases, it is increasing even when HIV incidence in the general population is in decline [4]. For example, in the United States, the number of new HIV infections among MSM has been increasing at a rate of 8% per year since 2001 [5]. Te health and prevention benefts of antiretroviral therapy (ART) in the management of HIV are now well documented [6-10]. Behavioral prevention programs, early diagnosis, prompt linkage to sustained care, retention in care, receipt of ART, and viral suppression constitute points along a comprehensive continuum of HIV care [11]. Te efective implementation of a comprehensive continuum of care, including unfettered access to and utilization of ART, is associated with reduced morbidity, reduced mortality, and reduced onward transmission of HIV [12-14]. However, current service delivery models are less than optimal in linking and retaining socially marginalized groups, resulting in drop-ofs in the treatment cascade and failure to fully realize the health and prevention benefts of ART [15,16]. Tese gaps are particularly true for MSM as evidenced by persistently high HIV prevalence and incidence rates. For MSM, HIV responses at the country level continue to be seriously hampered by daily experiences of stigma, discrimination, violence and criminalization [17-20]. MSM who live in countries that criminalize homosexuality have higher mean scores on perceived homophobia scales and decreased access to basic HIV services, including access to ART, compared to MSM who live in countries with more supportive legal frameworks [21]. Abstract Objectives: The health and prevention benefts of antiretroviral therapies (ART), delivered as part of comprehensive HIV care programs remain unrealized for men who have sex with men (MSM). This multilevel study explores the correlates of drop-off from the HIV care continuum in an international study of MSM, taking into account individual and regional differences in access to and utilization of care. Methods: We conducted a study of the continuum of HIV diagnosis and care among 6095 MSM using data collected from an international online survey of MSM conducted in 2012. In this model of the HIV treatment cascade, we treated each point along the continuum as an outcome variable. We then investigated the relationships between clinical care outcomes and a set of demographic and psychosocial factors that were hypothesized to correlate with the outcomes using bivariate and multivariable statistical techniques. Results: Among MSM living with HIV for longer than 12 months (n=632), 50%(n=319) were virologically suppressed. Among MSM recently infected with HIV (n=91), the proportion was relatively smaller at 33%. Signifcant correlates of being on ART and retained in care included: accessibility of HIV treatment; comfort with a healthcare provider; and engagement in a gay community. Perceptions of homophobia were negatively associated with being on ART and being retained in care. Conclusions: These fndings underscore the need for service delivery models that sensitively address HIV among MSM. Public health offcials should adopt comprehensive HIV programs that include mutually reinforcing components and that address varying needs of MSM newly diagnosed and living with HIV. Comprehensive HIV programs must also support the critical role communities play in linking and retaining MSM into HIV services. Further studies validating the fndings in country-specifc contexts are warranted. Key words: Men who have sex with men; MSM; HIV; HIV diagnosis; Access to care; HIV care continuum; HIV treatment cascade