Ayden Scheim

Presenters focused on cisgender men’s HIV risks and engagement in prevention. Results highlighted strong retention of men, benefits of PrEP for MSM, provided the first data on MSM in South Sudan, and showed mixed effects of interventions to engage heterosexual men in prevention and treatment across multiple African countries.

Among Bangkok MSM, mathematical modeling predicted large reductions in HIV incidence with high PrEP adherence—up to 1183 infections per 10000 averted with 90% adherence and no condom use among MSM who use drugs during sex. In a U.S. cohort, PrEP-using MSM had more condomless sex while on PrEP. Rectal STI incidence didn't increase during PrEP and was lowest after discontinuation. The first biobehavioral survey of South Sudanese MSM found 3.3% HIV prevalence (compared to a 2.6% national average). In 5 high-burden African countries, testing, circumcision, and treatment funding for men aged 15-49 was added to the PEPFAR DREAM intervention for young women. For each outcome, PEPFAR program data improved in 2-3 countries, particularly for treatment initiation. A microfinance and peer leadership intervention to prevent HIV and IPV among young Tanzanian men had high retention (82% at 30 months) and positive effects on secondary outcomes of HIV testing and gender norms.

Jonathon Rendina noted the U.S. PrEP results indicate that PrEP is “working as it should”: MSM are using PrEP when they are at high risk and stopping when they are no longer at risk. Much work remains to address HIV prevention capacity among MSM in other settings—only 42% of South Sudanese MSM had ever seen lubricants for sex. The microfinance intervention for Tanzanian young men was innovative and informed by community input, but men were skeptical. The intervention was theoretically-based (intending to increase men’s time horizons), but other approaches might be more gender-appropriate.