Increasing rates of sexually transmitted diseases in homosexual men in western Europe and the United States: Why?

STDs among homosexual and other men who have sex with men (MSM) are again on the increase. This is a finding that is consistent across Western Europe and the United States and, given the increasingly global interconnectedness of this community, is likely to have an impact on other geographic regions. The reasons for the increase are multifaceted, including substantial demographic shifts in MSM populations in industrialized countries; biologic factors such as epidemiologic synergy between HIV and other STDs; the possible transmission of drug-resistant STDs; and expansions in the sexual marketplace, which involves social and sexual networks that facilitate sex partner acquisition, with the Internet adding to, or in some cases replacing, more traditional meeting venues. Although evidence related to changing psychosocial contexts is emerging, a better understanding of the associations between high-risk sexual behavior and mental ill health, recreational drug use, socioeconomic deprivation, discrimination, and homophobia is required. In considering the strategic response to this issue, holistic approaches to improving sexual health among MSM within the "post-AIDS" context are urgently needed, alongside targeted interventions for HIV-positive MSM, the health care providers who care for them, and the custodians of social establishments directed at MSM.