Combating Anal Cancer Among HIV-Positive MSM in Asia

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In 2008, the Thai Red Cross AIDS Research Centre, a TREAT Asia network member in Bangkok, opened the Anonymous Clinic—a sexual health clinic with specific services for men who have sex with men (MSM). Because MSM living with HIV are twice as likely as those without HIV to develop the anal cancer associated with human papillomavirus (HPV), the clinic determined to start screening its patients for anal precancers.

Using funding from amfAR’s MSM Initiative (now the GMT Initiative), they purchased the high-resolution anoscopy microscope necessary to diagnose and treat both anal warts and precancerous anal lesions, and began providing anal Pap smears and treatment free of charge. This not only benefited their patients, it also generated some of the first data about HPV and anal neoplasia—the final stage the lesions reach before developing into cancer—among MSM in a resource-limited setting in the Asia-Pacific. TREAT Asia has been supporting the project since 2009.

The Thai Red Cross team found that approximately 10% of HIV-negative and 20% of HIV-positive MSM in Bangkok had pre-cancerous lesions, and almost 60% of positive MSM were infected with the strains of HPV most likely to progress to cancer, twice the rate of negative MSM. HIV-positive MSM were also much less likely to clear the infection without treatment, increasing their risk of developing anal neoplasia in the future.