In the four years since the United States became the first nation to approve Truvada (tenofovir/emtricitabine) as pre-exposure prophylaxis (PrEP), its rollout globally has been sluggish, resulting in a missed opportunity to confront the disproportionate epidemic of HIV among men who have sex with men (MSM) in particular. Publishing their findings in The Lancet, investigators analyzed medical research from January 2007 to October 2015 in order to track the evolution of the global response to the epidemic among MSM in recent years, especially following a call to action from researchers in 2012 to undertake greater disease-fighting efforts among this population.

On a bright note, the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) recently established a $100 million investment fund for so-called key populations of people affected by HIV, including MSM. Also, a handful of nations have followed the United States in approving PrEP.

But HIV incidence among MSM is “unacceptably high” in nations such as China, Kenya, Thailand, the United Kingdom and the United States where there are “substantial disparities” in subgroups of MSM, including younger men and racial minorities.

Some areas, such as New York City and San Francisco, have seen progress in rolling out PrEP. But on the whole, prescriptions for Truvada as prevention have been slow to spread, and the tablet’s use is insufficient to help drive down HIV’s transmission among MSM globally.

The lack of respect for LGBT rights has a significant impact on HIV among MSM around the world. The study found that while many nations have begun recognizing marriage equality, anti-LGBT legislation has increased in many nations, including Nigeria, Russia and the Gambia.

“While HIV rates have flattened overall in recent years, we’re really concerned that the HIV epidemic is continuing among gay men and we’re going in the wrong direction,” study leader Chris Beyrer, MD, MPH, the Desmond M. Tutu Professor of Public Health and Human Rights at the Bloomberg School and president of the International AIDS Society, said in a press release. “It’s a tragic situation and it’s painful that the history of AIDS is looking like its future, but that’s actually where we are. But the first step in taking on a problem is recognizing and articulating it and we’ve really done that here.”

To read a press release about the study, click here.

To read the study abstract, click here.