August 30, 2011
Young black gay and bisexual men are the only population in the U.S. in which the pace of HIV's spread is increasing, according to a startling study released by the Centers for Disease Control and Prevention yesterday.
CDC researchers looked at new infections between 2006 and 2009 and discovered that, as expected, we're still logging roughly 50,000 new infections overall each year in the U.S. We've been at that level for several years. The study also re-confirmed that African Americans are a wildly disproportionate number of those new infections. Blacks accounted for 44 percent of new infections, despite being just about 12 percent of the overall U.S. population in the 2010 Census.
But CDC noted with alarm that, unlike all other subpopulations in the U.S., black gay and bisexual men between the age of 18 and 29 saw a dramatic increase in infections: up by 48 percent in the three-year span of the study.
"We are deeply concerned by the alarming rise in new HIV infections in young, black gay and bisexual men and the continued impact of HIV among young gay and bisexual men of all races," CDC's HIV prevention director Jonathan Mermin declared in a statement. "We cannot allow the health of a new generation of gay men to be lost to a preventable disease. It's time to renew the focus on HIV among gay men and confront the homophobia and stigma that all too often accompany this disease."
The findings are dramatic, but they are not unexpected. They represent a worsening of a trend epidemiologists have followed for years, since at least the late 1990s. What's really new is the CDC's more aggressive and nuanced efforts to track HIV, a development made possible by recent improvements in testing and tracking technologies. Regardless, the concentration of the epidemic around not only black folks, but black gay and bisexual men is in fact alarming and long overdue for meaningful attention from both public health and the overall black community.
"They're calling this 'alarming' but it's clearly past that point," said Phill Wilson, director of of the Black AIDS Institute (for which I've worked previously as a consultant). Which begs the two perennial questions on HIV: Why is this happening and what can be done about it?
I've been reporting on and writing about the black epidemic, and the black gay epidemic specifically, for 15 years. I've learned about myriad causes for the striking disparities, ranging from biology to economics. And anybody who offers a singular and certain answer to either of the questions above is deluding themselves, lying to you or both. The difficult reality is that HIV has always exploited the messy, tangled web of our national and global inequities. Where there is poverty, there is HIV. Where there is poor access to health care overall, there is HIV. Where there is sexual shaming, there is HIV. Where people don't have the economic or emotional resources to protect themselves from a whole host of threats, there is HIV.
I could go on in this vein. Suffice to say that young, black gay and bisexual men are among the most economically, emotionally and culturally beat up groups of people in the U.S. They are uniquely at risk for a long list of social ills -- hate crime, homelessness, honestly just about any of the things researchers look at when measuring health risks among young people. So of course they are uniquely at risk for HIV, too.
So what has to happen? The real answer is everything. A massive, holistic intervention is needed, including everyone from black ministers on through to the targeted efforts of every public health department in America. But there are a couple of clear pressure points to address.
One is HIV testing. Research shows that, despite being at such high risk, black gay and bisexual men aren't doing anything more risky than their peers -- no higher drug use, no higher rate of unprotected sex (in fact, gay and bisexual men of all races report higher rates of protected sex than their peers). But research also shows young back gay and bi men are the least likely to know their HIV status or believe themselves to be at risk.
Another pressure point is access to health care for those who are positive and to the large and growing set of prevention tools for those who aren't. As Wilson puts it, "We now have the tools that could dramatically drive down new infections. We understand that people must be tested and know their status. We understand that linking 'poz' people to care right away saves lives. And we know that providing anti-retrovirals to healthy people can also save lives."
So let's do those things, at minimum. But that's going to require far more investment of resources from everyone, ranging from our own community to the public health sector. Until that happens, we'll keep getting "alarming" reports on new infections. And not for nothing: that's been going on for 30 damn years now.
Kai Wright is editorial director of Colorlines.com and an Alfred Knobler Fellow of The Nation Institute. His investigative reporting and news analysis appears regularly in The Nation, The Root and The American Prospect, among other publications, and he is a regular commentator on National Public Radio and in other broadcast media. His work explores the politics of sex, race and health.