September 21, 2011
The first of a two-part series examining what can be done to reverse the high rates of new HIV infection among Black gay and bisexual men.
The number of new HIV cases in the United States has remained fairly stable at about 50,000 per year between 2006 and 2009, according to data from the Centers for Disease Control and Prevention (CDC) that was published in early August in the online scientific journal PLoS ONE.
Predictably, the epidemic continues to affect Black America disproportionately: Forty-four percent of all new infections occurred among African Americans, who make up only about 13 percent of the population. And gay and bisexual men, who make up only an estimated 2 percent of the population, accounted for 61 percent of all new HIV infections in 2009. Young Black gay and bi men -- "men who have sex with men" (MSM), in public health jargon -- ages 13 to 29 experienced the greatest increases, with infection rates skyrocketing by more than 48 percent.
But government researchers described the soaring seroconversions among young Black MSM as "alarming." "The data is not surprising because we've been talking about young Black gay and bisexual men for some time," says A. Cornelius Baker, a member of the Presidential Advisory Council HIV/AIDS (PACHA), the senior communications consultant at AED Center on AIDS & Community Health and board chair of the Black AIDS Institute. "Now we have an opportunity to make some progress with bold and comprehensive strategies."
It's unclear why seroconversions are increasing.
"It's not just individual risk behavior. It's probably behavior plus late testing practices," says David J. Malebranche, M.D., M.P.H., assistant professor of medicine at Emory University in Atlanta and an expert on qualitative HIV behavioral prevention. "We see late testing across the Black community, such as in cancer, diabetes, high blood pressure. Plus, the heightened stigma of HIV certainly delays testing."
Experts estimate that African Americans make up 56 percent of all "late testers" -- people who learn of their positive HIV serostatus so far along in their illness that the disease progresses to AIDS within one year of diagnosis. "That means their viral loads are off the charts," Dr. Malebranche adds. The presence of high amounts of HIV in the body makes a person significantly more infectious.
Once people become aware of their HIV-positive status, not only are they more likely to take steps such as using condoms to avoid infecting their sexual partners, but research now shows that beginning treatment soon after diagnosis makes people with HIV/AIDS significantly less infectious.
But Black HIV-positive gay and bi men are least likely of all MSM to be aware of their serostatus. Among HIV-positive Black MSM under age 30, 71 percent were previously unaware of their infection. So not only does their own disease progress unimpeded, but they may unknowingly pass HIV to others.
"We also have higher rates of STDs that can lead to higher risk for HIV," says Dr. Malebranche. "We have to look at sexual networks among Black gay men, especially in Black gay enclaves in large urban centers and rural areas. We tend to sexually partner with each other more so than other races." A significant body of research has shown that sexual networks (pdf) can play a critical role in facilitating the spread of STDs, including HIV.
The apparent rise in new HIV infections could also reflect the success of recent efforts to aggressively test Black gay men, rather than an increase in new infections themselves, Dr. Malebranche adds.
For years HIV/AIDS activists have criticized the CDC for responding inadequately to persistently high increases in new infections among Black MSM. Today, however, the CDC is receiving high marks for a new social-marketing and public-awareness campaign to encourage HIV testing among Black MSM. The campaign, titled Testing Makes Us Stronger, debuted in August at the 2011 National HIV Prevention Conference in Atlanta and will officially launch on Sept. 27 in Atlanta, Houston, New York, Baltimore and Oakland, Calif.
The new data "underscores the urgency of reaching young Black men who have sex with men," Kevin Fenton, M.D., Ph.D., director of the CDC's National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, told reporters during a telebriefing. "We cannot allow the health of a new generation of young Black gay and bisexual men to be lost to essentially preventable diseases."
The testing message is a critical component of the new campaign.
"Knowing one's status is important in order to get medical care and treatment for their infection," says Richard Wolitski, a deputy director in the CDC's HIV/AIDS Prevention Division. "The CDC has shown that people who know their status engage in behaviors that significantly reduce risk for others of contracting HIV."
"Testing Makes Us Stronger builds on the strengths of young Black gay and bisexual men," adds Wolitski. "We wanted to show Black gay couples who are loving and supportive and, at the same time, document a diverse range of strong men in [the] community."
The program will include transit, magazine and online advertising -- and outreach across Facebook, Twitter, blogs and "hookup" websites popular with Black MSM.
"The young men we are targeting are on these sites," says Daniel Driffin, a 25-year-old prevention specialist at the Atlanta-based National AIDS & Education Services for Minorities. "It makes perfect sense for [the] CDC to be there -- especially because the first place many men [my age] get information is [the] Internet."
Kali Lindsey, the 30-year-old senior director of federal policy at Harlem United, was part of a CDC advisory group on the messaging. "The process was refreshing. They brought in about 19 or 20 of us who had expertise in delivering messages to Black gay men," he says.
Venton Jones, senior program associate for communications at the National Black Gay Men's Advocacy Coalition, also participated in the work group. "It's great that [the] CDC took our responses and made sure that the campaign portrayed the diversity of images of Black gay men," says the 27-year-old about the photography of the critically acclaimed Duane Cramer, a San Francisco-based Black gay photographer who snapped a variety of Black men for the campaign. "One or two images cannot fully represent who we are," Jones adds.
"The campaign is a step in the right direction to raise awareness in the community," says Harlem United's Lindsey, and "to encourage dialogue to where people are regularly engaging in conversations about HIV."
Rod McCullom has written and produced for ABC News and NBC, and his reporting and analysis have appeared in Ebony, The Advocate, ColorLines and other media. Rod blogs on politics, pop culture and Black gay news at rod20.com.