December 8, 2014
In the United States, gay, bisexual, and other men who have sex with men (MSM)*1 are disproportionately affected by HIV. Gay and bisexual men represent approximately 2% of the US population, but accounted for three-fourths of all estimated new HIV infections annually from 2008 to 2010.
Among gay and bisexual men, black/African American** gay and bisexual men -- especially those who are younger -- are the group most affected by HIV. In 2010, African American gay and bisexual men accounted for almost as many new HIV infections as white gay and bisexual men, despite the differences in population size of African Americans compared to whites.
Although some progress has been made against new HIV infections among African Americans overall, a recent study of gay and bisexual men in 19 US cities and the District of Columbia showed a 19% increase in self-reported sex without condoms in HIV-positive African American gay and bisexual men -- from 47% in 2005 to 56% in 2011.
Estimated Incidence of HIV Infection Among Men Who Have Sex With Men, by Race/Ethnicity and Age at Infection, 2010 -- United States
Source: CDC. Estimated HIV incidence among adults and adolescents in the United States, 2007-2010. HIV Surveillance Supplemental Report 2012;17(4).
* Hispanics/Latinos can be of any race.
In addition to the risk factors affecting all gay and bisexual men (larger percentage of men with HIV in sexual networks; sexual risk factors, such as anal sex; more sex partners compared to other men; stigma, homophobia, and discrimination), there are several factors specific to African American gay and bisexual men. For example,
Socioeconomic factors. African Americans are more likely than men of other races/ethnicities to encounter factors -- such as limited access to and use of quality health care, lower income and educational attainment, and higher rates of unemployment and incarceration, which place them at higher risk for HIV. These factors may explain why African Americans have worse outcomes on the HIV continuum of care, including lower rates of linkage to care, retention in care, being prescribed HIV treatment, and viral suppression. New data from 2010 indicate that 75% of HIV-infected African Americans aged 13 years or older are linked to care, 48% are retained in care, 46% are prescribed antiretroviral therapy, and only 35% are virally suppressed.
Greater risk of being exposed to HIV. African American gay and bisexual men are a small subset of all gay and bisexual men, and their partners tend to be other men of the same race. Because of the small population size and the prevalence of HIV in that population, African American gay and bisexual men have a greater statistical risk of being exposed to HIV within their sexual networks.
Having sexual relationships with older men, who are more likely to have HIV, also may increase risk for exposure among some young African American gay and bisexual men.
Lack of awareness of HIV status is also a factor. Many African American gay and bisexual men with HIV, particularly those who are younger, are unaware of their status. People who do not know they have HIV do not get medical care and may not adopt prevention behaviors, and thus can unknowingly infect others.
Stigma, homophobia, and discrimination put gay and bisexual men of all races and ethnicities at risk for multiple physical and mental health problems and may affect whether they seek and are able to receive high-quality health services, including HIV testing, treatment, and other prevention services.
CDC's approach to addressing the HIV epidemic among African American gay and bisexual men involves three areas of commitment:
CDC is using this approach to fund state and local health departments and community-based organizations (CBOs) to support HIV prevention services for gay and bisexual men.
Funding for National Capacity Building Assistance for High Impact Prevention addresses gaps in each step of the HIV care continuum by providing training and technical assistance for staff of health departments, CBOs, and health care organizations. Estimated annual funding will be $22 million.
To expand HIV prevention services for young gay and bisexual men of color, transgender youth of color, and their partners, CDC awarded $55 million to 34 CBOs with strong links to these populations. This funding is being used to provide HIV testing to more than 90,000 young gay and bisexual men and transgender youth of color, with a goal of identifying more than 3,500 previously unrecognized HIV infections and linking those who have an HIV infection to care and prevention services.
Through its Act Against AIDS campaigns, CDC aims to provide gay and bisexual men with effective and culturally appropriate messages about HIV prevention. The Testing Makes Us Stronger campaign, encourages African American gay and bisexual men aged 18 to 44 to get tested for HIV. Start Talking. Stop HIV. encourages gay and bisexual men to communicate about safer sex, testing, and other HIV prevention issues.
The Act Against AIDS Leadership Initiative, a partnership between CDC and leading national civic and social organizations representing the populations hardest hit by HIV and AIDS, intensifies HIV prevention efforts in these populations.
The MSM Testing Initiative will establish and evaluate an HIV testing and linkage-to-care program to identify gay and bisexual men with HIV who were previously unaware of their infection and link them to HIV medical care.
Finally, through the Diffusion of Effective Behavioral Interventions project, CDC supports programs for gay and bisexual men most at risk of acquiring or transmitting HIV.
CDC HIV Website
CDC Act Against AIDS Campaign