No Turning Back

Factors Behind a Possible Resurgence

Based on past prevention achievements, many people -- both within and outside the gay community -- mistakenly assume that the problem of HIV transmission among MSM has largely been addressed. However, ongoing and emerging challenges have meant that prevention must continually adapt to keep pace with an evolving disease. These challenges include:

A Shifting Epidemic Among MSM

Most of the prevention initiatives that proved so successful in the 1980s were implemented among white men with strong gay identities. Infection rates today remain high among African-American and Latino MSM, many of whom may not identify as gay or bisexual. Reaching these men requires new approaches to HIV prevention.

Difficulty Practicing Safer Sex Every Time

Research has demonstrated the difficulty of sustaining sexual behavior change over time in any population. Twenty years into the HIV epidemic, many older men who adopted safer sex practices in response to the initial health crisis may be finding it difficult to maintain these practices over the course of a lifetime.

Incorrect Assumptions About Partners' HIV Status

Surveys of MSM have found that some MSM may make false assumptions about their partners' HIV status. For example, an HIV-infected man may assume that his partner must be infected as well or he would insist on using a condom, while an uninfected man may assume his partner is also uninfected or he would use a condom.

Less Concern About Infection Due to New Treatments

The advent of combination therapy for treating HIV infection in the mid-1990s has posed new prevention challenges for MSM and others. Optimism about these treatments has led to increased risk behavior among some MSM, while some MSM mistakenly assume that they, or their partners, are not infectious when they take therapy and have low or undetectable viral loads.

Growing Population of HIV-Positive MSM

As a result of antiretroviral therapy, HIV-positive men are living longer, with substantially improved quality of life. Today, there are more HIV-positive individuals -- including more infected MSM -- living in the U.S. than at any time in the epidemic. With more HIV-infected people living longer, healthier lives, there are increased opportunities for HIV transmission.

Lack of Direct Experience with HIV/AIDS

Younger MSM -- many of whom have never known anyone infected with HIV or seen the toll of AIDS first-hand -- may be less motivated to practice safer sex.

Racism, Stigma and Lack of Services in Minority Communities

Social and economic factors including racism, homophobia, poverty, and lack of access to health care are barriers to receiving HIV prevention services, particularly for MSM of color.

The stigma of homosexuality in communities of color may inhibit men of color from identifying themselves as gay or bisexual, despite having sex with other men. This may prevent some men of color from seeking or receiving the HIV prevention and treatment services they need.

While many white MSM have traditionally had access to HIV prevention information and services through well-established community networks, similarly well-developed systems may not exist in African-American and Latino MSM communities, increasing the challenge of reaching these individuals. Additionally, research has found a general mistrust by African-American MSM of information that is provided by the government or by authority figures, pointing to an even greater need for programs which are developed in their own communities.⁽¹⁹⁾

The Role of Substance Use in HIV Transmission

Use of illegal drugs continues to be popular among some MSM, and studies indicate that substance use is often accompanied by increased sexual risk behavior.⁽²⁰⁾