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Pickett Fences

And the Band Plays On

Beyond Testing

September/October 2008

Jim Pickett

HIV has forced me to separate the bull from the shit, make priorities, get real.

Sounds familiar, doesn't it?

Meanwhile, back at the ranch -- the USA Not OK Corral -- gay men in the land of milk and honey continue to go hungry in the domestic AIDS epidemic.

If you're a black gay man, or a Latino gay man -- you're starving.
We, and I do mean the royal we (aka all of us, top to bottom, bottom to top, every one of our agencies, from the feds to the "mom and pop HIV shop" in your town), continue to miserably fail gay and bisexual men in the area of HIV prevention.

Back in June of 2008, just before National HIV Testing Day when everyone and their aunt is encouraged to get tested and know their status, right before the last orgiastic weekend of Gay Prides across the country, the Centers for Disease Control and Prevention released a report called "Trends in HIV/AIDS Diagnoses Among Men Who Have Sex with Men [MSM] -- 33 States, 2001-2006" in their venerable Morbidity and Mortality Weekly Report (MMWR June 27, 2008 / 57(25);681-686). With thanks to my friend and colleague David Munar for his precision analysis, here are some of the lowlights:

  • MSM diagnoses increased 8.6% from 2001-2006 in 33 states
  • Of 214,379 new HIV/AIDS infections reported in 33 states during the period, 46% -- by far the largest percentage -- occurred among MSM. Another 4% were among gay men who also injected drugs.
  • In 2001-2006, MSM remained the largest HIV transmission category and the only one associated with increasing numbers of HIV/AIDS diagnoses
  • Increases were highest for Western states (7.2% estimated annual increase) followed closely by Midwestern states (6.7% estimated annual increase)
  • The data excludes figures from California and Illinois, both of which include large gay populations
  • Observed increases were highest among MSM ages 13-24
  • From 2001-2006, cases among 13-24 black MSM increased 93.1% (from 938 cases in 2001 to 1,811 cases in 2006)
  • From 2001-2006, cases among 13-24 Asian/Pacific Islander MSM increased 255.6% (from 9 cases in 2001 to 32 cases in 2006)
  • From 2001-2006, cases among 13-24 Latino MSM increased 45.7% (from 330 cases in 2001 to 481 cases in 2006)
  • From 2001-2006, cases among 13-24 white MSM increased 63.4% (from 430 cases in 2001 to 703 in 2006)
Like how that sounds? How about that for a rhythm section? I for one simply adore all the chorus boys in their spandex and sparkles. Look at that stretch!

Someone asked me if I was surprised about this batch of rotten tomatoes (or is it poopy jalapeños these days? fecal lettuce?). Sadly, I replied that while the stats are shocking and speak to enormous suffering, and oh my god, the horrors of those catastrophic increases among our young gay guys, I was not in the least surprised. Why? Because we, and I do mean the royal we, have been essentially ignoring gay men of all colors in addressing this epidemic. Instead, we have chosen the politically expedient path of pushing the false notion of a generalized epidemic in which "we are all at risk." And yeah, another big problem many of us have helped orchestrate is making everything about testing, testing, testing. Where are we before the damn test? What are we doing to help ensure that sexually active gay men get consistent negatives on their tests, tests, tests?

"To reduce the impact of HIV/AIDS in the United States, HIV prevention services that aim to reduce the risk for acquiring and transmitting infection among MSM and link infected MSM to treatment must be expanded," recommends the CDC in the report.

Well, guess what? They don't have to do much to expand. Case in point -- in a May 2008 report called "An Assessment of CDC's HIV Prevention Interventions Portfolio: Identifying the Gaps," The AIDS Institute found that only four of 49 HIV/AIDS prevention strategies highly recommended by the CDC target gay men and none, zilch, zero were directed at black or Latino gay men.

We make up half the epidemic, half the epidemic, and we deserve less than 10% of the highly recommended interventions? In some urban areas, one in two black gay men are infected with HIV. That's half of all black gay men, and they get -- nothing. In major U.S. cities, as many as one in four Latino gay men have HIV -- nada. And for a little context, recall that gay men of all colors maybe make up about four percent of the entire U.S. population yet endure the rates I have described. How is that for a full-blown disparity? If we got the CDC up to eight highly recommended strategies, that would mean we increased prevention services targeted to gay men by 100%. But, hum a little ditty on this, would it be commensurate with the need?

Richard Wolitski, acting director of HIV/AIDS prevention at the CDC, told the Chicago Tribune, "One of the misperceptions that people have is that we have a sufficient number of well-researched interventions for preventing HIV/AIDS in [gay men] but that's not true." He went on to tell the Trib that a number of things were in the works for gay substance users, as well as research and training plans for black and Latino gay men.

Meanwhile, back at the USA Not OK Corral, gay men who are your friends, family, boyfriends, lovers, tricks, and exes, the gay men who are the people you meet while you're walking down the street, the people you meet each day, are getting infected in droves. Clearly, we can't wait for research and new trainings to be completed. We can't sit this one out and wait for the next dance. After all, we have always been at the center of the domestic epidemic, what could we possibly be waiting for?

If you claim to be doing HIV awareness, education and/or prevention work and you are neglecting gay men of all colors, and particularly black and Latino gay men and young gay men -- you are out of tune. If all you are doing is pushing testing on people, you are off the beat. If you are continuing to spread the notion that HIV is everybody's problem, you are rapping up the wrong tree. If you talk about the criminal disparities faced by black people in terms of this epidemic and as you lament the plight of black women you somehow "forget" to mention black gay men -- you've missed most of the chorus. And if you are serving gay men but insist on characterizing sex as dirty, scary, disease producing, and decidedly less than enjoyable, and if you are only addressing their needs with a narrow navel to knee focus -- the boys in the band won't be listening.

Recalling the Los Angeles Lesbian and Gay Community Center's "controversial" social marketing campaign from 2006, HIV is a gay disease. Make the score holistic and sing it, Mary.

"Keep it light, keep it bright, keep it gay." -- Roger DeBris, tres fey (and demented) director of "Springtime for Hitler" ("The Producers").

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This article was provided by Positively Aware. It is a part of the publication Positively Aware. Visit Positively Aware's website to find out more about the publication.
See Also
Fact Sheet: HIV/AIDS and Young Men Who Have Sex With Men
Quiz: Are You at Risk for HIV?
10 Common Fears About HIV Transmission
More Personal Views on HIV Prevention for Gay Men


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