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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

Reader Comments:

Comment by: Randall (Texas) Thu., Mar. 26, 2009 at 9:19 pm UTC
It is a gay disease Gay gay gay
Reply to this comment

Comment by: Harvett Ellington (East Cleveland, OH) Sat., Dec. 6, 2008 at 10:48 am UTC

I will have to say that HIV is not just a gay disease, but a human disease. Even if HIV was not present and another disease is, people will still point the finger because of the wrong they have done. I am a black woman who have seen the horrors of this disease from all walks of life. People need to stop playing as if they are so holy and fight against this horrific disease. And to the individual who said that the perpetrators need to be exposed for the promotion of perversion, you are absolutely right.
Reply to this comment

Comment by: Sara ZIll (Tallahassee) Fri., Oct. 3, 2008 at 5:14 pm UTC
I don't think that we just need to focus on the gays. it's like saying that all blacks have AIDS. I am doing a bicycle ride across Florida to let people know that it is not just the gays or the blacks that have it. My dad died of it, and he was neither nor. I think that this government needs to crack down on it instead of making all these new gadgets, take the time to try a little harder, years from now they are going to have a cure, and they are going to be like damn we should have tried harder. Just my own little personal outlook.
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Comment by: weedy (charlotte north carolina) Sun., Sep. 21, 2008 at 8:08 pm UTC
i totally agree with the author....from the perspective of someone who works in HIV prevention ...dealing directly with prevention efforts for African American gay men...when grants are written for monies to fund hiv prevention programs, the data used are always overwhelmingly gay, which is the reality, but the programs and populations targeted are not...this practice is not only with prevention, it is with HIV care, Ryan White, research, etc....If the data for funding says it's a gay disease, then common sense tells you what?...(DUCK) and hopefully one would be trying to stopped the Quacking for the humor, but this is an old Swan song...and we are still waiting on CHANGE....I'm waiting for the details of Obama's HIV prevention policies....haven't heard much from any of them about HIV...I
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Comment by: Jose (Miami, FL) Thu., Sep. 18, 2008 at 3:35 pm UTC
I had a conversation with someone recently regarding this same issue. For the record, I am a gay male and I have HIV. Is this a "gay disease"? Not really, but many believe it was the "gays" that began it "all." The stigma that HIV/AIDS is a "gay disease" is unfortunately still with us after all these decades which goes hand-in-hand with homophobia and tremendous ignorance.
The reasons for the recent rise in infections is many, but I believe it has to do with the current mentality that HIV is no longer a "death sentence" and that all you take is a "pill" and you are done. HIV/AIDS is now viewed by the medical community as a "manageable chronic disease." All my doctors have told me the same as well. So imagine, with this mentality, people will go out and have unprotected sex and be involved in high risk behaviors knowing that a pill will save them. In addition, HIV in the 80's and 90's was very visible with visually sick people walking around and people dying literally hourly. Also add to that, the out of control media attention HIV was getting. These days, HIV is no longer "visible", not advertised and not even spoken about -- it has been brushed under the rug.
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Comment by: Charlie Le Clair (Miami, Fl.) Thu., Sep. 18, 2008 at 12:36 pm UTC
As the Former Chair of the local planning body for
Ryan White 2005 to 2006, I think I am in the position
to state this. First I am sick and tired of people
saying this is a GAY disease, This is a Human disease!!!. Everybody of all races must and need to change their sexual habits and behaviors, This is a Must!! We must do more to get united, fight to get the government to increase funding for Housing and Medical Needs. Everybody stop bitching and start acting. Action speaks louder than words --
the squeaky wheel DOES GET THE GREASE!
Reply to this comment

Comment by: Angela (South Berwick, ME) Thu., Sep. 18, 2008 at 12:25 pm UTC
I think you are dead wrong. HIV is EVERYONE's concern. If you narrow it to one population, like you want to narrow it to gay men, then why would the rest of the population care, fund or help? Some would out of sheer humanitarian idealism, but most would shrug it off as "their problem" and where would we be today with all of our meds and live prolonging treatments if that attitude had been taken back in 1984? NOT where we are today, that's for sure! HIV is a HUMAN problem, not any one specific genre's. As a 20+ year survivor, and a woman, I believe that we, as humans, need to take more responsibility for ALL of the problems of the world ... HIV is not just a "gay man's disease" just like global warming is not just a "factory emissions" problem! We all need to band together and fight to make our planet better - this includes eradicating HIV and a lot of other issues facing the world's population.
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Comment by: Rebel Price (Hillsborough, NC) Thu., Sep. 18, 2008 at 10:20 am UTC
I think you bring out many good points, but the one I did not see you speak about was the gay man's responsibility to himself and other gay men. Do the men having unprotected sex NOT have direct control and responsibility for their lustful encounters? I think they most assuredly do. I think the gay community should not expect more from the heterosexual community than they are willing to do or give from their own gay community. What responsibilities does a gay person have to care for his physical health and to not pass infectious diseases to others? I am not gay bashing, I am demanding to know where is a gay man's social responsibility for the sexual life he chooses? Where? Is? It? Not in the numbers from the CDC!
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Comment by: Kate Gallivan (Buffalo, NY) Thu., Sep. 18, 2008 at 9:16 am UTC
Thank you for writing this important article. Prevention programs that are targeting resources to the highest risk communities should not have to apologize for doing so. I do feel, however, that targeting messages that promote testing to high risk communities is an important part of the HIV prevention and care continuum. Knowing your HIV status is powerful. Our test counselors have learned to sieze the moment when delivering negative test results and use that time to discuss ways that we can support someone in staying negative.
Reply to this comment

Comment by: x Thu., Sep. 18, 2008 at 9:06 am UTC
For a time just before the period you mention, the population with the fastest growing rate of new HIV infections was ethnic females and you're suggesting that HIV is only a gay disease? Your argument is not only WHY new infections are on the rise in that population (because they believe you), but also why funding for prevention efforts in the gay community is limited. When the homophobic general population believes it's just a "gay disease" and not "everyone's problem," why would anyone care enough for funding for prevention efforts in our community to increase? I don't see a lot of gay men out there raising funds/awareness for breast cancer -- because it doesn't typically affect them. And if no one else cares enough about the homosexual community, why would you expect the homosexual community to care enough about itself (internalized-homophobia)? The statistics you point out are skewed because they fail to point out that BECAUSE heterosexuals still don't believe that they are at equally at risk for HIV, they don't go get tested for it. Gay men are more likely to get tested, so the reported numbers will be higher in our population.
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Comment by: HIV+ (The World) Thu., Sep. 18, 2008 at 8:32 am UTC
Here's my comment (if it should ever get posted): The gay barebackers and their idiot followers have no one to blame for the continual spread of AIDS but themselves. With the help of the internet, their culture of self hatred spreads like a wildfire: iconic images of kinky men barebacking one another as if on a mission does nothing to prevent the spread of all STDs plus drug addiction and destructive mental patterns. I don't think I've read many articles which lay the responsibility at the perpetrators of this culture. I don't think I ever will.
Reply to this comment

Comment by: Lori (Peoria,IL) Thu., Sep. 18, 2008 at 6:20 am UTC
How dare you say that this disease is only a gay disease! Because of people like you there still is the stigma. Instead of focusing on who has it, why don't you focus on getting the word out?
From a straight, female 19-year survivor.
Reply to this comment

Comment by: Robert Evans (New York) Wed., Sep. 17, 2008 at 11:08 pm UTC
After a forum at the Gay Center in New York, led by a spokesman from GMHC, Robert Bank, I sent the following email to a worker there:

Dear Kristin,

Robert Bank introduced me to you Wed evening at the Center when I asked him if he knew when the date of the rally at City Hall will be to protest the state cutbacks in HIV services, since I'd also like to tell them that HIV education is not occurring in most public schools in New York, at least not the middle school in Harlem where I was a school psychologist for 24 years. Even though Governor Paterson himself is from Harlem, he feels that the state deficit must require cutbacks in not only HIV services but budgets for public schools as well. The last meeting I went to at GMHC (I've been in the building only twice) concerned the protests to the City Council.
So if you could email me the date and time of the protest rally at City Hall (and the location, if you know), I could put it on my calendar and could perhaps help bring attention to how the health of kids in Harlem and other public schools are being neglected by budget cutbacks, that we hope will become better under President Obama. City Hall is far away from where I live in Washington Heights.

Thank you.

Robert P Evans

She never has replied

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