Baltimore Leads in HIV Infection in Gay Men

CDC's recently released study involving men who have sex with men in 21 US cities found the proportion who were HIV-positive was greatest in Baltimore. In all, 38 percent of the about 500 MSM surveyed in Baltimore were infected. Of them, 73 percent were unaware of their infection, up from 62 percent in 2004-05.

While the survey findings are limited to men who frequent MSM-identified venues, local and federal officials say it is clear that testing and treatment lag for this most at-risk group.

It's alarming, and it does point to the importance of ensuring access to HIV testing, said Jennifer Horvath, a CDC spokesperson.

The stigma against being gay remains strong, especially in black communities, said Richard Matens, Baltimore's assistant commissioner for chronic diseases. Stigma, a sense of invincibility, lack of health insurance, HIV fears -- all are barriers to testing and treatment, said Collin Flynn, chief of the state's Center for HIV Surveillance.

Some people would rather admit injection drug use than homosexuality, Matens said. HIV interventions targeting injection drug users (IDUs) such as syringe-exchange programs have been effective in reducing the number of transmissions in Baltimore, he noted.

In 2008, the city had 200 new cases among IDUs, compared with 700 in 1994, Matens said. In 2001, MSM in Maryland trailed IDUs in new HIV cases. About six years ago, however, MSM surpassed IDUs in new cases.

The city has conducted focus groups in the gay community ahead of an awareness campaign, and it has chosen the Maryland Institute College of Art to create messages that resonate with MSM. Officials also do after-hours outreach in MSM clubs.

The high HIV rate is not likely to drop without more resources, said Heather Hauck, director of the state Infectious Disease and Environmental Health Administration.

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