Ask the Doctor: What Do Black Men Need to Know About HIV?

Theresa Mack, M.D., M.P.H.
Theresa Mack, M.D., M.P.H.

Every month, HIV specialist Theresa Mack, M.D., M.P.H.--an associate medical director at St. Luke's Medical Group in Harlem, N.Y.--will answer your most pressing HIV/AIDS questions.

HIV remains an epidemic in our community, and Black males account for the greatest number of new infections in the United States. Men who have sex with men (MSM) are particularly affected, with young Black MSM between the ages of 13 and 29 experiencing a 48 percent increase (pdf) in new HIV infections between 2006 and 2009.

Regardless of how you self-identify--heterosexual, gay, same-gender-loving, bisexual, MSM or MSMW (men who have sex with men and women)--unprotected sexual activity places you at risk for acquiring HIV.

A number of factors are believed to account for the increase in new infections among Black men:

  • Some heterosexual men have sex without a condom because they mistakenly believe that men cannot get HIV through sexual intercourse with a woman. However, that is a myth. If you have unprotected sex, you can get HIV.
  • Many young men are complacent about HIV prevention because medical advances are helping people live better and longer, so they have not seen large numbers of people die from AIDS. However, HIV is a disease that is better prevented than treated.
  • MSM have a greater risk of acquiring HIV with each sexual encounter, and that risk increases as they age because they are more like to encounter HIV-positive partners. Many young MSM have older partners, which puts the young men at greater risk of acquiring HIV.
  • Many Black men don't know their HIV status; stigma keeps them from getting tested for HIV.

Preventing Transmission

Men typically get diagnosed with HIV at an earlier stage in the disease than women do. Another difference between men and women is that women typically experience symptoms at a higher T-cell (CD4) count than men. For example, a man with a T-cell count of 300 is more likely to experience no symptoms than a woman with the same count.

Even if a man experiences no symptoms, it is important for him to begin antiretrovirals as soon as possible after an HIV diagnosis. Treating the disease not only enables him to maintain a longer and healthier life but also makes him less likely to transmit HIV to his sexual partners. This is also true for women.

Studies have shown that male circumcision has decreased the transmission of HIV from positive men to their female partners in African countries. Researchers are currently examining whether this is a prevention option for serodiscordant couples in the United States.

If an HIV-negative male or female has possible HIV exposure (sexual intercourse without a condom or the condom breaks), taking a PEP (postexposure prophylaxis) protocol may prevent HIV infection.

Maintaining Health

Annual checkups with your primary care provider are mandatory even if you are feeling well, regardless of your HIV status. If your physician doesn't talk to you about preventing HIV or, if you're already positive, not transmitting it to others, initiate the discussion and/or consider changing doctors.

Men should be screened not just for HIV and other sexually transmitted diseases but also for such conditions as diabetes, high blood pressure, high cholesterol and kidney disease. Men should also adopt certain healthy lifestyle habits, regardless of their HIV status:

  • Avoid smoking. Smokers between the ages of 65 and 75 should be screened for an abdominal aortic aneurysm, a condition in which the blood vessel that transfers blood to the abdomen, pelvis and legs becomes unusually large and can lead to a fatal aortic rupture.
  • Maintain a healthy weight.
  • Get approximately eight hours of sleep.
  • Make sure your immunizations are up-to-date. This means getting a pneumonia vaccine every five years, a flu vaccine every year and a tetanus booster every 10 years.
  • Talk to your doctor about getting screened for hepatitis C.
  • If you're a Black man, talk to your doctor to determine whether you should obtain a prostate-cancer screening at age 45. If you're HIV positive, speak to your doctor earlier.
  • Get a colonoscopy at age 50.

The bottom line is this: Having unprotected sex increases your risk of HIV infection every single time.

Tamara E. Holmes is a Washington, D.C.-based journalist who writes frequently about health and wellness.