At the XIV International AIDS Conference in Barcelona, Dr. Ron Valdiserri, deputy director of the U.S. Centers for Disease Control and Prevention (CDC) programs, released alarming data on the occurrence of unrecognized HIV infection and misperception of risk among young African-American "men who have sex with men" (MSM) -- the center's technical designation for gay and bisexual men.
This latest CDC data revealed that nine out of ten HIV-positive African Americans who participated in a study of young gay men were unaware of their HIV status.
Dr. Valdiserri also released data that indicates that rates of HIV infection have stabilized in the U.S. in recent years. Meanwhile, the widespread use of antiretroviral therapy in the U.S. has dramatically reduced the number of AIDS cases and deaths in adults and children since 1996. Since 1998, reported AIDS cases have remained at approximately 40,000 per year in the U.S.
The decrease in AIDS deaths over the last half-decade has given many people the misperception that AIDS and HIV are no longer a major health issue. However, the hundreds of thousands of individuals living with HIV in the U.S. are living with the day-to-day challenges of HIV. They struggle to adhere to complex treatment regimens, the life-changing side effects those meds can create, and drug resistance -- not to mention the socio-economic issues of work, housing and healthcare.
"Because of advances in treatment, HIV-positive individuals are living longer and healthier lives, and as new data clearly demonstrate -- they are continuing to have sexually active lives," Valdiserri stated. With the number of HIV-positive individuals continuing to increase, it is more urgent than ever that HIV prevention services for positives continue to expand and improve.
However, as Valdiserri emphasized, the "stability may not tell the whole story." While the overall rates of HIV infection may have stabilized, a closer look at the trends reveals that the majority of new infections are still occurring among gay and bisexual men, and specifically among African Americans in that population. The CDC estimates that approximately twenty-five percent of HIV-infected individuals in the U.S. are unaware of their infection. We must as a nation "move from apathy to action; from barriers to solutions, and from skepticism to resolve," Valdiserri declared in his opening statement.
Dr. Duncan MacKellar also presented new research data collected from the CDC's Young Men's Survey at the XIV International AIDS Conference. The CDC initiated a six-city study of men who have sex with men, or "MSM," in order to acquire data on the prevalence of HIV infection and the number of HIV-infected men who were unaware of their infection.
MacKellar discussed data from a scheduled poster presentation of his research at the Conference. From 1994-2000, 5,719 sexually active young men were recruited at 264 "gay-identified" locales, such as dance clubs, street corners and bars, in Baltimore, Dallas, Los Angeles, Miami, New York City and Seattle. The study was conducted in two phases. From 1994 to 1998, researchers enrolled MSM aged 15-22 years old and from 1998 to 2000 they enrolled MSM aged 23-29 years old.
At the locales, study participants were interviewed, offered counseling, and given HIV tests. Nineteen percent (1,089) of the study participants were African-American, 26 percent (1,497) were Latino, and 42 percent were (2,421) Caucasian. The fact that the vast majority of the study participants (95 percent) self-identified as either gay or bisexual is attributed to the fact that recruitment occurred at primarily gay venues.
Nearly ten percent of the participants, or 573 individuals, tested positive for HIV -- a rate nine times that of the general population. While African Americans only made up 19 percent of the total study group, they represented 43 percent, or 243 individuals, of those who tested positive for HIV disease.
Seventy-seven percent (440 of 573 individuals) of all positive participants did not know that they were HIV-positive, and 59 percent of the individuals who tested positive perceived themselves and their sexual partners as being at low or very low risk for infection. A distressing 91 percent (221) of the HIV-positive African Americans in this study did not know their HIV status.
Dr. MacKellar noted that 55 percent of the HIV-positive group had never tested or had last tested for HIV more than one year prior to entering the study. And half had engaged in unprotected anal sex with partners who they did not feel were at risk for HIV infection.
The reasons given for not using condoms with sexual partners (male and female) were varied, including that the participant "knew" himself to be HIV negative, "knew" his partner was HIV negative, or thought his partner was at low risk for being HIV infected. The survey also measured demographic characteristics, prior HIV testing including results of the most recent test, participants' perceived risk for HIV infection, and sexual behavior with men and women in the prior six months, including reasons for not using condoms.
The startling data clearly speaks to the challenges currently facing gay and bisexual men in the U.S. It also points to the need for increased funding to expand and improve HIV prevention programs, including supporting the efforts of community based organizations to reduce the stigma associated with HIV and testing for HIV.
Why is there such a high prevalence of African-American men who have sex with men living unknowingly with HIV disease? The reasons are both varied and plentiful. Many young men lack knowledge about how HIV is transmitted. Others live in areas with inadequate testing services or lack access to appropriate HIV prevention services.
That lack of appropriate and accessible prevention and testing interventions has several long-term implications. However, the immediate ramifications are two-fold. First, as the study points out, many MSM are unknowingly transmitting the virus to other men and women. Second, many HIV-positive individuals who do not know their HIV status are not accessing care and prevention services needed to live healthier lives.
Black gay activists responded to the study with a mixture of alarm and caution. While noting that the study further reveals the need for heightened efforts at stopping the spread of HIV among black gay youth, the advocates also urged observers not to further vilify an already stigmatized population.
As more researchers have focused on the startling HIV risk among black gay and bisexual men, some advocates have felt the media has responded to the new data by characterizing black gay men as sexually irresponsible. Those advocates now say MacKellar's findings disprove this notion, making it clear that the problem lies in getting these young men into testing.
"Now is the time to increase funding for HIV awareness and prevention programs for African-American gay men with messages that are culturally specific," said Steven Walker, a spokesperson for the National Advocates for Black Gay Health. "We must make sure that the persons delivering the message are knowledgeable and have close connections with the target group. Black gay men can best do this for the black gay community."