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Perceived Safety Intensifies
Danger for Gay and Bisexual Men
by Charles E. Clifton
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.
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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% (1,497) were Latino, and 42% were (2,421) Caucasian. The
fact that the vast majority of the study participants (95%)
self-identified as either gay or bisexual is attributed to
the fact that recruitment occurred at primarily gay venues.
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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.
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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% 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% (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.
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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 McKellar’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.”
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