HIV Rages Among Gay Black Men
An alarming 60 percent of black men who have sex with men in the United States will become infected with HIV by the age of 40, according to the latest research presented at the XIX International AIDS Conference in Washington, D.C.
The HIV Prevention Trials Network study (HPTN 061) involved 1,553 black men in six cities - Atlanta, Boston, Los Angeles, New York, San Francisco, and Washington - between 2009 and 2011.
It found that 2.8 percent of the study participants became infected with the virus each year, a rate almost half again that of white MSM, said Kenneth Mayer, the study co-chair and medical research director at Fenway Community Health in Boston.
"For younger black MSM, those under the age of 30, there was an HIV incidence rate of about 5.9 per year, or about three times the rate of white MSMs," said Sheldon D. Fields, assistant dean for clinical affairs and health policy at Florida International University. "These rates are comparable to [what is seen in] countries in sub-Saharan Africa that are hardest hit by the epidemic."
Almost all of the participants (97 percent) agreed to take an HIV test. More than half either did not know their HIV status or believed that they were negative when they entered the study, but in fact, 165 of those men (12 percent) were already infected but did not know it.
"Black MSM in America are more affected by HIV than any population in the developed world, it rivals the epidemic that we find in the developing world," said Phill Wilson, president of the Black AIDS Institute.
"Black gay and bisexual men account for only 1 in 500 Americans, but 1 in 4 new HIV infections," he said. "They are significantly less likely to be alive three years after being diagnosed with AIDS than are white or Latino MSMs."
The public face of the AIDS epidemic in the U.S. in the 1980s was of white gay men, "but from 1985 on there was a disproportionate impact in the African American community," said Cornelius Baker, a veteran AIDS advocate based in Washington. "We failed very early on to grapple as a country to wrestle with that disparity."
Baker said it is important to acknowledge the proactive steps that black gay men have taken to educate themselves and create a sense of community and support, often in the face of racism, AIDS phobia, and homophobia within the broader black community.
It has been difficult to financially sustain those efforts because of high rates of poverty within the black community that limit both financial support for organizations and access to health care, according to Baker.
An initial assumption was that black gay men must have been doing something different from other gay men that put them at higher risk for infection. But evidence over the years has shown that is simply not the case, said Gregorio Millett. He is a researcher with the Centers for Disease Control and Prevention and played a leading role in writing the national HIV/AIDS strategy for the United States, released in 2010 ( http://www.whitehouse.gov/sites/default/files/uploads/NHAS.pdf).
"They engage in comparable, if not less risky, behavior than other gay men," Millett said. Young black gay men in particular "are less likely to have amphetamine use, injection drug use, less likely to use drugs during sex, but they are still five times more likely to be HIV-positive and two-and-a-half times more likely to have an STD [sexually transmitted disease]."
"We need to refocus on the context," Millett said.
A leading factor is that the prevalence of HIV is higher among the pool of black gay men with whom they tend to have sex. Higher rates of poverty also mean that black gay men are less likely to be under medical care for their HIV.
"In terms of viral suppression, we are far less likely, at least 50 percent less likely, to be virally suppressed [below the level of detection] compared to white gay men," Millett said.