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Daily HIV/AIDS Report
Public Health &
Education | New CDC Data Report HIV Infections Up Among Gay Men,
Particularly African Americans
[Jun 01, 2001]
In a "special" June 1 edition of Morbidity
and Mortality Weekly Report devoted to 20 years of the AIDS
epidemic in the United States, the CDC
released new study findings that indicate the incidence rate of HIV among
men who have sex with men is rising to rates not seen since the early days
of the epidemic, and African-American men are among those hardest hit. At a
press conference yesterday in Washington, D.C., Helene Gayle, director of
the CDC's National Center
for HIV, STD and TB Prevention, said that the study "has documented
the dramatic impact HIV is having among gay and bisexual men of all races
and the urgent need to expand our prevention efforts for these men,
particularly in these African-American communities" (CDC
release, 5/31).
'Alarming'
Rates
The report focuses on a follow-up study to the Young Men's Survey conducted
between 1994 and 1998, which found a "high prevalence" of HIV in
men who have sex with men ages 15 to 22 in seven U.S. cities -- Baltimore,
Dallas, New York, Los Angeles, Miami, San Francisco and Seattle. Overall
prevalence of HIV was 7.2% for the 3,492 MSM surveyed. The second phase of
the study, which from 1998 to 2000 surveyed 2,942 MSM between the ages of 23
and 29 in six of the seven cities (excluding San Francisco), also found an
overall 7% prevalence rate, but the rate among African-American MSM was 32%.
The study also used a new blood test to determine the incidence rate of new
infections in the past year, which is also used as a measure of risk. The
overall incidence rate was 4.4%: 2.5% among whites, 3.5% among Hispanics and
14.7% among African Americans (MMWR, 6/1). These rates
"suggest" that there may be a "resurgent [HIV] epidemic"
among MSM, particularly among black MSM, the Washington Post
reports. In the early 1980s, during the initial years of the epidemic, the
incidence rate among MSM was 18%. Between 1985 and 1990, that rate dropped
to 3% to 5%, according to CDC epidemiologist Linda Valleroy, who headed the
new study. Several studies throughout the 1990s showed an incidence rate of
1.6% to 3.5% among MSM. The new figures indicate that the HIV/AIDS epidemic
among young MSM is "clearly on the upswing," according to the Post.
Surgeon General David Satcher tried to put the numbers in perspective,
saying that the prevalence rate among black MSM is "approaching
Botswana's level of infection" (Brown, Washington Post,
6/1). "We tend to think about our rates in the United States as being
so much less than what we are seeing in other countries, and that is true if
we look at it overall," Gayle explained. However, the survey "show[s]
that there may be populations in this country that have rates and potential
for explosion analogous to what we have seen in other parts of the
world," she added. Gayle and Valleroy said the rates were
"alarming" and "of critical public health importance,"
but "cautioned" that the results "do not necessarily hold
true" outside those cities studied. The sample size was
"small" and researchers recruited men from gay bars and other
"similar venues," whose "sexual practices and drug use may
not mirror those of other gay men." CDC officials estimate that the
incidence rate for black MSM may range anywhere from 7.9% to 27.1%. However,
health officials stressed that even the lower 7.9% rate "suggested a
resurgence" of HIV among young gay men. "The important thing about
this is there is a significant and continuing HIV epidemic among MSM in
these cities right now," Valleroy added (Altman, New York Times,
6/1).
What
Happened?
The causes of the increase in HIV infections are not known, the Post
reports, but some speculate that the success of drug therapies over the last
five years has lulled many young people into viewing HIV as a
"manageable, chronic disease" (Washington Post, 6/1).
People "think the new drugs will save them, let them look beautiful.
But what about my failing liver? What about my fabulous face with the sunken
cheeks? It is not a glamorous life," Sanford Gaylord, a black Chicago
author with HIV, said (Manier/Obejas, Chicago Tribune, 6/1).
Peter Piot, director of UNAIDS, said that a "mix of complacency and
sophisticated treatment may have undermined prevention campaigns" in
the West. The developed world has shown a "clear failure" in
prevention efforts and is "certainly not a model" for developing
nations in Africa and Asia to follow, he added ( Richmond
Times-Dispatch, 6/1). "The sense that the worst is over has
dangerously blinded the public. The disease is less visible -- there's less
drama, yet it's more widespread," Mathilde Krim, founding chair of the
American Foundation for AIDS research, said (Rose, New York Daily News,
6/1). "We are damned by our own successes. People don't perceive that
you get infected and die within two months. All these posters that say you
can climb mountains with AIDS. People feel it isn't too bad -- until they
get infected," Phill Wilson, founder of the African American AIDS
Policy and Training Institute, said (Cimons, Los Angeles Times,
6/1). The age of those being infected may also be a factor. "This is a
whole new generation who didn't see people they knew, their friends and
loved ones, withering away and dying," Marty Algaze, spokesperson for
the Gay Men's Health Crisis, said (Delfiner, New York Post,
6/1).
Reaching
Out to Minorities
The higher incidence rate among blacks is a "screaming emergency,"
Wilson said. The United States has "failed in developing prevention
messages for young black men who have sex with men," he added. The
country has been "reluctant" to mount prevention campaigns aimed
at black MSM, partly because of a greater "broad social prejudice"
against young black men, he said, adding, "We cannot ask someone to
protect his life if you have not convinced him that his life is worth
protecting" (Washington Post, 6/1). Homophobia has also
contributed to the failure of prevention efforts, experts say. McCay
Moiforay, who worked on the Baltimore portion of the survey, said black MSM
have "more trouble gaining acceptance from family and friends"
than in other cultures, which complicates talking about AIDS and learning
how to protect oneself. The "lack of acceptance" has also led many
MSM to continue relationships with women, putting their partners and
children at risk (Bor, Baltimore Sun, 6/1).
A New Plan
Reaching these "hidden" black MSM "might be one of the most
difficult challenges to date," Thomas Liberti, chief of the HIV/AIDS
bureau for the Florida Department of Health in Tallahassee, said (Suriano, Orlando
Sentinel, 6/1). "There was a long-standing feeling that HIV was
not a problem for communities of color. People thought of this as a white
gay disease and not as a disease that was going to impact the
African-American community," Gayle said (Marziani, Washington
Times, 6/1). To change that opinion and reach more minorities, the
CDC announced in January a new "strategic plan" to "targe[t]"
those at highest risk of HIV infection, including minority MSM. The agency
has already convened two meetings to "outlin[e] prevention priorities
for MSM." Any such prevention programs "must address the stigma of
homosexuality," which prevents many men from "accessing needed
prevention and treatment services," Gayle said. The CDC donates nearly
$400 million annually to state and local prevention programs and this year
will include $12 million for community-based organizations dedicated to
developing programs for minority MSM. An additional $3 million will go to
national and regional groups to provide "training and technical
assistance" to such groups (CDC release, 5/31).
Overall
Findings
The MMWR also examines the past 20 years of the AIDS epidemic
more generally. Some of its other findings:
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As of December
31, 2000, 774,467 Americans were reported to have AIDS, 448,060 of whom
have died.
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As of December
31, 2000, there were 322,865 Americans living with AIDS; 79% were men,
61% were black or Hispanic and 41% were infected through homosexual
contact (MMWR, 6/1).
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