Gay-HIV Epidemic Continues; Black Men at Highest Risk
Whether these numbers represent a resurgence of HIV among gay men depends upon whom one asks. Torian says the new numbers are "at best" as bad as it has ever been. Valleroy objects to the word "resurgence" because it implies that HIV among young gay men had gone away for a while -- and it never has.
CDC AIDS director Helene Gayle, MD, takes a longer view.
"It's a resurgence in the sense that our society has let up to a certain extent," she tells WebMD. "It's a societal resurgence, even if it's seen mainly in groups that have had consistent risk behavior over time. We have not put a focus on maintaining prevention efforts at the levels where they need to be. We need to be concerned about it."
Valleroy says it's time to act.
"There have been gaps in what we have been doing in prevention," she says. "Prevention efforts have been fairly good at reaching white men, older men in their late 20s and 30s -- less good at reaching adolescents or people in college. I would like to see more efforts in different cities to reach young men. It is a problem in schools, because they have a problem with sex education -- certainly with gay sex education. A lot can be done to reach younger men before they start going out and having sex."
To Valleroy and Torian, this means individualizing prevention efforts.
"Especially with African-American gay men, there could be a greater effort in trying to figure out where they are and trying to reach them," Valleroy says. "We should be spending time figuring out where this person is having problems -- is it drinking, self-esteem, drugs, depression? Prevention should be more centered on individual people and their risks. We are all different, and we slip up for different reasons."
The Young Men's Survey combined data collection with prevention outreach -- and showed that it can work. The cost of such an effort, however, will not be small.
"If there is any model that can help, it is this," Torian says, "Dr. Valleroy deserves the credit for developing it. It's the kind of trusting relationship that this team is providing that makes all the difference. It's expensive and labor intensive, and you can't do it with civil service workers because you must be out on the streets between midnight and 6 a.m. Case finding is the key -- find the partners and take them to their first clinic appointment."