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    Men's HIV/AIDS Epidemic: It's Back

    Complacency Fuels Rising HIV Rate in Men Who Have Sex With Men

    Breaking the Silence continued...

    But many gay community leaders spoke out and promoted safe-sex messages. The result was one of the largest and fastest behavior changes in the history of public health -- and a sharp decline in HIV infections among gay men.

    These safe-sex messages now are not reaching young men who have sex with men -- especially men who don't consider themselves gay, men of color, and men whose larger communities still stigmatize homosexuality. Such men are far more likely to get, and spread, HIV.

    "It is a particular issue for nonwhites, for both African Americans and Hispanics," Jaffe says. "And those are very hard populations to get to, because if you ask them to identify with messages tailored for the white, mainstream gay community, that may not be effective."

    What's needed, Jaffe and colleagues suggest, is a new generation of leadership -- both in the public health community and in the communities of men who have sex with men.

    "We have to start talking about his. We can't just say the status quo is OK, because it isn't," Jaffe says.

    It isn't that gay community organizations aren't active any more. But their focus in recent years has been on advocating for expanded access to treatment and more funding for treatment research.

    "Our hope is they will become more engaged in advocating more for prevention and prevention research," Jaffe says. "Where is the kind of advocacy we saw in the mid-'80s for safer sex and in the mid-'90s for treatment? Where is it?"

    Jaffe's co-authors are Ronald O. Valdiserri, MD, MPH, former deputy director of the CDC's HIV/AIDS center and now chief consultant to the Veteran's Administration's Public Health Strategic Health Care Group; and Kevin M. De Cock, MD, former director of the CDC's division of AIDS prevention and now director of the World Health Organization's department of HIV/AIDS.

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