Gay-HIV Epidemic Continues; Black Men at Highest Risk

Medically Reviewed by Charlotte E. Grayson Mathis, MD
From the WebMD Archives

Feb. 5, 2001 (Chicago) -- Young men across the U.S. continue to engage in unprotected anal and oral sex. The consequence: HIV rates among young gays are higher than ever, according to new government data reported here at the 8th Annual Retrovirus Conference.

"This is a public health emergency," says Lucia V. Torian, PhD, director of the office of AIDS research for the New York City Department of Health. "Our study shows that there is a segment of people with a very high prevalence of HIV infection and very high-level risk of HIV transmission. We need to identify these people, we need to get them to health services, we need to get them and their partners into treatment so they can stop transmitting disease."

It's not just New York. Torian's study was part of the larger Young Men's Survey led by Linda Valleroy, PhD, an epidemiologist with the Centers for Disease Control and Prevention (CDC) in Atlanta. Valleroy and colleagues spread out across the U.S. to focus on 23- to 29-year-old men in six cities: Baltimore, Dallas, Los Angeles, Miami, New York, and Seattle. They didn't just go to dance halls. They hit the streets in the early hours of the morning, ultimately stopping 3,000 men on their way to coffeehouses or movies, bookstores or bars, spending 45 minutes or more to take a complete behavioral inventory along with a blood sample for HIV testing.

Here's what they found. Thirty percent of black, young, gay men have HIV infection -- a rate as high as anywhere in the world, including the worst-hit parts of Africa. HIV prevalence is 15% among Hispanic gay men, 7% among white gay men, and 10% among those of other race/ethnicity. Overall, 12.3% of these young men who have sex with men also have HIV infection.

"What was really distressing to us was the 30% prevalence among African-Americans," Valleroy tells WebMD. "It is pretty much the same in all of the cities."

The news gets worse. Only 29% of the HIV-infected men even knew they were carrying the AIDS virus, and only 18% were getting medical care. In just the last six months before being interviewed, nearly half of all of the gay men -- 46% -- had unprotected anal sex.

"We were so disheartened to find out that so few HIV-positive men knew they were infected," Valleroy says. "That means newly infected people are transmitting the virus without knowing it."

HIV is a human virus, not a gay virus. The New York City data reveals this in a sobering statistic: More than two-thirds of the men in the study -- including 60% of self-identified gay men and 96% of self-identified bisexuals -- reported having sex with a woman.

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."