AIDS Issues Update Blog

Dispatches from the fight against homelessness and AIDS


Posted by Tim Murphy , December 09, 2013


Alex, 20, says, “I have three strikes against me: I’m black, I’m gay, and I’m in a wheelchair.” Photo: Nicole Bengiveno/The New York Times

We want to take a moment to highlight a story the NYTimes put on its cover last Friday. It lays bare something that the NYC health department neither highlighted amid its recent reports boasting that HIV infections in NYC are down 38 percent over the past decade nor has put out any major public campaigns about: Even though poor young Black and Latino men who have sex with men make up less than 1 percent of the national population, they continue to make up 25 percent of new HIV infections nationally—and nearly half of new infections in NYC.

The article also includes transgender women of color in this group.

Here is the meat of the story in terms of explaining why rates in this group remain so high:

“According to a major C.D.C.-led study, a male-male sex act for a young black American is eight times as likely to end in H.I.V. infection as it is for his white peers.

That is true even though, on average, black youths in the study took fewer risks than their white peers: they had fewer partners, engaged in fewer acts of sex while drunk or high, and used condoms more often.

They had other risk factors. Lacking health insurance, they were less likely to have seen doctors regularly and more likely to have syphilis, which creates a path for H.I.V.

But the crucial factor was that more of their partners were older black men, who are much more likely to have untreated H.I.V. than older white men.

Among the poor, untreated or inadequately treated H.I.V. is the norm, not the exception, said Perry N. Halkitis, a professor of psychology and public health at New York University. According to the C.D.C., 79 percent of H.I.V.-infected black men who have sex with men and 74 percent of Hispanics are not “virally suppressed,” meaning they can transmit the infection, either because they are not yet on antiretroviral drugs or are not taking them daily.”

And here is what the article says about why no headway has been made reversing rates in this group:

“The prospects for change look grim. Critics say little is being done to save this group, and none of it with any great urgency.

“There wasn’t even an ad campaign aimed at young black men until last year — what’s that about?” said Krishna Stone, a spokeswoman for GMHC, which was founded in the 1980s as the Gay Men’s Health Crisis.

Phill Wilson, president of the Black AIDS Institute in Los Angeles, said there were “no models out there right now for reaching these men.”

Federal and state health officials agreed that it had taken years to shift prevention messages away from targets chosen 30 years ago: men who frequent gay bars, many of whom are white and middle-class, and heterosexual teenagers, who are at relatively low risk. Funding for health agencies has been flat, and there has been little political pressure to focus on young gay blacks and Hispanics.

Reaching those men “is the Holy Grail, and we’re working on it,” said Dr. Jonathan Mermin, director of H.I.V. prevention at the C.D.C. His agency created its Testing Makes Us Stronger campaign — the one Ms. Stone referred to — and has granted millions of dollars to local health departments and community groups to pay for testing.

But he could not name a city or state with proven success in lowering infection rates in young gay minority men.”

Several people in the story point out the tremendous power Obama himself could have by saying something publicly about HIV/AIDS in this population. It wouldn’t be the first time he has spoken out in identification with young men of color (“If I had a son, he’d look like Trayvon”) and it wouldn’t be the first time he’s bravely stood up for the rights and wellness of LGBT people. It would be an amazing and transformative gesture from the president, and/or the First Lady. It could help refocus HIV prevention in the U.S. toward the group that needs it most.

Meanwhile, perhaps one of the first public health campaigns we’ll see from a De Blasio-era health department is one that highlights prevention and services for the city’s young Black and Latino gay and bi men. If the city can slather the subways with campaigns like the current one against sugary drinks, you’d think they could find the political will and the funding for a campaign that speaks to the single group still in the crosshairs of an epidemic that otherwise appears, fortunately, to be on the downturn in the city.

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