MSM of color need HIV men's health leadership

Their infection rates are up

Young black men who have sex with men (MSM) had a 48% increase in new HIV infections between 2006 and 2009, according to the latest data reported by the Centers for Disease Control and Prevention (CDC) of Atlanta, GA.

"Greater than one-fourth of all new HIV infections in 2009 — 29% — were among young MSM, and it is largely driven by a sharp, statistically significant rise among black MSM," says Donna McCree, PhD, MPH, RPh, associate director for health equity in CDC's division of HIV/AIDS prevention in Atlanta, GA.

Young black MSM, those between 13 and 29 years of age, had 4,400 new infection cases in 2006. By 2009, this had risen to 6,500 new cases.

"We must take action there because individual risk behavior alone doesn't explain it," McCree says. "They are more likely to have older partners who are more likely to be infected, and this increases their risk with every sexual encounter."

Although the numbers are high, they don't reflect the epidemic's total impact on this population since many people infected with HIV do not know their HIV status.

"Young black HIV-positive MSM are less likely to be aware of their infection status," McCree says. "There's an issue of stigma; homophobia prevents many individuals from being tested because of the stigma associated with it."

"Young people may not have the insurance, or they have limited access to antiretroviral therapy (ART)," she adds. "We know that HIV-positive black MSM are half as likely to be taking ART as HIV-positive white MSM."

The five-year-old National Black Gay Men's Advocacy Coalition was created by black gay leaders in the United States to advance policy initiatives that would tackle this problem, and the recent data are a call to arms for the very same community leaders, says Cornelius A. Baker, a senior policy advisor for the National Black Gay Men's Advocacy Coalition in Washington, DC. Baker also was appointed to the Presidential Advisory Council on HIV/AIDS in 2009, and he is a senior communications advisor for the Center on AIDS & Community Health, FHI360, in Washington, DC.

The rise in HIV infections among MSM of color can be directly connected to the way federal politics have stigmatized gay and bisexual men and HIV prevention messages targeting them, Baker says.

"It's due to the [Jesse] Helms amendment where we couldn't focus HIV prevention efforts in a specific way," he explains.

Sen. Jesse Helms convinced the U.S. Congress in 1987 to prohibit the use of federal tax dollars for AIDS education materials that promote or encourage homosexual activities.

"Basically the 'no promo homo' amendment did not allow us to address sexual health and sex needs in a comprehensive platform for gay men," Baker says. "As a result, we saw an increase in HIV among all gay men, but with the most startling increase among young, black gay men."

In addition, the funding programs focused on young black and Latino gay men has been inadequate, Baker says.

"This population is largely out of the health care system," he says. "They're getting infected at an earlier age, both in families and communities, and there's not a lot of discussion about that."

The population has high unemployment and is subject to cultural stigmas. Since these young, black MSM come of age in an environment that already has a high level of HIV and other sexually-transmitted diseases, they are at greater risk of becoming infected with each sexual encounter.

Simply telling young men to not have unprotected sex is a flawed strategy, Baker notes.

"Everyone has known about HIV for 30 years, but everybody has known that smoking can give you lung cancer for 50 years," he says. "And yet one-quarter of our population still smokes."

Greater awareness is not the answer; the solution is to provide comprehensive health care access to these marginalized young men, and training doctors to speak directly to them about sexual risks, he adds.

"We just had a report come out from the National Medical Association, and in that study it showed that a majority of black physicians were hesitant about discussing HIV infection with their patients because they felt it represented a judgment on a person's sexuality or was stigmatizing their behaviors," Baker says. "So you have doctors subject to the same social stigmas, which are preventing them from asking a 17-year-old young man if he ever slept with another man and whether he wants a condom."

Increased testing and treatment access are the only way the epidemic can be conquered, he notes.

"Accessing appropriate treatment is a challenge especially since the epidemic is spreading most rapidly in the South, and most southern states right now have ADAP waiting lists, which is the primary access to treatment for this population," Baker says.

The CDC's initiative to increase HIV testing is a good first step, but it has to be followed up with building up a highly skilled network of organizations across the country that can serve young black gay men, Baker says.

These could include Title 10 community health centers, which are a natural resource for reproductive health and should be more engaged in the health and welfare of young men who are sexually active, he notes.

Plus there should be federal funding of research that will provide answers to why the epidemic is expanding among young MSM of color and what will work to stop the growth.

"There's a lot of speculation about why the epidemic is taking such a burden in this population, and we don't have all the answers, so we need to know more about why it is happening," Baker says.

"There has to be a real deliberate engagement about interrupting the epidemic in this population at the same level there was in interrupting mother-to-child transmission in the U.S.," he adds. "It took a lot of effort and work."

The CDC is involved in community mobilization efforts and getting partners involved, including the National Urban League and the NAACP, McCree says.

"We want to see what's going on with young black men so we can have an impact on this preventable epidemic," she adds.