AIDS Guide for Health Care Workers

Facts about HIV/AIDS and the epidemic's continued impact on gay and bisexual men

This group still has greatest risk, despite prevention efforts

The Centers for Disease Control and Prevention of Atlanta recently released a study showing that men who have sex with men (MSM) continue to be the population at highest risk for HIV infection, despite significant declines in their HIV infections rates since the peak years of the mid- and late-1980’s. (To see related chart, click here.)

Improvements in medication regimens and the relatively stable new national infection rate may have lulled some health care professionals into believing that prevention efforts are no longer as crucial for the gay and bisexual population. There have been significant strides made in reducing high-risk behavior among MSM, but these efforts must be continued and given even more emphasis as new generations of MSM emerge in the at-risk population.

The CDC lists these facts about MSM in the United States, offers ideas for prevention strategies, and explains why this population is particularly vulnerable to the HIV epidemic:

• The number of deaths from AIDS among heterosexuals added to the deaths among injection drug users still does not equal the 260,000-plus deaths among MSM.

• By gender, 70% of new HIV infections each year occur among men.

• MSM represent the largest proportion of new infections with 42%, heterosexual sex accounts for 33% of new infections, and injection drug use causes 25% of new infections.

• Categorized by race, 54% of new HIV infections occur among blacks, 26% among whites, 19% among Hispanics, and 1% among other races.

• As of December 2000, 774,467 AIDS cases have been reported in the U.S., with about 83% of those involving men. A total of 8,908 AIDS cases have been reported among children ages 12 and under.

• As of December 2000, 330,160 AIDS cases have been reported among whites, 292,522 were reported among blacks, and 141,694 were reported among Hispanics.

• Since the beginning of the epidemic, 448,060 deaths were reported through December 2000, more than 85% involving men.

• Of the total AIDS deaths, 206,909 were whites, 158,892 were blacks, and 77,698 were Hispanics.

• Throughout the 1990’s, advances in HIV treatments led to dramatic declines in AIDS deaths and slowed the progression from HIV to AIDS. In recent years, however, the rate of decline for both cases and deaths has begun to slow, and in 1999, the annual number of AIDS cases appeared to be leveling, while the decline in AIDS deaths has slowed considerably.

• More people are living with AIDS than ever before. In 1998, 274,624 people were living with AIDS; in 1999, there were 299,944 people living with AIDS; and in 2000, there were 322,865 people living with AIDS.

• Of the 800,000 to 900,000 people living with HIV in the United States, an estimated 365,000 to 535,000 are MSM.

• An estimated 16,800 MSM are infected with HIV each year, and MSM account for 42% of new HIV infections overall and 60% of new HIV infections among men.

• A seven-city study conducted between 1994 and 1998 found that in the 15-22 age group, 14.1% of young African-American MSM were infected, compared with 6.9% of Latinos and 3.3% of young white MSM.

• A six-city study conducted from 1998 to 2000 found that 30% of African-American MSM ages 23-29 were HIV-positive, compared with 15% of Latino MSM and 7% of white MSM.

• The proportion of MSM with gonorrhea, which can increase chances of contracting or spreading HIV by as much as two to five times, increased threefold from 4.5% in 1992 to 13.2% in 1999 in a 29-city study of STD clinics.

• From January to July of 2000, there were 66 cases of syphilis reported among MSM in southern California, compared to 26 cases during the same time period in 1999, a 150% increase. Similar outbreaks among MSM have been reported in New York, Chicago, San Francisco, and Seattle.

• STD outbreaks in several major cities across the United States have shown that 25%-73% of MSM with syphilis and 25%-54% of MSM with gonorrhea are co-infected with HIV.

• In one 12-city study, researchers found that 19% of HIV-positive MSM engaged in unprotected anal sex from 1996 to 1998, compared with 13% from 1995 to 1996.

• In 2000, health officials in San Francisco reported preliminary data indicating an increase in the estimated HIV incidence among MSM from 1.04% in 1997 to a projected 2.2% in 2001.

• Twenty years into the HIV epidemic, many older men who adopted safer sex practices in response to the initial health crisis may be finding it difficult to maintain these practices indefinitely.

• Surveys with MSM have found that some MSM may make false assumptions about their partners’ HIV status. For example, an HIV-infected man may assume that his partner must be infected as well or he would insist on using a condom, while an uninfected man may assume his partner also is uninfected or he would use a condom.

• Effective antiretroviral therapy and the fact that HIV-positive people are living longer and healthier lives have created a false perception among some that HIV is no longer a major health threat.

• Some MSM falsely assume that individuals who are taking antiretroviral medication are no longer infectious and therefore don’t need to practice safer sex.

• Younger MSM, many of whom have never known anyone infected with HIV or who have not seen the toll of AIDS first-hand, may be less motivated to practice safer sex.

• Social and economic factors, including racism, homophobia, poverty, and lack of access to health care, are barriers to receiving HIV prevention information, particularly for MSM of color.

• Researchers say the stigma placed upon homosexuality in communities of color may inhibit men of color from identifying as gay or bisexual, despite the fact that they’re having sex with other men. In a recent survey of HIV-positive men infected through homosexual sex, 24% of African-Americans and 15% of Latinos described themselves as heterosexual, compared to about 6% of whites. This may prevent men of color from seeking or receiving the HIV prevention and treatment services they need.

• While white MSM have traditionally had access to HIV prevention information and services through well-established community networks, similar systems do not exist in African-American and Latino MSM communities, increasing the challenge of reaching these individuals.