Special Report: Two Decades of AIDS

Young blacks’ HIV risk reaches African proportions

Six-city study shows potential for disaster

(Editor’s note: The Centers for Disease Control and Prevention in Atlanta released a special issue on the AIDS epidemic in a June MMWR, reminding the public that AIDS was first reported in the MMWR on June 5, 1981, and highlighting new research on the alarmingly high incidence of HIV among young gay and bisexual men of six key cities. The impact of the CDC’s findings and some additional information about current prevention plans will highlighted in this two-part special report. Look for stories summarizing the epidemic’s toll around the world and the CDC’s five-year prevention plan in the August issue of AIDS Alert.)

Two decades into the AIDS epidemic, the disease continues to plague the gay and bisexual community, especially men of color. The Centers for Disease Control and Prevention in Atlanta published in June a study of six large cities showing that young gay and bisexual men who are also African-American have an HIV-infection rate that is comparable to some of the hardest-hit regions of sub-Saharan Africa. The data, which still are being analyzed, indicate that HIV prevalence among black men ages 23-29 who have sex with men (MSM) was 14.7%. That prevalence rate means that nearly one in six black gay and bisexual men who were uninfected at the beginning of the year in those six cities would become infected by the year’s end. Among white MSM, the incidence rate was 2.5%, and among Hispanic MSM, the rate was 3.5%. The overall 4.4% incidence rate for this age group of MSM is comparable to incidence studies of prevalence during the mid-1980s, when the gay community was hardest hit by the epidemic.1

Among gay and bisexual men ages 15-22 in seven large U.S. cities, the HIV incidence rate per year was 2.6%. Among black men of this age group, the incidence rate was 4%, and among white men it was 2.4%.1 (To see HIV prevalence chart, click here.)

"The 14.7% incidence rate of black gay and bisexual men is extremely high and is comparable to incidence rates we now see in South Africa," says Linda Valleroy, MD, MPH, a CDC epidemiologist and the author of the most recent study. Valleroy, along with Helene D. Gayle, MD, MPH, director of the CDC’s National Center for HIV, STD, and TB Prevention, and Phill Wilson, executive director of the African-American AIDS Policy & Training Institute of Los Angeles, spoke about the study at a recent teleconference.

The new study included data from a sampling of young gay and bisexual men in Baltimore, Dallas, Los Angeles, Miami, New York City, and Seattle. A seventh city, San Francisco, was part of the project, but was excluded as part of the study’s second phase, which details the incidence of HIV among MSM ages 23-29. "These new statistics absolutely remind us that the epidemic is not over, and it’s important to resist any impression that it might be over," Wilson says. "Too many of us are still getting infected, getting sick, and are dying, and too few of us are getting tested or seeking treatment."

In response to these findings and to earlier reports that the epidemic is disproportionately affecting the African-American community and men who have sex with men, the CDC has issued public health bulletins to local health departments to put people on alert about rising trends of sexually transmitted diseases (STDs) and HIV among MSM, Gayle says.

The epidemic has had a far greater impact on the United States and the world than what could have been predicted a decade ago, with nearly 450,000 Americans dead of the disease and 22 million dead worldwide. In addition, the overall infection rate is estimated to be 40,000, which has been level for a number of years, Gayle says.

However, within the overall level infection rate is the disturbing statistic that young African-American MSM have five times the HIV incidence rate of young white MSM and four times the rate of young Latino MSM, Valleroy notes. The study shows that it’s important to send prevention messages to black gay and bisexual men while they are adolescents and through their early 20s, Valleroy says.

This may be a difficult population to reach because black homosexual men are stigmatized twice in this country, first for being black and secondly for their sexual orientation, Wilson says. "If you are gay and black and under age 30 in New York City, you are more likely to be HIV-positive than people in the hardest-hit areas of Africa," Wilson says. "Some of us are shamed into silence so we stay in marriages, putting our wives and children, as well as male partners, at risk."

The CDC has mounted a response to the continuing high rate of infection by developing a new plan to reduce by half the number of new infections within the next five years, Gayle says. "At least 300,000 people are infected and don’t know that, so the real focus is on making sure people are aware of the services available, targeting HIV services to HIV-positive individuals, and providing linkages to care and services," she says. Gayle adds that the CDC also will continue to target prevention programs and funding to the communities at greatest risk of infection.

Reference

1. HIV incidence among young men who have sex with men — seven U.S. cities, 1994-2000. MMWR 2001; 50:440-444.