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Alarming HIV infection rate among black gay and bisexual men

By Frederick Sparks

The HIV infection rate among black men who have sex with men (MSM) in the U.S. now rivals what is seen in the worst impacted parts of the world, including Southern Africa, according to recent studies.  The numbers were more alarming than expected for health care providers, researchers and policy professionals already focused on this issue.

A study by the HIV Prevention Trial Network (HPTN) found that black MSM in the U.S. who are under 30 have a 5.9% infection rate, which is 3 times the rate among their white peers and is comparable to rates in the general population in sub-saharan Africa’s hardest hit regions.

The findings of the Black AIDS Institute’s recently released report  on AIDS among black gay men in the U.S. paint a bleak picture as well.  An estimated 25% of black MSM in the U.S. at age 25 are HIV positive,  at age 40, the number goes up to 60%.   Sixty.

Yet studies do not point to a higher degree of risky sexual behavior as the explanation for the higher rates among black MSM as compared to their white counterparts; in fact some studies show black MSM are less likely to engage in risky sexual behavior than their white and Latino counterparts. The discrepancy results in part from diminished access to and utilization of health care services, including testing allowing for early diagnosis and for antiretroviral treatment that lower viral loads and reduce the chance of passing the virus. Lower rates of testing also result in higher rates of other untreated STDs which increase the chance of transmission.

The study also found that black MSM in the Bible Belt south have seen the greatest increase in infection rate, and are also least likely to have access to HIV related resources, due in part to political leadership which hardly prioritizes such concerns; many of the governors of these states have vowed not to implement portions of “Obamacare” that have the potential to level the playing field in terms of access to health resources.

But black mainstream and white LGBT mainstream organizations and political leadership have also largely ignored the epidemic among black MSM. The report identifies the black church as “both a challenge and an opportunity” to build leadership on this issue, noting that the church plays a role in the marginalization of MSM and in reinforcing internalized homophobia.

The report also calls for initiatives to increase the level of testing among black MSM, increasing access to and use of  for treatment of HIV as well as prophylaxis that can prevent infection if taken soon after an exposure to the virus, and for an end to the disparity in treatment and prevention programs aimed at black MSM.

Comments

  1. F says

    I’ve been trying to sort out my head after reading this, but I realized I can’t even begin to respond to that in any way.

  2. James Michael Howard says

    It is my hypothesis that evolution selected DHEA because it optimizes replication and transcription of DNA. Therefore DHEA levels affect all tissues. Therefore, in 1985 (copyrighted), I first suggested that low DHEA may be the basis of AIDS (not called AIDS at the time). Subsequently I decided that the actual symptoms of AIDS are caused by the loss of DHEA. Low DHEA has been proven in HIV / AIDS.

    It is also part of my work that excessive testosterone reduces DHEA. Therefore, individuals with high testosterone will be more vulnerable to the HIV.

    It is known that male homosexuals produce less DHEA than heterosexual males and that black males produce more testosterone than white males.

    I suggest the findings of HPTN 061 are due to high testosterone and low DHEA in black, male homosexuals.

    James Michael Howard
    Fayetteville, Arkansas

  3. Gregory in Seattle says

    I’m a part of the Community Advisory Board for the Seattle HIV Vaccine Trials Unit. We have discussed the issue of rising HIV rates in the African American community, particularly in the rural south, since this map was published.

    I think saying that “black mainstream and white LGBT mainstream organizations and political leadership have also largely ignored the epidemic among black MSM” is somewhat misleading. Most education efforts have been directed at gay men, with outreach being done through bars, bath houses, gay publications and pride events. Many black men who have sex with men do not identify as gay: they do not go to bars or bath houses, they do not read gay publications and they do not attend pride events. It’s not that black MSM are being overlooked so much as many do not self-identify as gay or bisexual, and so are not being reached.

    The solution is to increase the investment in education and outreach and to broaden the demographics being targeted, and to get local, state and federal governments and leaders to start treating HIV/AIDS as a health crisis rather than as a divine judgement. Unfortunately, in much of the United States that challenge is a very steep hill to climb.

    • fredericksparks says

      okay, so once it was figured out that bars, bath houses and pride events weren’t the avenues to reach black MSM (and how long did that take), how was the targeting changed? That’s the point.

      • Kevin says

        You’ve gone directly to the heart of the problem.

        Black men who have sex with men are much harder to reach with educational messages for a variety of reasons.

        I participated in outreach efforts as part of a community education resource back in the early-1990s. It was frustrating as all get-out. Because there didn’t appear to be any “community” to reach out to. Just guys who were engaging in risky behavior. Two-by-two.

        There were also tremendous roadblocks put in our path by black Christian churches (“our members don’t do that”) and the black Muslims (“AIDS is a white conspiracy”). The black Muslims also were selling Kemron (oral interferon) back then as the “cure”, even though the clinical research had already been done and showed it was ineffective. But that, too, was seen as part of the white conspiracy.

        It’s really hard to reach communities that believe your honest well-intentioned efforts are an attempt to promote genocide.

        I think the black community needs to give HIV educators more and better advice. Where do we go to reach at-risk individuals? 20 years later and we’re still clueless. And the problem has only gotten worse. And the only answer offered — “black churches” — clearly has not worked. Not 20 years ago, and not today.

      • Gregory in Seattle says

        Right now, much of the outreach and education is being done by urban LGBT groups who work to reach urban men and women that self-identify as LGBT. They limit their focus as a matter of managing already limited and diminishing resources.

        There are national and local organizations that likewise look to their own. The National Native American AIDS Prevention Center has dozens of affiliate groups working on reservations and in both urban and rural non-reservation enclaves. The Latino Commission on AIDS likewise has dozens of affiliated groups around the US that focus on Latin@ and Spanish-speaking communities. The Black AIDS Institute, based in Los Angeles, is working on education and outreach in the black communities of southern California.

        My cousin (herself African American; my extended family is multi-racial) worked for several years with an organization in Oakland, California that focused on reaching the black communities of the San Francisco Bay Area, primarily women. Even with the support of city, county and state governments, even with the considerable resources in neighboring San Francisco County, even with the support of many community leaders in an urban, largely progressive city, it was often an uphill climb.

        The most successful outreach and education programs in fighting HIV/AIDS — in the United States and elsewhere around the world — have all been local efforts: people talking to friends and family, to members of their faith group, to aquaintances at the salon, barbershop and grocery store. The most successful way to fight HIV/AIDS among African Americans is going to be for African Americans to come together work within their own communities. They do not have to go it alone: there are a lot of already extant groups that can help with organizing and finding funds. And yes, in the rural south there will be A LOT of push-back against this sort of thing. I will require the courage to be a tall poppy in a field of mown grass and it will require changing a lot of people’s misperceptions and prejudices. But it is not something that can be done by just throwing money, or by outsiders coming in and issuing directives.

        • fredericksparks says

          One of the issues raised in the Black AIDS Institute report “Back of the Line” is that there is currently no method for tracking the proportion of federal HIV prevention funds that are targeted to black MSM.

          “But it is not something that can be done by just throwing money, or by outsiders coming in and issuing directives.” Which is why the Black AIDS Institute report call for greater leadership from both within and without the community

          • Gregory in Seattle says

            I wish I had solid answers to offer. Heck, I’d be happy with something more than just Jell-o answers. I do know, however, that a meaningful approach cannot be imposed from the outside.

  4. says

    As I was reading this, I was wondering of the higher rates of blacks in prisons might have an impact as well. I am not an expert, but I have read that MSM is relatively hign among otherwise straight men during incarceration.

    Is the racism in the law enforcement and judicial systems partially to blame here? And could outreach in prison be effective?

    • fredericksparks says

      The report from the Black AIDS Institute notes that there isn’t conclusive data supporting significant infection rates during incarceration; it appears most incarcerated MSM who are positive are entering prison already positive.

      The disproportionate incarceration rate does however impact joblessness and the other sytematic issues that lead to the disparity in health care access, which contributes to the problem.

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