A study of black gay and bisexual men in six U.S. cities finds that rates of HIV are increasing at a troublesome pace: each year, nearly 3% of gay black men become infected with HIV, a 50% higher rate than among their white counterparts.
The new-infection rate in gay black men under 30 is even higher, at 6% a year, according to the new data presented Monday at the annual International AIDS Conference in Washington, D.C. These numbers are comparable to HIV rates seen in sub-Saharan Africa, in countries that are hardest hit by HIV, the authors of the study note.
“This is extremely concerning,” Kenneth Mayer, medical research director at Fenway Health, a leading HIV/AIDS clinic in Boston, and co-chair of the study, told USA Today. “Here we are, this far into the epidemic, and we have these rates.”
The new numbers come from the HIV Prevention Trials Network (HPTN), a study funded by the National Institutes of Health. The study, conducted between 2009 and 2011, involved 1,553 gay and bisexual men from Atlanta, Boston, New York, Los Angeles, San Francisco and Washington, D.C.
The majority of the men in the study identified themselves as black. Not all the men identified themselves as gay or bisexual, but all the participants were having unprotected sex with men. More than 97% of men enrolled were willing to have an HIV test, and the results suggest that many men are not fully aware of their HIV risk: among those who thought they were HIV-negative or didn’t know their status, 12% tested positive.
“The…study findings are a sobering wake-up call,” said study author Dr. Wafaa El-Sadr in a statement.
Last week, another new study [PDF] by the Black AIDS Institute also highlighted the alarming rate of infection among black men who have sex with men (MSM). While only 1 in 500 Americans is a black gay or bisexual male, they account for 1 in 4 new HIV infections in the United States, the report found. It also found that a black gay man has a 1 in 4 chance of becoming infected by age 25; by age 40, he has a 60% of becoming HIV positive.
The Centers for Disease Control and Prevention (CDC) notes that from 2006 to 2009, HIV infections among black gay and bisexual men under 30 increased 48% and that African Americans are overall disproportionately affected by HIV. Blacks make up 14% of the U.S. population, but account for 44% of all new HIV infections. According to 2009 data, 73% of new infections in black men are in gay and bisexual men.
“We have known that black MSM are affected by HIV at disproportionately higher rates when compared to other MSM in the U.S., but the [new study's] HIV incidence rates were extremely high,” said study co-chair Dr. Darrell Wheeler, dean of the school of social work at Loyola University, in the statement. “They make it very clear that we must urgently find and implement ways to stem the spread of HIV among black gay men in this country, and critically among young black gay men.”
The study found further that HIV risk among this population was associated with income and health overall. Those who tested positive for HIV were more likely to have another sexually transmitted disease (STD) and to be poor. USA Today reported:
Both increase the risk of disease transmission. STDs create inflammation that make it easier for the AIDS virus to enter the body. And because poor people generally have more problems getting health care, they’re less likely to be tested, know their status and be on treatment, Mayer says. Recent studies show that effective treatment can make patients virtually non-contagious, and most AIDS researchers at the conference this week now seem to see “treatment as prevention” as the best hope for containing the disease.
The study reinforces the notion that fighting AIDS will involve more than just changing individual behavior, Mayer says. Research has consistently linked HIV infections with poverty, suggesting that the country needs to address “structural” issues, such as homelessness, discrimination and economic opportunity, Mayer says.
More than a million Americans are currently living with HIV, a high HIV rate that makes prevention efforts more difficult. As Mayer pointed out, prevention becomes even more problematic among the small population of gay black men who tend to date other men within their racial group and face even higher risks of being exposed to HIV.
Recent data show that the disparities between black and white gay men don’t come down to risky behavior. Blacks and whites tend to have similar numbers of sexual partners and are equally likely to to have risky sex. CDC data also suggest that the higher rate in black gay men isn’t attributable to jail time or circumcision rates.
Further analysis of data from the HPTN study will focus on how behavioral and societal factors affect HIV risk in gay black men, including incarceration, childhood experience, social and sexual networks, discrimination and homophobia, and access to health care.