CDC Briefing Discusses Complex Causes of Rising HIV Rates Among Young Gay Men

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In the lead-up to World AIDS Day, the CDC hosted an LGBT media web briefing on combatting the resurgence of HIV among young gay and bisexual men, in collaboration with the Human Rights Campaign Foundation, the National Black Gay Men's Advocacy Coalition, and New York's Ali Forney Center. Panelist discussed the many social factors -- including homophobia, racism, depression, drug and alcohol use, and homelessness -- that contribute to higher HIV risk among young men who have sex with men.

According to the Centers for Disease Control and Prevention (CDC), an estimated 1.1 million people are living with HIV in the U.S., with approximately 50,000 people newly infected annually -- a number that has not changed in several years. About 80% of people with HIV know they are infected, about two-thirds have been linked to care, 37% are retained in care, one-third are prescribed antiretroviral therapy (ART), and only 25% achieve and maintain viral suppression.

While new HIV infections have declined among most population groups, they continue to rise among men who have sex with men, in particular among young gay and bisexual men and young men of color.

A variety of social factors including homophobia, racism, depression, drug and alcohol use, and homelessness contribute to higher HIV risk among young men who have sex with men, said Jonathan Mermin, director of the CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. "Stigma, family and community rejection, all these factors can take a heavy toll on mental health. LGBT youth are more likely to report feeling sad, more likely to report attempting suicide, and more likely to have risky sex."

Gay and bisexual men under age 25 account for nearly 1 in 5 new HIV infections, with a 22% increase in recent years, Mermin explained. In a recent 20-city study, about half were unaware they were infected.

Black men account for more than half of new infections among young gay/bi men. Studies have shown that while young black gay men do not engage in riskier sex or drug use behavior, their partners are more likely to be HIV positive due to higher prevalence in that community.

"Young black men don't take more risks, but more black men are living with HIV," said Daniel Driffin, chair of NBGMAC's Young Black Gay Men’s Leadership Initiative. "Getting into care, getting on treatment, and lowering viral load protect everyone, not just yourself."

Jeff Krehely, vice president of the HRC Foundation, acknowledged that large LGBT organizations have lapsed in their attention to HIV as the movement has focused on same-sex marriage.

Marriage is a tangible issue with a clear goal, but HIV and health advocacy are "more of a gray area," he said. "It's a complicated scientific issue and a complicated social issue. "The community needs to dedicate itself again to HIV" and "put the issue back on the map...We need to start re-educating members that there's a lot more to LGBT quality of life than just marriage equality."

"Homeless LGBT youth are at ground zero of HIV risk," said Carl Siciliano, founder and executive directorof the Ali Forney Center, an agency providing services to homeless LGBT youth in New York City. "Society gives them a message that they don’t matter when they're sleeping in a subway car or an abandoned warehouse."

"So many kids on the street have no way to survive outside of prostitution or survival sex," he continued, offering the example of a transgender girl on his agency's waiting list whose choices are to stay in a men's shelter -- a humiliating and frightening experience -- or to stay with a man at his apartment in exchange for unprotected sex.

"You can educate a homeless kid until the cows come home, but if they don’t have a place to sleep at night there are so many forces leading them to have unprotected sex," he stressed. "If we are not willing to provide housing for LGBT youth, we are consenting to them becoming HIV-positive."

Moderator Thomas Roberts of MSNBC raised the issue of whether young people who did not live through the worst years of the AIDS epidemic have become complacent about HIV because they don't see it as a death sentence.

But Siciliano disagreed. "Kids don't want to get HIV and they don't feel like it's no big deal," he said. "If they test positive they're despondent. Having HIV adds one more layer of stigma."

Asked about concrete steps, Krehely suggested that one thing the movement can do is push medical professionals to get training in LGBT cultural competency. But much of what needs to be done involves the "boring budget process in DC" to gain things like more shelter beds and mental health services for at-risk youth.

"If you've had risky sex, you can go to a doctor and discuss taking PEP [post-exposure prophylaxis with antiretrovirals], but that doesn't deal with the underlying problem," Mermin concluded. "The medical system often deals with that upper level, but unless we deal with deeper issues, we're not going to solve the epidemic¾and if we don't solve the HIV epidemic among gay men, we're not going to solve it for the nation."

11/26/13

Source

CDC, et al. Combatting a Resurgence of HIV among Young Gay Men. Web briefing. November 21, 2013.