December 1, 2011
Those of us who work in clinics that see new HIV infections know it, but it seems like most everyone else remains oblivious to the surge of HIV among young black men who have sex with men (BMSM). In 2006, when the U.S. Centers for Disease Control and Prevention (CDC) released a new estimate of 56,000 annual new HIV infections, it also reported that over 50 percent of the cases were in MSM. What was lost was just who these men were. In an update to that estimate that includes data up to 2009 and employs improved methods to account for missing data, the CDC highlights the leading edge of the epidemic in the U.S. is BMSM.
The annual incidence of HIV in 2009 is estimated at 48,100 (95% CI: 42,200-54,000); the HIV incidence from 2006-2009 was stable. However, in 2009, MSM accounted for 61 percent of new infections and there was a 21-percent increase (P = .017) in HIV incidence for people aged 13-29, driven by a 34-percent increase in MSM. Further, there was a 48-percent increase among young BMSM (P = .001). In fact, among people aged 13-29, only MSM experienced significant increases in incidence, and among 13- to 29-year-old MSM incidence increased significantly among young BMSM. In 2009, heterosexual contact accounted for 27 percent of new cases, injection drug use (IDU) for 9 percent, and MSM/IDU for 3 percent.
The domestic HIV epidemic has locked young BMSM in its sights and pulled the trigger. Frustratingly, the reasons that young BMSM are at such a heightened risk for HIV acquisition remain unclear. High rates of HIV in African-American communities, the use of the Internet and social networking to facilitate risky hook ups, concurrent sexually transmitted infections, homophobia, and other factors have been invoked to explain this epidemic within the epidemic.
Increased access and uptake of HIV testing have become a priority in many urban areas and are the centerpiece of the CDC's "Testing Makes Us Stronger" campaign. This is one of several national and local initiatives described in the White House's National AIDS Policy (see www.whitehouse.gov/blog/2011/09/27/addressing-hiv-epidemic-among-gay-and-bisexual-men) that include enhanced testing and counseling aimed at young African Americans.
One can only hope that these and other initiatives can survive the budget standoff sequestration process and other deficit-reduction activities. But, demonstration projects and CDC- and National-Institutes-of-Health-funded studies alone will not make a difference. Knowledge has to be put into practice in order to be powerful. Even now, with what we know, more can be done. As Dr. Kevin Fenton, Director of the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention at the CDC, pleads:
Today, right now, we desperately need new champions and leaders from the gay community and from all communities where MSM are heavily affected to take this information and these promising breakthroughs and help to nurture a movement that not only promotes awareness of the HIV epidemic and its toll on gay and bisexual men but access to education, prevention, and care to make full use of all of the tools we have at hand currently. The gay community's leadership once drove the nation to act against AIDS -- that same energy and commitment is needed today. We cannot allow the health and the lives of gay and bisexual men to be lost to a preventable disease.
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