A review of:
Kenneth Mayer, et al. An evolving concentrated epidemic: comparison of socioeconomic, behavioural and biological factors among newly diagnosed, previously diagnosed and HIV-negative black men who have sex with men in six U.S. cities (HPTN 061). 19th International AIDS Conference; Washington, DC; July 22-27, 2012; Abstract MOAC0105.
Beryl Koblin, et al. Correlates of HIV incidence among black men who have sex with men in 6 U.S. cities (HPTN 061). 19th International AIDS Conference; Washington, DC; July 22-27, 2012; Abstract MOAC0106.
One of the most striking, if not horrifying, stories of 2012 comes from HIV Prevention Trials Network (HPTN) 061, a.k.a. the BROTHERS study. This is a longitudinal study of black MSM (BMSM) recruited in Atlanta, Boston, Los Angeles, New York City, San Francisco and Washington, D.C., to determine the feasibility of a risk reduction intervention. More than 1,500 men were enrolled, a third of whom under the age of 30. The findings of this study starkly reveal where HIV is and where it is heading.
An incredible 11% of the men recruited were known to be HIV infected at entry. Another 10% were newly diagnosed with HIV on study entry (including 3 with acute infection).
So, let's stop there: Over 20% of BMSM in recruited in these cities were HIV infected. It should be acknowledged that, to get into the study, a man must have had unprotected anal intercourse with a man in the prior 6 months. But still, this is an incredibly high number.
It gets worse.
Of the 1,009 men who were uninfected at baseline and had follow-up data over a year, 26 became HIV infected during the study (annual incidence of 2.8%). Your jaws should be dropping.
Of these 26 young men, 20 were between the ages of 18 and 30 years, 19 had sex exclusively with men and 20 had an income less than $20,000 per year. In addition, those who self-identified as gay or homosexual were at greater risk of seroconversion -- and, not surprising, so were men reporting unprotected sex and those with a sexually transmitted infection at baseline. A separate report found that 60% of the HPTN 061 cohort had been incarcerated and that 24% were locked up during the study, providing another potential opportunity to intervene.
These are extremely concerning results. The prevalence and incidence of HIV among the men studied was astounding, about an order of magnitude greater than that seen in a similar HPTN study of women living in areas where poverty and HIV prevalence were common.
Our reflexive demands for action need to be accompanied by realistic and scalable interventions that can meaningfully reduce the transmission of HIV by and to BMSM. The HPTN study provides a roadmap. The correlates of infection (youth, poverty, gay identity) reveal points to leverage. The fires are burning. Will we respond?
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