February 5, 2001
Many recent reports indicate that MSM (men having sex with men) are ignoring safe sex guidelines resulting in resurgent rates of STDs and new HIV infection. This is of obvious importance as it helps in designing new prevention programs and, hopefully, will allow the public to learn from others' mistakes. Research done in San Francisco in the late 1980s showed that people changed their behavior when they personally knew someone who was sick or infected, not as a result of public health education efforts. This is particularly dangerous for young men who don't know peers who have been ill with HIV. This study was a cross-sectional multi-site survey in six U.S. cities of 23- to 29-year-old men and included over 2,400 young MSM with equal distribution among the six cities.
There were high prevalence rates of HIV among the men who completed the study (12.3%) and this increased with age as men from 23-25 had a 10.2% rate as compared with 14.2% in the 26-29 age range. Race/ethnicity was a significant factor as well with African-Americans (30%) being the most common racial group affected with Hispanic (15%), Whites (7%), Asian (3%) and other (10%). This was a sexually active group, as young men are known to be, with 93% of these men having had oral or anal sex with at least one man in the last six months.
46% of the men had unprotected anal sex within the last six months, with approximately 38% describing their activity as either insertive and 33% receptive with the remainder apparently participating in both. Within this sexually active population, 29% knew their positive HIV status, with 18% currently using meds at the time of the study. Of the remaining men, 54% had a negative test in the past. Two associated studies reported first a similar prevalence rate of HIV in MSM in this age group (17%) with a higher prevalence to 33% in the African American community illustrating the particular need for education programs with emphasis on communities at highest risk. Secondly, a study by Flaks et al. reported that people who practiced unsafe sex were less likely to be adherent -- creating the greater risk of spreading HIV.
These studies provide stark news that young MSM are sexually active in unsafe ways and that the prevalence is way too high for all groups and even worse for blacks. We need to change our educational and prevention efforts, perhaps bring in peer groups with older groups to allow young people to understand the downside of HIV infection and not only the successes in HIV treatment. It would be a pity if the lost generation of MSM in their 50s could not prevent the suffering, toxicity, and stress of HIV infection on young men in their 20s now just learning to be men.
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