State Of Affairs: Crisis In Prevention For Gay Community

At current transmission rates, half of all men who have sex with men will be infected in 30 years, 70 percent of black men who have sex with men will be infected. What's are we doing wrong?

BY Todd Heywood

December 05 2013 7:00 AM ET

Jake Sobo (not his real name) is a blogger. He’s gay. He’s unapologetic about being a bottom. He’s also been using Truvada, an anti-HIV drug, to prevent becoming infected for a year. The intervention is called pre-exposure prophylaxis, or PrEP.

“I started taking PrEP because I didn’t use condoms every time and because I knew my odds of getting HIV were eventually going to approach 100 percent,” Sobo said. “Let’s face it, in some gay urban enclaves, one in four gay men have HIV and about 50 percent can expect to get it by the time they’re 50.  I’m a bottom, which means I’m at a particularly increased risk. PrEP was my way of taking control of my sexual health. I’m so grateful that this technology exists to help keep me negative.”

Despite the intervention being approved by the Food and Drug Administration, Sobo finds himself targeted with recriminations on his various blog posts and reposts – and by allies and friends.

“Even some allies of mine have come dangerously close to shaming me for my sexual proclivities,” Sobo tells us in an email interview. “We can barely help ourselves from trying to make people feel bad about the sex they have. Having sex behind closed doors is okay — as long as you don’t talk about it publicly, for Pete’s sake!”

Sobo’s experience represents the need for a re-imagination of HIV prevention messages and tools. An evolution which finds itself being fought on various fronts, with experts falling back on condoms-only prevention messages, despite evidence that condoms do not work as well as other risk reduction techniques to prevent new HIV infections.

And even as the debate rages, HIV among men who have sex with men (MSMs) – including gay, bisexual, and straight-identified but homosexually active men, as well transgender women (who are not tracked as a separate risk category) – continues to spread.

“Unconscionable” Rates and Prevalence

Michigan has made strides to reverse increasing infections in women and intravenous drug users (IVDUs) over the past decade, but the risk category of MSMs continue to represent the single largest group of people represented in new infections annually. And statistical models show a trend AIDS service organization leaders in Michigan have called “staggering.”

In February, BTL reported on statistics presented by Greg Millett, an employee of the Centers for Disease Control in Atlanta assigned to the White House Office of National AIDS Policy (ONAP). Millet reported in a session on HIV during the National Gay and Lesbian Task Force Creating Change Conference in Atlanta, that the current cohort of men who have sex with men who are currently age 20 have a 10 percent overall HIV prevalence rate, and it’s 20 percent in black men who have sex with men. At current transmission rates, half of all men who have sex with men in that cohort will be infected in 30 years, 70 percent of black men who have sex with men will be infected.

Despite years of indoctrination that HIV is the result of promiscuity, Millett also noted that 68 percent of new infections are occurring in the context of primary sexual relationships — that’s boyfriends and friends with benefits in non-science parlance — among men who have sex with men.  

The reason?

Men who have sex with men are not availing themselves of HIV testing nearly as often as they need to, resulting in accidental transmissions as a result of not knowing one’s HIV status. In fact, a new National Institutes of Health study reports that half of people infected will go on to infect at least one other person in the year following their infection – most often before the person is even aware they are infected. Another NIH study reported a person who was unaware of his or her HIV infection was 3.5 times more likely to transmit the virus to another person.

Underscoring those findings, a CDC study in 2010 involving 21 U.S. cities, including Detroit, found that one in five gay/bisexual men who attend bars and nightclubs was infected with HIV. Of those who were infected, 44 percent were unaware of their infection. National studies estimate that 20 percent of people infected with HIV are unaware of their infection.

Over half of cases in Michigan are in men who have sex with men. In addition, many of the new cases of HIV are being reported in young men who have sex with men — between 13 and 24. For instance, in Ingham County, which has the highest prevalence of HIV in Michigan outside of Detroit, one in five persons living with HIV who are aware of their infection is in that age group. Six percent of them at 13-19 and 14 percent are between 20 and 24.

Tags: Prevention