Shocking Increase in HIV Infection Rate Among Young Gay, Bi Men

[Since1993]

http://www.advocate.com/health/2014/07/22/shocking-increase-hiv-infection-rate-among-young-gay-bi-men

Shocking Increase in HIV Infection Rate Among Young Gay, Bi Men

While overall HIV infection rates have decreased nationwide, young gay men are seeing a frightening uptick in new infections, according to the CDC.

BY Sunnivie Brydum
.
July 22 2014 2:49 PM ET

New HIV infections among gay and bisexual men between the ages of 13 and 24 increased by a staggering 132.5 percent between 2001 and 2011, according to a new report from the Centers for Disease Control and Prevention.

But the annual diagnosis rate for the general American population dropped by a third over the same time period, according to research culled from CDC data and published today in The Journal of the American Medical Association.

Although 500,000 new cases of HIV were diagnosed over the decade-long study, the annual rate of diagnoses decreased from 24 out of every 100,000 people to 16 out of every 100,000 people, marking a decrease in annual rate of diagnosis by 33 percent, according to WebMD's HealthDay News.

Advances in screening and prevention efforts have prompted the overall decrease in new infections, according to the report, as annual diagnosis rates dropped for heterosexual men by about one-quarter, among women by about half, and among intravenous drug users by nearly 70 percent. 

But those messages and prevention efforts seem to be missing the youngest generation, which is also less likely to be tested regularly, according to the report. Between 2001 and 2011, newly diagnosed cases among young gay and bisexual men rose from about 3,000 to roughly 7,000, according to WebMD. Although the study did not report the mode of infection for these young men, researchers suggest the numbers indicate that many in the group are having condomless sex. And while the World Health Organization and the federal government recently suggested all gay men and other high-risk groups use pre-exposure prophylaxis, or PrEP, the treatment, which involves HIV-negative individuals using antiretroviral medications, is controversial, as some say it encourages higher-risk behavior, like having sex without condoms.

"There’s a new generation that comes up and many don’t have firsthand experience with the devastation we saw in the earlier years," lead study author Amy Lansky, the CDC’s deputy director for surveillance, epidemiology and laboratory science in the Division of HIV/AIDS Prevention in Atlanta told Bloomberg Businessweek.

"It's been more than 30 years since the first cases were reported," Lansky told HealthDay News. "It's harder to maintain that sense of urgency."

Lansky also noted that gay and bisexual men have a higher prevalence of HIV, putting them at "greater risk of being exposed with each sexual encounter." Greater rates of substance abuse and lack of access to health care play a role in the increasing rates among young men, as well, Lansky said.

Thanks to an increase in data collection nationwide, this study was the first to look at HIV incidence rates in people age 13 and older in all 50 states, and Washington, D.C., over a 10-year period. And while the overall annual diagnosis rate decreased by 33 percent, the report notes that an estimated 1.1 million Americans are living with HIV — and roughly 16 percent of those individuals don't know they're infected.

[zach]

i see two things driving this

young men are bulletproof, and a complete failure of sexual education

[wolfter]

I am not surprised at all.  I shared a couple of years ago, the conversation I had with my nephew who was a Junior at OU.  He recently had several friends test positive and they're not even really bothered by the news.  They have a complete lack of understanding the long term implications.

They're misguided by the belief that they only have to take a pill and are somehow liberated because they no longer have to worry about contracting the virus.

[wolfter]

If there was ever time for a younger generation to step up......  Is this a statistic that says some of our efforts were nil?

[Since1993]

Pre-HAART, there was a definitive sense of urgency in the gay community and a more unified message about HIV/AIDS prevention.  We had already lost a lot of souls and the future was uncertain for a lot of us.  Death rates continued to rise. You could walk into most any gay-owned/friendly establishment and a basket of condoms was always visible.  HIV/AIDS activists, although sometimes disagreeing about the path to take, seemed to tap into the resilience of cohesiveness of the Gay Community for support.  It was the most defining civil rights moment since Stonewall.

When Protease Inhibitors came and HAART began reducing the levels of detectable HIV in blood serum in mid to late 90's, the death rates began declining.  Falling death rates was a huge victory for at least being able to keep the virus at bay until a cure could be found.  A sense of victory and renewed sense of optimism grew.  In spite of these gains, the stigma associated with HIV/AIDS largely remained, which continued to be a barrier in getting people to get tested and treatment.

In an effort to remove HIV/AIDS stigma, there has been a push to downplay the terminal effects of HIV/AIDS by promoting HIV/AIDS as a chronic, manageable disease "like diabetes".  ASO's, health officials, educators and the like have shifted their focus from prevention to getting people linked into care to create an "undetectable community".  Their premise, is that if every HIV+ individual becomes undetectable, HIV will eventually become eradicated.

The "Berlin Patient", HIV Vaccine trials, the "Mississippi Baby", PrEP brought hope for a cure.

Dr. Gardner's 2011 US study http://blog.aids.gov/2012/07/hivaids-treatment-cascade-helps-identify-gaps-in-care-retention.htmlabout the cascade treatment model brought forth a lot of valuable information for policy makers.  Only 28% of all HIV-infected individuals are undetectable and only about 50% of those who get linked into care, stay in care and take their medications.  The death rate of AIDS is around 18,000 souls annually.

Barriers of access to HIV-medications and primary care reduced have been reduced for the past 23 years since Ryan White Care Act funds were appropriated.  So why are so few HIV+ individuals in the US virally undetectable and fall out of medical care?  I'm not expert, but I have an opinon why.

Education.  When the primary focus post-HAART shifted from HIV/AIDS education to treatment, they lost the ear of young gay men.  What young gay men understood was, that if they contracted HIV, they could just take a pill because HIV no longer kills, its "just like diabetes".  ASO's and HIV clinics continue to pedal "HIV is just like diabetes" without educating that people are still dying of AIDS because they don't take their medication.  A sense of apathy has set-in ASO's as death rates from AIDS fell and the focus shifted to disease management.  The energy and focus of HIV-prevention and activism shifted to Gay Marriage rights.  Meanwhile, there continues to be no cure for HIV/AIDS.

I am thankful this younger generation doesn't have to carry the burden my generation suffered.  It is appalling to me that after 30 years, HIV/AIDS infection rates are increasing within the gay community because we took our eye off the ball of education and prevention.  So much energy has been placed on treatment, but only 28% of HIV+ individuals in the US are undetectable and less than half stay linked into treatment. 

Stop telling people HIV is "like diabetes".  It's not.  You can't go to jail for sleeping with someone if you have diabetes, and people with diabetes don't face the stigma we do.  This false sense of security, and "wrong message" sent to young gay men, knowing so few are getting and staying linked into care is fueling the increase of HIV infections in the gay community.  Until a cure is found, only education and prevention will decrease the rates of new HIV infections within our community.

[aaware72]

The increase in new cases of HIV infection in the 13-24 year old age group.  W. LeBlanc, Assistant Director, of The Southern New Hampshire HIV/AIDS Task Force (SNHATF), believes that one of the major reasons we are seeing an increase of infection in the younger age groups are funding cuts that happened about six years ago.  She explains that up until this time in which funding was cut they had a full time outreach group that performed HIV/AIDS education in the community. SNHATF is a community based nonprofit AIDS Service Organization (ASO) that was formed in 1997 to help people who are living or at risk for infection of HIV/AIDS. (personal communication, September 26, 2013).  The Foundation for AIDS Research (FAR) (2011) explains that the largest population affected by HIV/AIDS is gay and bisexual men and this group accounts for 57 percent of new HIV infections.   This is also the population that has seen a steady rise in new infections over the past two decades.  They predict that in the absence of new intervention methods that a gay man who is 18 years old today faces a two in five chance of being infected with HIV by the age 40.  This is partly due to the lack of anti-discrimination laws, enforcement of anti-bully in schools, and healthcare workers who are not properly trained to specific health related needs of lesbian, gay, bisexual and transgender (LGBT) are making this group vulnerable to HIV and furthering anti-gay stigma and discrimination.  There is a disproportionate allocation of funding and resources for programs with only three percent of federal funding going towards AIDS prevention programs which has led to consistent under prioritized of this highest at risk group.  This is clear to see as FAR points out that the Center for Dieses Control (CDC) only has allocated just 41 percent of their external budget for HIV prevention programs targeted for gay and bisexual men.  This group is the only group that has seen an increase in new infections and accounts for more than 50 percent of all new HIV infections.  Furthermore, there are social and structural factors that hinder risk reduction for gay and bisexual men.  These are factors such as internalized homophobia, victimization by violence or sexual abuse, poverty, poor access to services, depression or other mental health disorders, and alcohol and drug abuse.  Then there are stigmas and underlying psychosocial problems that cause many gay and bisexual men not to seek out HIV testing and prevention services.  The primary factor that impedes HIV prevention is the history of stigma and social disapproval of homosexual identity and behavior.   Gay and bisexual youth are at a much greater risk to consider suicide and to follow through on those suicidal thoughts than their non-gay peers. Even though there have been more social acceptance of gay and bisexual men in recent years; nevertheless, there are still a large number of youth that still commit suicide because they are traumatized by anti-gay bullying, harassment, and social isolation.  An increase in mental health issues are related to stress that gay and bisexual adolescents have.  Discrimination against gay and bisexual men causes psychosocial problems that increase their susceptibility to HIV and other health problems.  A 2005 study of  LGBT people who lived in area that have laws in place to protect against hate crimes and employment discrimination were more likely to suffer from psychiatric disorders than their counterpart that lives in area without laws in place.  It has been shown that due to the association of growing up gay and living in a society where homosexuality gay and bisexual men are highly stigmatized has led to mood or anxiety disorders and intimate partner violence which caused them to be more likely to use drugs.  These factors have led to an increase in gay and bisexual men to become vulnerable to HIV infection along with other health problem.  There is also a link between this and an association with unprotected sex and the increased risk of getting infected with HIV.  Gay and bisexual men experience health care providers that are not able to provide high quality care and support that addresses the risks that gay and bisexual men have.  Because of the association of shame and internalized homophobia that adolescent experience it has prevented them from having an open and trusting relationship with their healthcare provider.  One survey showed that 39 percent of gay and bisexual men did not disclose their sexual orientation with their doctor.  Lastly the Foundation for AIDS Research explains that even the CDC has recognized the value of community-level interventions and how it plays a key role in promoting early prevention strategies.  However, the CDC has failed to do research and fund programs focused on gay and bisexual men.  These types of programs play a critical role in delivering of HIV prevention information and services to gay and bisexual men.  There needs to be broader behavioral intervention which works to give gay and bisexual youth the knowledge, motivation, and skills needed to reduce their risk for HIV (p. 2-7).

D’Afflitti & Merzel (2003) tells us there are three stages that a community level intervention goes through.  First it involves the initial mobilization of community members and organizations and establishment of a program organizational structure.   In most cases there is a main group that is formed, such as a community advisory board.  It was noted though that these boards had a limited impact on issues because of agency funding.  The other issue that came up was the lack of community involvement and their input on selection of issues to be addressed.  The next stage involved program planning and implementation.  This stage was noted as the stage in which there was the greatest amount of community involvement.  However if in stage one there was lack of input on the selection of issue to be addressed then there was a lack of community engagement and support for the programs.  Lastly there was the refinement and the institutionalization of interventions through community involvement and collaboration.  In the end one of the barriers that prevented the goal in the first stage came down to a lack of funding.  These challenges have been the experience of many prevention programs that were unable to engage the community in implementation of the program along with the funding to sustaining them (p. 558). In conclusion they state:

“The success of a number of community HIV interventions in changing sexual and drug-use behaviors indicates the potential of community-based programs as an important approach for achieving public health improvements. The accomplishments of the HIV programs indicate that obtaining considerable community input for the development and delivery of interventions and focusing on changing social norms as a means of altering individual behavior should be considered critical aspects of community-based health promotion. At the same time, the nature and degree of the risk involved and the targeting of relatively smaller, more homogenous social groups distinguish HIV programs from other health promotion efforts” (p. 569).

References:

Breu, G. & Valente, J. (2014) Reaching out to prevent HIV in high-risk youth.  Retrieved on
January 9, 2014, from, http://www.usatoday.com/story/news/nation/2014/01/08/hiv-testing-outreach/4193777/

D’Afflitti, J., & Merzel, C. (2003) Reconsidering Community-Based Health Promotion:
Promise, Performance, and Potential.  Retrieved on February 11, 2014, from, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1447790/pdf/0930557.pdf

The Foundation for AIDS Research (2011) A New HIV Prevention Paradigm for Gay
And Bisexual Men in the U.S.  Retrieved on February 8, 2014, from,
http://www.amfar.org/uploadedFiles/In_the_Community/Publications/IssBriefGayMen.pdf

[mrtoad]

I am not remotely shocked.They say this same thing every  year (if not 3-4 times a yr) .Yet other 'studies' say the opposite.Scare tactics and headline grabbers i'ld say.

[tednlou2]

Very sad to read these stats.  Infection rates have dropped in all groups, except for MSM, where they are rising.  I was just reading about the huge rise in Bangkok. 


http://www.poz.com/articles/Bangkok_gays_761_26037.shtml

[dico]

Very sad to read these stats.  Infection rates have dropped in all groups, except for MSM, where they are rising.  I was just reading about the huge rise in Bangkok. 


http://www.poz.com/articles/Bangkok_gays_761_26037.shtml

Gays are the single most affected group outside Africa. It is suprising. I never heard of a virus that specifically affect a subgroup of population. There is definitely something strange. Dont forget that everybody thought it was a gay syndrome in the beginning of the 1980s.

[Miss Philicia]

Gays are the single most affected group outside Africa. It is suprising. I never heard of a virus that specifically affect a subgroup of population. There is definitely something strange. Dont forget that everybody thought it was a gay syndrome in the beginning of the 1980s.

I'm not sure you understand what you are saying. The virus enters a certain demographic group in a certain geographical area, and then it has trouble hopping over to other groups in that area. It has nothing to do with being straight or gay.

Africa is not the only place where one finds heterosexual infections to be the largest. Have you investigated affected groups with HIV in Russia/Eastern Europe and Central Asia? Or the Middle East and North Africa? In China the prevalence is the same with IDU and MSM. India: 48% are either women or children, remaining are men that are heterosexual -- but keep in mind that most men there that engage in homosexual activity have wives and do not consider themselves "gay" in the Western sense. (this reporting difficulty exists in a lot of places).

As far as your comment about "the 80's" that was the media that was enforcing that story line about it being contained in the gay community. Researchers were, somewhat, quickly aware that it would begin to affect other groups over time. All they had to do is look at IDUs and people in Haiti. It wasn't that complicated to see unless you were homophobic.

[elf]

Well, at least here in ''my'' country, you don't see gay groups trying to fight HIV infection through education or preventive programs (although the incidence of HIV is 5-10 % in the MSM group), because they're too busy fighting for marriage equality.

[tednlou2]

Are there studies on why HIV affects so many heterosexuals in Africa, but the majority of cases here are MSM?  Wouldn't one expect to see similar numbers of heterosexuals infected here?  Is it simply that HIV got a head start in Africa and in heterosexuals, whereas it got going mainly in the gay community here?  Higher rates of untreated STI's there, which raises the risk of infection?  Rape stats in many African countries?