AIDS: Surges Among African-American, Hispanic Gay Men
Non-Hispanic black gay men and Hispanic gay men now outnumber white gay men in AIDS diagnoses and exhibit smaller proportionate declines in AIDS incidence and deaths, according to this week's Morbidity and Mortality Weekly Report. The report studied data collected from 1989 to 1998 on AIDS diagnoses and HIV diagnoses in the 25 states that have conducted HIV surveillance since 1994. Between 1989 and 1998, 290,582 men who have sex with men were diagnosed with AIDS. In 1989, 31% of AIDS cases in that group were among racial and ethnic minorities; by 1998, 52% of AIDS cases were among minorities. Specifically, the proportion of cases among gay non-Hispanic blacks increased from 19% to 33% during that time period, while the percentages for Hispanics increased from 12% to 18%. Examining data from the 25 states with HIV surveillance, researchers found that 40% of the 23,680 gay men diagnosed with HIV or AIDS from 1996-1998 were non-Hispanic black and 7% Hispanic. Further, a larger proportion of diagnoses among non-Hispanic blacks and Hispanics occurred in those ages 13-24, which the researchers suggest could be a sign that "racial/ethnic [homosexual men] may become infected at younger ages compared with white [homosexual men]." As non-Hispanic blacks and Hispanics exhibited higher infection rates, decreases in AIDS deaths and incidence were small. For all gay men, AIDS incidence declined 22% from 1996-1997. The rate of decline slowed to 12% in 1998 compared to 1997. From 1996-1998, for non-Hispanic blacks that number declined 23%, compared to decreases of 39% for non-Hispanic whites and 26% for Hispanics. Deaths among all gay men with AIDS declined 49% from 1996-1997; the rate of decline slowed to 23% the next year. For the 1996-1998 period, AIDS deaths declined 65% for non-Hispanic whites, 60% for Hispanics and 53% for non-Hispanic blacks (MMWR, 1/14).
What's Going On?
Although some may be surprised by the study's findings, Dr. Helene Gayle, director of the CDC's center for HIV prevention, said, "From our surveillance data ... it was just a matter of time before this crossover (of racial groups) would occur. This trend has been going on all along, and people have ignored it. In a lot of ways, the surprise is that people are surprised" (Brown, Washington Post, 1/14). The shift is a result of several factors, the New York Times reports, including the fact that white gay men have "educated themselves about the use of condoms and other prevention measures, while minorities largely ignored the issue of infection with HIV." Part of that problem is linked to the stigma associated with homosexuality, which "may be even greater among blacks and Hispanics than it is among whites." Backing that notion up is the finding in MMWR that many non-Hispanic black and Hispanic men who became infected with HIV from having homosexual sex did not identify themselves as either homosexual or bisexual. Twenty-four percent of non-Hispanic blacks and 15% of Hispanics identified themselves as heterosexual despite having had sex with men, compared to 6% of white males. Gayle said those individuals may not consider themselves at a high risk for AIDS and, therefore, "may not seek or receive ... treatment services they need and many unintentionally put their male and female sex partners and children at risk" (Altman, New York Times, 1/14). She added, "The African-American and Latino communities must recognize that this is not a disease that only affects white, gay men" (Sternberg, USA Today, 1/14).
Blaming the Silence
Leo Rennie, deputy director of the Harlem Directors' Group, A New York City-based coalition of black AIDS-related organizations, agreed with Gayle, saying, "One of the biggest reasons AIDS has escalated in the African-American community is the silence there that is so pervasive about what puts our people at risk." Ravinia Hayes-Cozier, executive director of the Harlem Directors' Group, added, "Since it's not discussed and since men aren't encouraged to discuss their sexuality, they hide it, and they have no place to go to talk among themselves about how sex is putting them at risk" (Waldholz, Wall Street Journal, 1/14). Julio Abreu, associate director of government affairs for AIDS Action, said, "The AIDS epidemic is once again exposing disparities in access to care in America. Our failures to reinvigorate prevention for the most vulnerable communities has resulted in an explosion of AIDS cases among people of color" (AIDS Action release, 1/14). The MMWR study notes that the surveillance data "highlight the importance of increased efforts to promote HIV prevention and treatment services in racial/ethnic minority communities, particularly among non-Hispanic black and Hispanic" gay men. Further, prevention programs should focus on both HIV-infected and uninfected populations with efforts to promote risk-reduction behavior among at-risk youth (MMWR, 1/14). Gayle noted that funding secured by the Congressional Black Caucus helped the CDC to grant an additional $7 million to community-based programs reaching out to minority/ethnic gay men, but the amount was "clearly a drop in the bucket" (Waldholz, Wall Street Journal, 1/14).