Young Gay Men Fueling Rise in HIV Rates
0The AIDS crisis that ravaged the gay community in cities like New York and San Francisco may be less visible, but it is still raging, health experts earn--and a new wave of HIV infections may be about to crest.
For some time, researchers have noted that despite efforts to promote safer sex, HIV rates are climbing among young gay men. So are rates for other sexually transmitted diseases, such as syphilis; unfortunately, individuals already infected with one STI may be at an elevated risk for contracting others, including HIV.
While some of the blame may rest with younger gays not having access to safer sex messages, a perception among young MSMs (men who have sex with men) that AIDS is no longer a serious health concern may also be driving the increased incidence in HIV. Most serious of all, however, is a tendency toward unsafe sex and other risky behaviors, such as drug use, which affect judgment and may lead to more unsafe sex-and a higher rate of HIV infection.
And the trend is not confined to the United States: researchers in the U.K. and Europe have also noted the increase, reported British newspaper The Guardian on Sept. 7. "By investigating the genetic profile of the virus in more than 500 newly screened patients over nine years, scientists in Belgium have identified clusters of people with type B virus--not the one that is most prevalent in Africa," The Guardian reported. "Those infected are almost all white, male, gay and young," the article continued.
The researchers noted that, "Members of this cluster are significantly younger than the rest of the population and have more chlamydia and syphilis infections," the article said.
That is not to say that heterosexuals do not also face the risk of contracting HIV; overall, just under half of the new cases of HIV in Britain were gay men, but straights were also getting infected. One main difference was that while gays seemed to be getting infected without traveling to other countries, heterosexuals--who were picking up a different strain of the virus--seemed to be contracting the virus while abroad, the article said.
"Gay men are still the most at risk of HIV infection in the UK," said Nick Partridge, the head of British AIDS charity the Terrence Higgins Trust. "We also know that more than a quarter of people with HIV in the UK are currently undiagnosed, and they're far more likely to pass the virus on than those who know they have it."
The Belgian study, which looked at HIV trends in Britain and Europe, was carried out by researchers at Ghent University. But health experts in the United States also cautioned that HIV remains a serious health threat here.
In a Sept. 3 release from New York-based Gay Men's Health Crisis (GMHC), Dr. Marjorie Hill, the group's CEO, warned, "A new wave of HIV infections is about to hit New York and we had all better get ready for it," and went on to echo that one major concern is the number of people living with HIV who have not gotten tested, and so don't know that they have it.
However, Dr. Hill continued, a new state law requiring routine HIV testing is likely to lead to a sharp uptick in reported new cases. "Previously, patients were required to sign a separate written consent form in order to get tested for HIV," explained Dr. Hill. "Now, if you agree to a quick swab test, you will only have to give oral consent.
"When undergoing routine medical procedures or check-ups, you will be offered a standard HIV blood test to sign off on along with the battery of tests that most patients receive. Once you give your consent, it stays in effect for all your future blood tests," Hill added, going on to cite the Centers for Disease Control and Prevention as projecting an estimate that says "100,000 people in New York City alone are currently living with HIV infection, but more than 25,000 of them do not know it."
Added Hill, "Most of these unknowing carriers of HIV feel and look healthy and are, in most respects. But they are missing out on treatments that could prevent them from progressing to AIDS. Plus, they are in danger of transmitting the virus to others, continuing to fuel the epidemic."
One crucial benefit of testing is that the sooner HIV+ individuals know their status, the sooner they can begin taking medication to keep the virus in check. Though there is no cure for HIV, modern treatment regimens can help many HIV+ people keep their viral loads down to undetectable levels, meaning that they have a better chance at a normal life span. But early treatment is the key, a Chicago specialist in HIV/AIDS, Dr. James Sullivan, said recently.
Young Gays At Risk
But young gays might not be getting a comprehensive picture of the epidemic, or of the health risks of unsafe sex. "HIV prevention was once driven in part by the fear of the horrible, disfiguring diseases that preceded the untimely deaths of our friends and loved ones," noted Hill. "Now, the number of older people living with AIDS is skyrocketing as new infections rise among the young.
"Today, fewer people even acknowledge having HIV/AIDS because they are experiencing relatively good health (if they have access to treatment) and do not want to complicate their employment or community lives," Hill added. "That has made HIV prevention much, much harder in 2010, especially among young people who are under the illusion that there is a cure for HIV that involves just taking a few pills. It in fact involves taking drugs almost daily that can have very debilitating side effects for the rest of your life."
The current economic downturn may also figure into the health equation, noted Hill. "This new AIDS crisis is coming at a time when state and federal funding for AIDS is being cut in the current economic crisis. While New York has one of the best AIDS Drug Assistance Programs (ADAP) in the country to make sure that all people with HIV can afford their drugs, other states have long waiting lists to receive these lifesaving treatments. And with most HIV infections disproportionately hitting poorer people of color and others who are disenfranchised, the challenge of getting them the treatment, services, and prevention they need is even more challenging."
Combating HIV and AIDS domestically and globally has been a priority for the current and past administrations. Earlier this summer, the White House Office of National AIDS Policy (ONAP) unveiled a National HIV/AIDS Strategy geared toward reducing transmission of the virus, helping HIV+ individuals stay healthy, and closing gaps in health care that can leave some people living with the virus underserved.
Globally, however, efforts to fight the spread of HIV have been hampered by anti-gay laws designed to punish people who have sexual relations with others of the same gender, according to the head of UNAIDS, Michel Sidib�. Worldwide, 85 nations regard same-sex intimacy as a criminal activity; seven of those countries mete out the death penalty for same-gender sex, with a possible eighth--Uganda, now mulling stricter laws against gays that include the death penalty--on the horizon.
Sidib� acknowledged that in some societies, an anti-gay sentiment is growing--but he warned that writing prejudice against homosexuals into law could result in a backlash in the form of a health crisis affecting everyone. "We must insist that the rights of the minorities are upheld. If we don't do that," Sidib� said, "I think the epidemic will grow again." The UNAIDS head added, "We cannot accept the tyranny of the majority."
One hot spot in the culture wars concerns making sound, science-based sex education available to adolescents. Researchers who conducted a survey of young gays, bisexuals, and other MSMs have concluded that effective education efforts concerning HIV/AIDS are best possible if directed at youths in their early teens.
A July 29 article at AIDSMeds.com recounts that a paper presented at last month's AIDS Conference, which took place in Vienna, indicates that young MSMs fail to grasp the risky nature of unprotected sex.
The study, authored by D. Dennis Flores III, et al., indicated that young MSMs had received inadequate sex education in schools, with gay sex typically not being covered in sex ed curricula. Moreover, young MSMs often had no positive gay role models, and found their sexual partners--and role models--via the Internet, where safer sex between men was often not depicted. Instead, the report said, young MSMs saw risky sexual behavior talking place, and this became their model for sexual encounters.
One 24-year-old told the researchers that what he saw online "sure has taught me a lot of tricks. Things that I never thought were humanly possible. It gave me a reference," added the young man.
The report also indicated that as many as half of the young gay men surveyed were introduced to sex through abusive or coercive relationships. The end result of all this was that risky patterns of habitual sexual behavior had already been instilled in young MSMs before education efforts designed to reduce HIV transmission among gay youth became available to them. Indeed, some of the young men surveyed had become HIV-positive before they received the factual information that might have helped them avoid contracting the virus.
AIDSMeds.com recounted that the reports recommendations included comprehensive, fact-based sex education for students as early as elementary school or middle school at the latest. The report also emphasized the need for young MSMs to receive understanding and acceptance from their families, and suggested that GLBT youth who were out and open make it a point to become leaders and role models at their schools.
But not everyone is supportive of the idea of elementary or middle school students being presented with fact-based sex education, or with sex education curricula that include objective, science-based information on safer sex and same-sex contact. A Health and Human Services program to fund two separate approaches to sex education--one an abstinence-based model, and the other an evidence-based modell--was announced June 30, but the fact-based model was subjected to criticism from pundits on the right, who claimed-erroneously--that federal funds were being withheld unfairly from abstinence programs.