D Gregory Smith

U.S. Gay Men's Astonishing HIV/STD Rates

Filed By D Gregory Smith | March 12, 2010 4:00 PM | comments

Filed in: Living, Media
Tags: CDC, condom fatigue, gay priorities, HIV/AIDS, MSM, PWH, STD, syphilis

At the National STD Prevention Conference on Wednesday, the CDC (Centers for Disease Control and Prevention) released some astonishing data regarding rates of infection among MSM (Men who have Sex with Men).

The data indicate that rates of HIV infection among gay men and other men who have sex with men (MSM) are more than 44 times higher than rates among heterosexual men and more than 40 times higher than women. Rates of syphilis, an STD that can facilitate HIV infection and, if left untreated, may lead to sight loss and severe damage to the nervous system, are reported to be more than 46 times higher among gay men and other MSM than among heterosexual men and more than 71 times higher than among women. (Full presser here).

Disturbing statistics indeed. But for all this darkness, there's a light on the horizon:

While the heavy toll of HIV and syphilis among gay and bisexual men has been long recognized, this analysis shows just how stark the health disparities are between this and other populations," said Kevin Fenton, M.D., director of CDC's National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. "It is clear that we will not be able to stop the U.S. HIV epidemic until every affected community, along with health officials nationwide, prioritize the needs of gay and bisexual men with HIV prevention efforts. (emphasis mine)

Listen up: "Prioritize the needs of gay and bisexual men with HIV prevention efforts." That means at the head of the line, the top of the list, etc. That means that they are publicly saying that what has been done in the past to target MSM is not working. To my knowledge this has never been said before by the CDC. I don't want to blow this out of proportion, but this may change the face of outreach and prevention efforts in the U.S. I'm an optimist, but I'm also a realist.

It's not going to happen without our help.

As MSM, PWH (Persons with HIV), LGBTIQ, allies, families, friends, we not only have to hold our state and local agencies and organizations to this, we have to help figure out what's gone wrong. So let's get started.

These are completely preventible diseases. We are not preventing them (granted, I have one of them). For openers, I'll throw out some questions:

  • Have we stopped caring about ourselves and our partners? Have we lost our self-respect?
  • Have we simply accepted that as gay/bi/dl(down low) men, this is the price we pay?
  • Do young gay men know what a pain in the ass it is to have HIV? Are PWH telling them?
  • Are we STD ignorant?Syphilis can be just as deadly as HIV.
  • Are men just stupid in the face of sex?
  • Are we just tired?
  • What can we do to stop the infection of our community? What will work?

Discuss.


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A. J. Lopp | March 12, 2010 4:40 PM

After a flurry of pseudo-military assaults on this enemy during the 1980's and early 90's, the GLBT community is now MIA --- for the most part, it has become old hat. But the stats you cite, Gregory, illustrate the consequences of this loss of interest. In addition to this, we no longer insist on a cure instead of maintenance drugs, no one discusses an HIV vaccine any more except an elite community of scientists, and we have handed over worrying about HIV/AIDS in Africa to Bill and Melinda Gates. (Not all rich people are bad! Bless them!)

There are also generational issues to consider. HIV prevention is not sexy to many who are younger than the Boomers, and many of us who have survived are now reaching the chapter of life when it is natural to slow down a bit even if our health is otherwise perfect. Not to pick on any one person, but I gather that nowadays even Larry Kramer prefers to spend Saturday night with his cat.

So, this is something we just live with, accept, and move on from?

In the U.S., HIV is primarily a gay disease- these statistics just seem to confirm that. Public opinion will follow.

I wonder when the state and federal agencies who have to pay for all the queers in drug therapy for HIV will decide they don't have to pay because they're "only queers".

Maybe then we'll see some action. Or maybe we'll just stay home with our cats.

A. J. Lopp | March 12, 2010 9:55 PM

I did not mean to sound like this state of apathy is OK --- it is not, in fact, it is dreadful!

But unfortunately, I'm as stymied as anyone else.

And I was making too much of an effort to make a point (hopefully not) at your expense.
It is SO frustrating. I just worry that we're contributing to our own deep worthlessness by accepting this as ok.

Rick Sours | March 12, 2010 5:00 PM

Having lived through the 1980's and seen that
era of the AIDS epidemic, I find these findings
truly sad.

I simply do not understand.

beergoggles | March 12, 2010 5:07 PM

The recording methodology has changed hasn't it? Ppl can no longer get anonymous testing like they could in the old days, so there are probably fewer being tested while the cdc is keeping better tabs on the data they do get.

Most states still have anonymous rapid testing- for a reactive test, a possible positive, the confirmatory blood test is confidential like any other medical record.

I live in Palm Springs the home of the famous "White Party" that draws 20,000 gay men for non stop partying for three days. Circuit parties raise money to benefit HIV/Aids organizations but once the parties get rolling sexual inhibitions are let down and there is non stop sex, by the pool, in the hotel rooms on the dance floor. Gay men want to have a good time for a few days. There are no easy answers. It's very sad as many leave the weekend HIV infected.
I worked with Sean Strub the editor of POZ magazine to develop a vaccine. We couldn't get the interest from the National Institute of Health to work with us so I gave up. Too much pressure from the religious right in government against the "gay lifestyle". Of course Billy Graham had no trouble influencing President Bush to send billions to Africa where HIV/AIDS is mainly heterosexual and it's the Christian thing to help THEM, but we gay/bi men get the blame for spreading it. But what is all that money doing for the crises in Africa? Infections rates grow every year.

Juston Thouron Juston Thouron | March 13, 2010 12:51 AM

Greg, I have found these questions difficult to respond to because there seem to be so many different answers to them. So, I've been trying to focus on distinguishing characteristics between straights and gays regarding attitudes towards safe sex.

First, I wonder if part of the higher rates of STD transmission have to do with greater sexual activity. I mean that gay men have more sexual partners and have more sex than their hetero counterparts. This may be relevant in that if a gay man only practices safe sex 90% of the time, he can infect any more partners than his hetero counterpart. I wonder if there are any statistics corrected for this fact (not that it could make up for 44 TIMES the rate of transmission, but it may correct it down somewhat).

Second, I wonder if people really understand how quickly someone newly infected with HIV can infect another. There may be many people out there who erroneously believe that if someone tested HIV- last week, that means they couldn't transmit HIV even if they had been infected since. This is incorrect, but many may not know this.

Which leads me to my third point. If someone is even getting tested monthly, by the time they show up as HIV+ they could have infected many others. Knowing their HIV status is crucial. But knowing their partner's HIV status is as well, but if that person got infected since their last test and they aren't practicing safe sex ......

With these two factors, I wonder if STD transmission rates would be corrected to levels comparable to the hetero population?

All excellent questions/points, Juston.

We can't even seem to get sexually active men to get tested once a month. The average, I think (from a study I remember a few years ago) is 16 months.

Fear and denial win again.

Rick Sours | March 13, 2010 8:43 AM

We are all sexual beings and the HIV virus is only transmitted in very specific sexual activities. Regardless of the number of sexual partners or where one may engage in sex; the bottom line is if one engages in certain activities safe sex (condom usage) should be practiced.

I would like to add some points to this discussion - glad to see it happening here. It is much more complex than addressing individual behavior - there are huge structural issues at play here.

NATIONALLY, PUBLIC HEALTH ENTITIES HAVE PROVIDED INADEQUATE HIV PREVENTION SERVICES FOR GAY/BI MEN

• CDC spends approximately $650 million per year on HIV prevention activities. Approximately $300 million of that goes to state and city health departments that have consistently under-funded services targeting gay and bisexual men. Between 2005-2007, only 29% of federal risk- reduction funding managed by state and local health departments supported services for gay/bi/MSM.

o For federally funded counseling, testing and referral services (CTR), state and local health departments directed only 11% of the total funds distributed during the same period toward gay/bi/MSM.

o Most of the CTR allocation went to the general population and the majority of that money was directed to low-risk heterosexuals, according to the CDC.

o In 2009, only 20% of gay/bi/MSM had access to HIV prevention services.


INTERVENTIONS MUST EXPAND FOCUS BEYOND INDIVIDUAL-LEVEL EMPHASIS

• Understanding the factors related to changing trends in the HIV epidemic among MSM is complex and multifactorial, and cannot be attributed simply to individual-level behavior. Continued emphasis on prevention of individual-level risk behaviors will only have a limited impact on the disproportionate rates of HIV infection.

• Current data show that Black MSM have higher rates of HIV prevalence than White or Hispanic MSM despite comparable levels of sexual and drug use risk behaviors and similar frequency of HIV testing.

• Historically inadequate, disproportionate resources directed toward gay/bi/MSM are a contributing factor to the general gay/bi/MSM disparities, and particularly impact gay/bi/MSM of color.

• Higher prevalence of HIV among gay/bi/MSM and relatively closed sexual networks – particularly among black gay/bi/MSM, increase the chance of exposure per unprotected sexual act.

• Unprotected anal intercourse is the most efficient means of transmitting HIV.

• Interventions must address structural issues such as institutionalized homophobia, stigma and discrimination, as well as human and civil rights, and lack of access to health care. Additionally, the role of community viral load and sexual networks requires further study.

• There is a pressing need for the development of new prevention methods such as topical and oral prevention as well as preventative and therapeutic vaccines.

SHORTCHANGING HIV SERVICES WILL ESCALATE DISPARITIES AND UNACCEPTABLE OUTCOMES

• Years of neglect and the federal emphasis on ineffective abstinence-only programs that negate the existence of gay/bi/MSM have taken their toll.

• Gay/bi/MSM must be prioritized in every community in the country if the United States is to adequately address the HIV epidemic.

• Proportionate resources must be allocated to programs serving gay/bi/MSM and must include funding for culturally competent mental health and substance use programs. This includes federal, state and local funding.

Beautiful breakdown of the numbers and issues, Jim. I hope people reprint your words and statistics and post them on the walls of every LGBTIQ Advocacy office/group in the nation.

Which brings me to another point: Why aren't the big LGBT organizations on this? Where is the HRC, the Task Force, etc.?

We have to start thinking this is discrimination- maybe even greater than marriage equality, which, comparatively, seems a much safer torch to take up....

HRC, NGLTF and the Equality organizations have fallen in with the raison d'etre of politicians. Raise money and kiss ass with donors with money. Yes they should help with education regarding HIV infection but that is not a popular black tie fundraising thing to do. Fundraising is the catalyst for their being. Fundraising workshops are a feature at the NGLTF Task Force annual gathering at pricey hotels. As if my money is going to work towards their solving LGBT HIV/AIDS problems? What it does is pay the rent on buildings and gives the staff a salary. I wish the situation was different but it is a reflection of non profit 501 (c) 3 corporate competition for the gay dollar.

Michael Connolly | March 13, 2010 1:03 PM

When I worked at the AIDS Action Committee of Massachusetts in the late 1980s, the percent of Federal money going to combat HIV among gay men was.... zero. Congress was willing to spend on women, people of color, infants, and other "innocent victims." So, now we're up to 11%. When it should be closer to 50%.

Homophobia is measurable. This a clear measure of it.

I'm not surprised by the disparities you quoted, Greg. Truth is; gay male sex is the perfect petri dish for HIV infection when you factor in anatomy, cultural mores, etc.. I don't see that changing anytime soon. Het's have an advantage in that they have longer courtships prior to sex (in most instances) and because fidelity is a larger value for them. As well; they've been acclimated to condom use for literally centuries now. But to answer a couple of your questions: No; younger gay men have no real idea that HIV is the pain in the ass it is. Among their peers with HIV; they see mostly young men who are more or less thriving. They don't interact much with long term survivors who have multiple complications (acquired over time) nor do they know how to measure the loss of intangibles like loss of energy or the financial poverty that this disease inevitably imposes as time goes on. As always with youth; they lack the maturity to see a larger, long-term picture of consequences to their actions. When I was 25 years old, I 'planned ahead' no further than the next holiday weekend, or just managing to pay that month's bills. Shortsighted? Of course - but that's youth for ya.... ---- Are men just stupid in the face of sex? Yes; we are. We always have been. We always will be - even in the face of death. Just ask any Republican or televangelist, right? As a former Act Up'r and prevention writer for 20+ yrs, I've pondered your very same questions for what feels like eons now. For myself, I've concluded that the only thing that 'sometimes' works is to scare the beJesus out of those at risk with true tales from my own crypt and those of my elder infected peers. We need to be unflinching and un-coddling. As well, we need to glorify and put upon pedestals those who remain uninfected, as hard as that often is to maintain. And we need to do that even if it 'hurts' the feelings of those who are infected.

Great points, but I wonder whether straights are better at condom usage than G/B men. Most women I know are on the pill or IUD, and most straight men I talk to hate condoms as much as the rest of us.

I also agree that HIV rates are increasing because the fear has abated, I'm just not sure I want to live under the specter of fear that I remember so vividly from the 80's. Fear works in weight loss, too. But studies have shown that people who work at losing weight sensibly and compassionately rather than abusing themselves psychologically, keep it off. The others yo-yo.

I hope we can do this sensibly- and with some passion and conviction.

I agree. Preaching fear doesn't work. We have to make condom use fun and sexy to use. I guarantee you if skater Johnny Weir brought out a line of personalized condoms it would do wonders to enlighten the young. Have you seen him on the Sundance Channel? Be Good Johnny Weir. He is adorable and a future star preaching in your face Conservative America.

It is good that we (members of the LBGT community) are having this discussion regarding the alarming rate of HIV infection among our community. Having done alot of volunteer work involving the AIDS crisis in the 1980's in a large urban area, I certainly am very concerned with these facts and figures. In years past, if one were infected with the HIV virus it was a death sentence. Today, with proper treatment that is no longer true. That being said; what about the quality of life?

For several years which we lived in Tucson, Arizona my Partner did volunteer work at Wingspan. We both heard young Gay men say that they expected to be infected with the HIV by their mid forties. Guess it is also a generational thing, in that certain age group thing differently.

Just like you said before: sad.

Sad that we as Elders have run out of gas. Sad that the young don't have the serious information available to take care of themselves. Sad that our society and government don't take us seriously.

I just hope we can transform our melancholia into action.

The most important single reason why HIV is so prevalent among gay males is the number of sexual partners they have. Most heterosexuals can count the number of lifetime sexual partners on their fingers, and have some left over. Gay men can do that in a single year, or month, or in some instances a single night. Yes, condoms are important but so too is reducing the number of sexual partners. The following key literature is from the Kinsey website.

Bob Roehr


http://www.kinseyinstitute.org/resources/FAQ.html#number

•Males 30-44 report an average of 6-8 female sexual partners in their lifetime (Mosher, Chandra, & Jones, 2005).

•Females 30-44 report an average of 4 male sexual partners in their lifetime (Mosher, Chandra, & Jones, 2005).

•3% of men have had zero sexual partners since the age of 18, 20% have had 1 partner, 21% have had 2-4 partners, 23% have had 5-10 partners, 16% have had 11-20 partners, and 17% have had 21 or more partners (Laumann, Gagnon, Michael, Michaels, 1994).

•3% of women have had zero sexual partners since the age of 18, 31% have had 1 partner, 36% have had 2-4 partners, 20% have had 5-10 partners, 6% have had 11-20 partners, and 3% have had 21 or more partners (Laumann, Gagnon, Michael, Michaels, 1994).

How does that work? If men have more sexual partners in their lives than women do, either there are lots more gay men than their are lesbians, or.... I don't really see how, in a closed population, there could be men having sex on average more than women are, unless the vast majority of sex going on isn't straight.

I don't know what's the cause of these numbers, and I'm sure there are many. One that annoys me, though, is the fact that a lot of people tend to cling to the "Young men just don't get how terrible HIV is." Really? Then why do most of the people I see having sex or offering to have sex without a condom are over 40?

Part of the problem is worsening sex ed in schools, part is that HIV isn't the death sentence it used to be, part is that people don't care about community much any more, part is fatigue, and I'm sure that's only covering about 10% of the problem.

Bottom line, though, people don't like having sex with condoms all the time and they look for ways to avoid them. And all the ads saying that sex is the same with or without condoms aren't going to convince people to stop believing their lying rectums.

Most recent age grouping of newly infected is:
13-29, 34%; 30-39, 31%; 40-49, 25%, over 50, 10% (CDC).

So most new infections are trending younger. I've had an alarmingly large influx of newly infected guys under 24 in my practice and HIV+ support groups.

You're right in saying that we don't have the whole picture, and it may be too easy to put the blame on young guys, but- and this doesn't speak for everyone of course- of 20 newly infected guys I've met with in the last year, only 2 had ever met an HIV+ person (obviously that they knew of) before their diagnosis.

I'm just saying HIV+ persons could be very effective simply by telling their stories and sharing their concerns.

Juston Thouron Juston Thouron | March 13, 2010 9:20 PM

Whenever a singular behavioral phenomenon appears in a minority community, my mind gravitates towards looking at how that minority is treated by the majority. All explanatory roads seem to dead-end there.

I think it would be beneficial for everyone on this thread to read the following resource:
http://www.lgbthealth.net/downloads/research/Human_Impact_of_Homophobia.pdf


Here are some excerpts from page 19:

"Although few studies have directly
linked particular stressors resulting
from homophobia and their health and
social outcomes, most researchers agree
that homophobia increases a multitude
of risk factors associated with
psychological, psychosocial, psychiatric,
social and health problems and that
homophobia is a major health hazard to
GLB and society."

"Ross(1989) studied homosexually oriented
males in four countries (i.e., Sweden,
Finland, Ireland and Australia) and
found that homosexual adolescents are
likely to have more problems in the
more anti-homosexual countries. This
suggests that the level of homophobia
manifested in a particular country or
culture may be directly linked to the
extent of GLB health and social
problems"

Completely agree.

Guilt and shame, internalized homophobia, fear of recrimination (employer, religion, family, peers) are all part of the mix.
As well-adjusted as some of us are, the subliminal messages of "less than" are still quite powerful, and it takes its toll. We cope by self-medicating, screwing, spending, etc., all which eventually compounds stress and can lead to a lifetime of mental illness issues, HIV, STD's, addiction, etc.

All from being overtly or subliminally discriminated against by the majority.

...and an excellent resource- I just slogged through most of it (my eyes strain easily on the computer)
Recommend others do so, too.

My concern is that more and more sexy&good looking gay men get STD. It seems that gay men is easier to get an STD.
According to the report from the largest STD dating site == Positivefish.com ==(if I spell the site correctly), the gay subscribers
increased continually. Most of them are sexy.

It has been pointed out that Gay men have a greater number of sexual partners than their heterosexual counter-parts. Of course, the greater the number of sexual partners the greater the chances that the partner will be HIV+. The only way the HIV virus can be transmitted is in very specific conditions. This is irrespective of the number of sexual partners.

There are cases whereby individuals have had sex with only one person; that person was HIV+, they engaged in high risk activities and did not use a condom. In some cases, individuals who only had sex with one person became HIV+. In my opinion, this is why Gay men should practice safe sex and always use a condom if they are going to engage in anal intercourse.

It is important for Gay men not be fearful and to realize that they can have sex if they use common sense and practice safe sex.

Finally, about 70% of the men I socialized in the 1980's have since died of AIDS. I want the future generations of Gay men to have good quality lives.

The short answer is sluts and hos that men are more likely than women to associate with. But there probably also is a self-reporting bias as culture/society tends to encourage men to have more sex and women fewer. As a result, men tend to lie about having a greater number of partners whil women lie about having fewer.

"So most new infections are trending younger."

Part of this is simply a matter of statistics. An increasing portion of each progressively older age group already are infected with HIV so there are fewer left who are available to become infected.

The curve would be a lot flatter if one measured the portion of uninfected men in each age group who became infected during that period.

I appreciate your diligence.
The CDC measures both age at time of diagnosis, the current ages of people living with HIV, and the age of HIV+ persons at death, plus many other variables.
When I asked a professional scientist whether your concerns could be verified, she said it would have been accounted for, but it would be statistically a very small difference.

How about the reason is indiscriminate sex, drugs and a general feeling that HIV is a manageable condition, and a failure of the community to scold those who go barebacking(Yes, you Sully) as well as those who sponsor sex party events?

Yes, I know that I will get some sh*t for saying this, but this, not wishful thinking about the validity of stats, is the issue.

Juston Thouron Juston Thouron | March 14, 2010 7:08 PM

Maura, I'm not going to give you sh*t for pointing out the obvious. But we are human beings, not machines. If rationality were the rule the world would have been a very different place from the beginning.

Consistent condom use community wide would end the HIV epidemic, yes. Then we could gain independence from the Feds and cure ourselves no matter how our society feels about us. But that will take some doing. Also, when considering that many in our community are in the closet, to varying degrees, and do not interact with other gays except when pursuing sex, I wonder how many community-based outreach messages will actually reach those gays? Even if a safe sex message came from the top and was directed towards as wide an audience as possible, I doubt it would scare people into engaging in protected sex. The "This is your brain on drugs" commercials didn't end illegal drug use.

I've wanted to address something on this thread since yesterday and I'm going to do it now: Men (straight or gay) hate condoms with a passion, have always hated condoms and always will hate condoms. Perhaps we need to approach barrier protection from another angle? I am not an inventor or scientist but until we, as a society, can understand just how much men hate condoms and come up with a solution, a cure will be the only thing that ends the tragedy of HIV transmission. After all, existing condoms have not eliminated unwanted pregnancies, have they?

As for personal responsibility as a solution, I am all for it. But history demonstrated long before the social and medical sciences that significant numbers of an oppressed minority behave, well, as if they are oppressed. Apathy is the effect of acquiescence. To what? That nobody gives a damn. And that there is nothing one can do about that oneself. Add to that the fact that youth (at all times in all ages in all communities) tend towards higher risk behaviors and some of the CDC's stats become understandable. After word of HIV got out in the 1980's the older generation still had lots of unprotected sex.

Does anyone on this thread doubt that if we had full equality, HIV transmission rates would drop precipitously?

Nope.
As I said above, the guilt and shame are powerful- you said it beautifully.

I am glad many of the posts on here don't demonize gay men - and am equally sad that many do.

One need not be reckless "slut", an irresponsible "ho" to be exposed to HIV. Most gay men, in fact, are none of the above.

Most infections, in fact, don't happen at drug fueled bareback sex parties.

But I don't want to argue those points, actually. Because those of you who get off on riding their moral high horse and screeching about "bad" gay men - don't really know what you are talking about. It is easy, and feels good, to holler, doesn't it? But it does ZERO good.

I was excited to see Juston bring up the idea of alternatives to condoms. Yes, most men don't seem to like them, do they? Women, as a matter of fact, don't much like them either. Condoms interfere with intimacy for many people - gay or straight - and there are lots of reasons they are not used that can't be chalked up to "bad" behavior.

In fact, many people stop using condoms in the context of marriage, partnerships, and other significant relationships because they want to feel closer.

That said, there are indeed a number of approaches being explored to offer different options for protection. One is oral exposure, or pre-exposure prophylaxis (PrEP). This is where an individual would take an antiretroviral pill every day (or some other frequency) to ward off HIV if exposed. Around 20,000 ppl around the world are taking part in PrEP trials right now. You can learn more about PrEP here - http://www.avac.org/ht/d/sp/i/262/pid/262 - on the AIDS Vaccine Advocacy Coaliton's website. Oral prevention wouldn't supplant condoms - but would be another tool in the proverbial prevention toolbox. There could very well be efficacy data coming out later this year.

Another interesting thing in the research and development pipeline - microbicides. A microbicide is a topical agent (perhaps a lube or a gel) that could be applied vaginally or rectally to prevent HIV. Other ways to deliver a microbicide could be an enema, a douche, a vaginal ring... These things don't exist yet - but there is a vibrant array of research activities going on to develop vaginal products, and a growing segment of the field is focusing on rectal microbicides, to protect women and men who engage in anal intercourse. More women have anal intercourse than men, and most of that is unprotected, by the way.

As chair of the International Rectal Microbicide Advocates, known as IRMA, I would like those interested to visit our website and blog to learn more about the science, and the advocacy underway to bring safe, effective, acceptable and accessible rectal microbicides to market - rectalmicrobicides.org.

Its important that we have a number of different tools at our disposal to protect ourselves. Relying on one - the male condom - is pretty ridiculous. It would be wonderful if our energy went into advocacy around these potential new options. And we could also expend some energy on promoting the new female condom for anal use in the meantime(see ringonit.org for info there.)

Finally, let's remember that we as gay men are strong and resilient and creative and loving. We took care of ourselves during the 80's and 90's - and we are doing so now - in the face of serious obstacles - many of which have been laid out here. There is a community and we do care.

...and it's the humanity of it all that keeps us talking in spite of frustration, pain, loss and fear.
That's the part I love.

Rick Sours | March 15, 2010 8:29 AM

Upon reading the various entities in the exchange of ideas, there is still an extreme sense of sadness. The question seems to be what can we as members of the LBGT community do to turn around this alarming trend? It goes without saying the importance of realistic sex education targeting Gay men. Years ago for Gay men, sex was a way to feel included and accepted.

Maybe some of us have been lead to believe that with the further acceptance of members of the LBGT community, the self-esteem of Gay men had greatly improved. Maybe the question is what can we as members of the LBGT community do to help improve the self-esteem of Gay men?

I think that last point is always something we can work on. Again, the guilt and shame thing is huge. So is depression. We can build self-esteem by consistently affirming self-worth, but it's hard, when swimming against the tide sometimes...

The CDC measures both age at time of diagnosis, the current ages of people living with HIV, and the age of HIV+ persons at death, plus many other variables.
When I asked a professional scientist whether your concerns could be verified, she said it would have been accounted for, but it would be statistically a very small difference.>>

I'm writing this as a personal note and not necessarily for posting.

The national HIV/AIDS figures issued by the CDC are not measured or directly gathered by the CDC; rather the CDC compiles data submitted by the 50+ individual state health departments (plus DC, Puerto Rico, etc).

I don't know who your scientist is, but she is wrong on both points.

A say that as a biomedical journalist who is a regular contributor (93 articles last year) to BMJ (formally the British Medical Journal) and other medical trade publications. I've also been the DC corresondent for the Bay Area Reporter, Windy City Times, and other gay papers since 1993. My primary focus is HIV and infectious disease.

Finally, my two separate comments were made with regard to what others had written and somehow did not end up being posted there. They don't make as much sense when they are posted as part of the main thread instead of as a comment to another comment.

Thanks for your response.
I'm not a statistician, so I will defer to your obvious expertise with the numbers. "Measuring" and "compiling" have obviously been used interchangeably here. I also didn't mean to call your competence into question- just acting on information I was given to continue the conversation. Thank you for lending your experience and knowledge here. Your voice is appreciated.

I have to say - can we get beyond the "low self-esteem" and shame thing? Sure, these things are issues - but c'mon - lot's of gay men don't have low self esteem and shame issues, and still make decisions to have unprotected sex.

Many times those decisions are based on intimacy - not self loathing and shame. The whole meme that gay men are damaged - that has come up here over and over - is just so tired. It's not true much of the time, and much of the rest of that time, it's only part of the story.

So - can we move the discussion beyond how we need to fix each other and address structural issues around access to health care, homophobic structures that limit access, and the need for a comprehensive, holistic gay men's health agenda that doesn't solely defer to HIV and STDs but embraces physical, emotional/mental and spiritual health as well???

Can we move beyond the notion that gay men are nothing but a collection of deficits and focus on our strengths as we confront the issues that are important to us?

If I hear one more person chalk up HIV and STD rates to a simplistic "they just need to love themselves more" I am going to scream.

Yeah, and I don't think most of us think it's that simple either. All the points raised above have their place.

And it's not all about "fixing" the damaged-although some of us are. It's about support where we need it. It's about acknowledging strength where we have it and addressing weakness where it exists.

The reality is that we are still infecting each other, and there's a lot of paralysis, confusion, fear, fatigue and anger involved. There's also a lot of courage, strength, caring, concern and passion- as you remind us. We have to look at them all to move ahead.

Juston Thouron Juston Thouron | March 16, 2010 12:47 AM

Jim when I first read your post I noticed the following; "So - can we move the discussion beyond how we need to fix each other..." followed in the same paragraph by, "but embraces physical, emotional/mental and spiritual health as well???"

I admit that, for the purposes of discussion on this thread, it may be good to move on and focus on other approaches because that is where solutions are to be found. But, and I may be wrong here, you seem to be coming from a community-centric perspective, as if the LGBT community can solve all of these problems on it's own. It can't. I would point to Lambda Legal's Survey on Discrimination Against LGBT People and People Living with HIV
News Release: http://www.lambdalegal.org/news/pr/xny_20100204_lambda-releases-health.html

"Almost 36 percent of respondents living with HIV reported that health care professionals refused to touch them or used excessive precautions and nearly 26 percent were blamed for their own health status."

"Nearly 21 percent of transgender and gender-nonconforming respondents reported being subjected to harsh or abusive language from a
health care professional, and almost 8 percent reported experiencing physically rough or abusive treatment from a health care professional. Over 20 percent of transgender and gender-nonconforming respondents reported being blamed for their own health conditions.

Among the survey's Key Recommendations (beginning on page 2 of the Executive Summary) are:

"Establish nondiscrimination, fair visitation and other policies that prohibit bias and discrimination based on sexual orientation, gender identity and expression and HIV status, recognize families of LGBT people and their wishes and provide a process for reporting and redressing discrimination if it occurs.

and,

"Require health profession students and health professionals to undergo significant cultural competency training about sexual orientation, gender identity and expression and HIV status.

"Include training about the specific ways LGBT people and people living with HIV who are also people of color, low-income, seniors or members of other underserved populations may experience discrimination in health care settings and establish policies to prevent them."

Most of the solutions above are going to be the result of political action. LGBT centers across the country can refer LGBT/HIV+ persons to professionals experienced in LGBT/HIV cases to help. But those are not the only professionals at risk/ill persons will interact with, especially if they have to go to the hospital.

A good attitude is essential for personal survival and well being. But with the problems we are facing, "focusing on our strengths" will not get us where we need to be. And I understand that you feel like screaming at simplistic solutions, but statements about our strength meant to reassure us can also come across as simplistic.

"...structural issues around access to health care, homophobic structures that limit access, and the need for a comprehensive, holistic gay men's health agenda..."

...will be resolved only when political activity makes more funding available. Yes, not just for medical care but also for training for HC professionals in dealing with our community in general. With the present crisis in health care, we have a long way to go.


Being community centric doesn't mean we don't do advocacy for better policy, better legislation, appropriate funding, etc. It doesn't mean we have all the answers, or that we don't need allies.

My day job is Advocacy Director at the AIDS Foundation of Chicago. As a person living with HIV myself for the last 15 years, I believe one of the most powerful, empowered ways for us to make a difference is to advocate and lobby for change. People living with HIV demanding change is exactly what being community-centric is - people with HIV have the power and the tools to affect change - and there are many historical and current examples of this. Telling our stories and speaking truth to power is what it's all about - and no one can do that, or should do that, for us.

LGBT folks also have powerful historical and current examples of advocacy for change. That power is in our hands - and we should continue to use it on matters that are important to us.

My argument is - we have the tools and the talent in our community to address our challenges, which are significant. We are the solutions in that we are the experts - and in our advocacy, we make our arguments in that manner, and convince others to work with us.

People with HIV need doctors and health care workers and policy makers and funders and drug companies and insurance companies and elected officials, etc to tackle this epidemic here and abroad. But it is WE who are the agents of change, and it is US who frame and prioritize the issues. If we had let others do it for us, we would have many, many, many more graves than we already have.

We don't need fixing - we need alliance and action - led by the experts.

I love Lambda Legal, they do excellent work. But the survey you cite has several limitations, not the least of which the report itself mentions:

"The survey was not based on a random sample, but used “convenience sampling” and “snowball sampling,” which means that responses came from those who chose to take the survey and many learned about it through e-mails and blog posts."

That means it is not necessarily representative. And we know that people who have a problem or complaint are much more likely than people who are happy with the service to respond to such a survey.

Importantly, the survey doesn't have a comparator arm of heterosexuals, so we don't know how those responses (representative or not) stack up against other folks.

What we do know is that most people like to be touched in an affirming manner. Touch can be an important part of care. Most patients like it and they complain when their physicians all too often do not do it.

So the survey lacks the important "compared to what" element.

That said, the recommendations in the report are good; they do not need a survey to justify their implementation.

Juston Thouron Juston Thouron | March 16, 2010 5:05 PM

@Greg, Jim and Bob. The point of the original post is that something isn't working. Present advocacy efforts are not stopping the rising rates of HIV transmission.

Perhaps, together we have drilled down to some bedrock lying underneath the issues discussed on this thread.

What is the difference between advocacy and political activity? Whatever definition is given the practical reality on the ground is that advocacy will, in fact, change some people's minds (as it has since Stonewall) but only on a case by case basis.

Political change becomes the law of the land and with that change comes universal advocacy from all governmental authority in the U.S. Discrimination ceases to be the rule and becomes the exception. Advocacy has brought us a long way but it's boundary is defined by the political, not the other way around.

Activism, advocacy and politics - all go hand in hand.

These activities are what influence policy makers and funders. And once policy is changed, legislation is enacted, and things are funded, advocacy is all about implementation and monitoring.

IMHO - a lot of energy and a lot of resources have been sucked into marriage and the military in our community - and LGBT orgs who aren't HIV or health oriented have completely forgotten this issue.

Are there any LBT foundations that fund HIV/AIDS work? If there are, I am not familiar.

Seems we have some advocacy to do right in our own front and back yards.

I agree. An advocacy foundation sounds like something we should explore. NAPWA could certainly use the help....

i do not know what to say about the rising infection rates of young gay men. i am 28, almost 29, and i remember the sex ed from high school. very scary pictures of various diseases, but almost no mention of HIV among homosexual/bisexual men. there was also no mention of the fact that HIV transmission is much more likely in anal sex than any other sexual practice i know of. personally, i am almost obsessive about safe sex practices, but that has nothing to do with what i was taught in school. i truly do not know where i learned safe sex, beyond the abstain, abstain, abstain method. the sex ed i had in high school only discussed condoms, dental dams, the female condom, etc because a question was asked. and the answer given was always truthful, but also followed by the abstinence is the only truly safe sex answer. personal responsibilty is key for prevention of any STD, but the education available in the public school system is truly deficient. it also doesnt help that the person giving the sex ed seminar was 'creepy'. i didnt like him, he seemed to give off vibes that said sex was immoral period and only to be tolerated for the purpose of reproduction. i dont know why he did the seminar, but he did. i do not recall any sex ed in the health class or in the biology class took. lack of education could be a problem. i have NEVER seen a same-sex safe sex ad on TV, not that i watch a lot of TV but still.

i do know that part of the problem with increased infection rates is that the latest estimates i saw say that someone infected with HIV will live in relative health for 20 yrs with the new drug therapies available. unless you look, and look hard, few of the drug therapies tell you what the side-effects of the drug is. the only reason i know some of the side-effects is friend of a friend information combined with personal research. the lovely new drug-therapies that help maintain the health of an HIV infected individual would not sound like such a pleasant alternative to safe sex if all the side-effects and potential drug-interactions were proclaimed louder. of course, how do you convince a drug company to essentially bad-mouth its own product?

as to the greater number of sexual partners among homosexual/bisexual men vs that of heterosexual men, i beleive there is some truth in this statement. a few years ago i was worried that i might be a slut. i eventually came to the conclusion that i enjoy sex and there is nothing wrong with that, but that i am probably a slut(not that i mind). during the process of determining if i was extremely promiscuious i asked nearly everyone i know how many partners they have had and here were the answer(or as close as i can remember) that i got. my mom, yes i asked my mom, had had 6 partners in her life, dad 4, my brother 2, my sister 3, other sister 5, step sister 1, other step sister 7, step brother 5, step mom 4, im sure the trend is obvious here and i made sure they included encounters that were simply oral or mutual masturbation(not that any of my straight cousins admited to this). i have had something 30 and 40 partners, tho i have only had anal sex with 6 of them(3 long-term relationships and 2 very close friends with bennies and, to my shame, one one-night-stand/extended weekend with a guy i picked up at the bar). As i am sure is the case with most homosexual men, the majority of my family is straight. the answers i got from my fellow gay men were on par with mine or higher. more sexual encounters means more chances of exposure. as a side note, only one of the relationships every involved barebacking and the barebacking happened only after we had been together for 7 monthes or so and after we had both been tested. The one-night-stand involved some barebacking and i got very very very lucky to not have caught anything.

a preventative as sure as the condom in preventing disease that wasnt the condom would be a great thing. i wouldnt say i hate condoms, but, regardless of what the ads say, use of a condom cuts down on some of the pleasure of sex as both a bottom and top. this might be part of the problem with the infection rate. people, in general, have trouble not pursuing maximum even when we know it might be a risky behavior. i suppose it might be related to the only a bird in the hand is worth 2 in the bush. what i mean is that when weighed against what is considered by most to be a very managable disease, the pleasure of right now is worth more than possible shortened life-span and potentially painful death.

i know i didnt touch on the disproportionate funding for HIV/AIDS prevention from the government, and that was on purpose. i dislike politics, and always have, so i dont really know what the stats would be for the monetary dispersal by group. i will simply take it as fact that the monies are not proportionately attributed.

my personal favorite reason for the skyrocketing infection rate is yes. every single idea given seems to be a possible contributing factor. i do know that a couple of the factors are beyond changing. homosexual/bisexual men tend to be more promiscuous. i dont think there is much you can do about that. increasing education that actually addresses all the issues about safe sex would probably help, espcially if accompanied by very graphic photos and/or personally related stories by someone who has HIV/AIDS. the problem i see there is that scaring ppl into doing what is right is a fine line. you would have to be careful that nothing sounded/looked like a scare tactic but more like brutal honesty. i think the development of an alternative to the condom that is just as effective at preventing the spread of infectious disease would be a bonus even if the only infection it prevents is HIV. to be honest, none of the other STD's scare me anywhere near as much. i also think that more money should be spent on research for a cure not drug-therapies.

i do know why i have never had an STD of any kind. a small dose of luck and a very large dose paranoia about safe-sex.

please feel free to be brutally honest in your response to my post. i tend to be a very direct person and i do not mind when someone is that direct with me.