Hard Truths (About Gay Men & HIV)

National Gay Men’s HIV/AIDS Awareness Day – NGMHAAD – is coming September 27, three months to the day after National HIV Testing Day, and hard on the heels of July’s landmark International AIDS Conference (IAC) in Washington, D.C. We have two messages this year: Be aware, know your risk, and, Let’s end this epidemic! Because we matter – and we can.

Speaker after speaker at IAC returned to this year’s good but challenging news: yes, we still need more science to stamp out HIV – more and better antivirals, an effective vaccine, and a functional cure – but we already have all the biomedical tools we need to make new HIV infections a thing of the past. The hard part is reaching “key populations” – groups with high rates of existing infections and new infections because they have been marginalized, stigmatized, denied civil rights, and excluded from health care.

NGMHAAD is for one of those “key populations:” this country’s men who have sex with men (MSM). NAPWA founded NGMHAAD in 2008 because we want them to know the epidemic isn’t over. We want them to know how high their HIV risk really is – because so many are already infected, and too many don’t know it. And we want them to know that we’ve come a long way since AIDS was first reported in 1981, and even further since Stonewall, but stigma is still driving this epidemic and gay men don’t have to take it anymore.

So let’s look at some numbers and see what that the gay men’s HIV epidemic looks like in the U.S.

The July 28 issue of The Lancet opened an admirable series of articles on HIV among gay men worldwide with a look at epidemiology, and reported that HIV prevalence among men who have sex with men in its North American region is a jaw-dropping 15.4% – almost one in six. The real prevalence may be a little lower – The Lancet assumes that only 3.7% of American men are MSM, a number we think is too low, and raising the estimated number of MSM would reduce the calculated prevalence a little – but it’s still clear that prevalence is breathtakingly higher among MSM than in the rest of the population.

Let’s calculate just how much higher.

About 251 million Americans are 15 or older. If 5 percent of the men are MSM, we have 6.3 million MSM and 245 million “others” 15-and-older in this country. We’re all familiar with the CDC’s estimates that 1.2 million Americans are living with HIV, and 60% of them are MSM. That gives us 480,000 infections in 245 million “others,” for a prevalence of 0.2% – one in five hundred. It also gives us 720,000 infections in 6.3 million American MSM, for a prevalence of 11.5% – just shy of one in eight. HIV prevalence among American MSM is almost 60 times what it is in the rest of the population.

That means HIV-negative MSM who are active with partners whose status they don’t know are at much higher risk than many realize. So the first and most important message of National Gay Men’s Awareness Day is – simply – be aware. Know your status. Know your risk. If you aren’t absolutely sure you know your own and your partner’s status, keep your condoms handy.

In September 10’s Positive Voice, we’ll write about how we got to where we are and what’s needed to deal with the MSM epidemic on the ground. Why near-universal testing is so important when prevalence is already so high. The need to confront stigma and talk frankly about sex in communities where this is deeply uncomfortable. The need for pride and love. The need to have culturally competent and welcoming health care for MSM.

And in the September 24 issue, just three days before NGMHAAD, we’ll remember the quarter-million (at least) American MSM who have died of AIDS and examine our responsibility as their survivors to demand action to end this epidemic once and for all. Now that we can, we must.

Gay Men’s Wives, Homophobia and HIV (dgsmith.org)
The Ongoing HIV/AIDS Epidemic Among Active ‘Gay’ Men (illuminati360.wordpress.com)
Gay, bisexual black men at high risk for HIV (thechart.blogs.cnn.com)
Anti-Gay Stigma And Criminalization Help Maintain HIV Epidemic (thinkprogress.org)

Infographic: Ending The Drug War Will Help End AIDS

Jul20 by D Gregory Smith

From Jag Davies, Drug Policy Alliance in today’s Huffington Post:

Throughout the world, research has consistently shown that drug criminalization forces people who use drugs away from public health services and into hidden environments where HIV risks become significantly elevated. Mass incarceration of nonviolent drug offenders also plays a major role in spreading the pandemic, as inhumane conditions and lack of HIV prevention or treatment measures in prison lead to HIV outbreaks and AIDS cases behind bars – and among families and communities once those imprisoned are released.

Yet in countries where addiction is treated as a health issue, the fight against HIV/AIDS is being won. New HIV infections in countries such as Australia, Germany and Switzerland have been virtually eliminated among people who use drugs, just as mother-to-child HIV transmission has been eliminated in countries that make medicines for pregnant women accessible.

In the United States, however, the federal government has resisted evidence-based HIV prevention strategies — costing us hundreds of thousands of lives and billions of dollars. Congress re-instated a longstanding ban last December that prohibits using federal funds for syringe access programs — a move that will cost thousands of more lives in years to come.

Money talks- just remind your politicians that the money they are not spending on “immorality” is costing the taxpayers 1000x the amount in the long run…

CDC Analysis: 4 out of 10 HIV-Diagnosed Not In Care

Aug31 by D Gregory Smith

An analysis of epidemiological data by the Centers for Disease Control has arrived at a startling conclusion: as many as 4 out of 10 persons diagnosed with HIV do not remain in care.

Despite all the medical evidence which advocates early HIV treatment for a healthy life, people are still not accessing care. The specific reasons are unclear, but the National HIV Treatment Guidelines are very clear: Persons with HIV are to be tested for Viral Load and CD4 counts ever 3-4 months, unless they are considered “virus-suppressed” (usually with an undetectable viral load and normal CD4 count with no medication changes over a period of time), then it is every 6-12 months.

So, what’s happening?

In surveillance data from 13 regions, only 59% of people recently diagnosed with HIV had had a test for viral load or CD4-positive T-cell count within the previous year, according to Irene Hall, PhD, head of the CDC’s HIV incidence and case surveillance branch.

The finding implies that the remaining 41% are not under a physician’s continuing care, Hall said in a teleconference during the 2011 National HIV Prevention Conference in Atlanta.

The two tests are a “marker for being in care,” Hall told MedPage Today.

Maybe it’s time to start talking seriously about barriers to proper care, including discrimination, poverty, cultural issues and race.

At a time when we know treatment is prevention, it’s important that the members of our communities who are HIV infected receive the care they need.

I’m wondering if it’s about support. Many of the people in my HIV+ support groups help each other with their health care- talking honestly about issues, sharing resources- even giving each other rides to doc or lab visits. They stay on their meds, talk realistically about their health, exercise, pay closer attention to nutrition and reducing stress. They do it because they have people they can speak to honestly about their disease- people who know firsthand what it’s like. And, for the most part, they’re having incredible, fulfilling lives.

In my experience, it’s the people who are trying to deal with HIV on their own who don’t do so well.

Depression and fear can play an enormous part in healthcare apathy- and it’s a well-documented fact that fear and depression are alleviated by concern and compassion from family and friends- and involvement with others who share similar circumstances.

So, in the interest of trying to understand this better, I have a couple of questions:

Do you know anyone (maybe it’s you) with HIV who is not getting care for their disease? What can be done to get them into care?

I’d like to follow up with your responses- so feel free to contact me at Dgsma@hotmail.com if you are uncomfortable leaving a response in the thread.

New National HIV Strategy Unveiled

Jul14 by D Gregory Smith

“The United States will become a place where new HIV infections are rare and when they do occur, every person, regardless of age, gender, race/ethnicity, sexual orientation, or socio-economic circumstance, will have unfettered access to high quality, life-extending care, free from stigma and discrimination.”

A visionary national strategy (the first!) for dealing with HIV has been unveiled. Read it here.

Whatever you might think, this is the first time an administration has actually had a plan that specifically deals with gay/bi men in a light that’s not defamatory and shameful sounding. The government has also appropriated $25 million dollars for ADAP, The AIDS Drug Assistance Program.

From the response by NAPWA, the National Association of People with AIDS:

Overall, the plan is thoughtful and lays down some meaningful and aggressive goals to reduce the number of new infections and improve access to care for persons living with HIV. President Obama, as part of his campaign for President, promised the nation that he would develop such a strategy; NAPWA thanks the President for fulfilling this important commitment.

Frank Oldham, President and CEO of NAPWA stated “On behalf of the 1.2 million people living with HIV in the United States, I wish to thank the President and Jeff Crowley for releasing this long awaited document. NAPWA promises to work with the Administration and Congress to ensure that this becomes a living breathing document that has a meaningful and fruitful impact on the lives of people living with HIV.”

Overall, the strategy has three basic goals, which NAPWA wishes to comment on:

(1) Reducing new HIV infections, with a particular focus on communities where HIV is concentrated. The Administration’s goal of reducing new infections by 25% is an important goal that we must all work together to ensure is not only met, but exceeded.

(2) Increasing access to care and improving health outcomes for people living with HIV. NAPWA particularly applauds the goals of establishing a seamless system of care for people when they are diagnosed with HIV, increasing the number of HIV clinical care providers, and addressing the complex co-morbid conditions of many individuals living with HIV, including issues such as access to housing. In light of the current AIDS Drug Assistance Program (ADAP) crisis, with over 2,200 individuals on waiting lists for HIV medications, it is very apparent that this goal will only be met with the significant introduction of new federal resources to meet the growing demand for HIV services. The Administration and Congress must step up to the plate to provide new federal funding not only to address to the ADAP crisis, but also to help meet the goals laid out in this important plan.

(3) Reducing HIV-related health disparities, including recognizing the role that stigma continues to play in reducing access to care and getting people tested. We at NAPWA recognize on a very person level the major and ongoing role that stigma continues to play in the everyday lives of people living with HIV, including promoting fear, inhibiting disclosure, and reducing persons access to the HIV care they need and deserve. In order to effectively address the HIV epidemic, reducing stigma must play a major role in any strategy.

Stated Matthew Lesieur, Director of Public Policy, “The release of the nation’s first National AIDS Strategy is only the beginning. Now the long road ahead lies in making this strategy a reality that has value to the average person living with HIV. ”

Founded in 1983, NAPWA is the first coalition of people living with HIV/AIDS in the world as well as the oldest AIDS organization in the United States. NAPWA is the trusted, independent voice of the more than one million people living with HIV/AIDS in America.

For more information, visit http://www.napwa.org.

7/15 Update: Dan O’Neill’s excellent analysis here.