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The Shocking Second HIV Epidemic Among U.S. Gay Men That No One Is Talking About
Pop quiz, no cheating allowed: if you had to guess, would you say that HIV and AIDS rates among gay men in the United States are A) declining, B) remaining stable, or C) rising?
The correct answer is C) rising, at an alarming8% per year. HIV incidence — that is, the proportion of a population infected — among gay men in the United States rises by that amount every year since at least 2001. Overall, this incidence, at 15.4% cumulatively, is just slightly lower than the incidence among gay men in Sub–Saharan Africa. And there’s a good case to be made that the real numbers are actually higher; for instance, we know they’re higher in some major metropolitan areas, where the incidence among MSM (men who have sex with men) is oneinfive. In San Francisco, it may beashighasonein four.
Overall, the Centers for Disease Control and Prevention (CDC) estimates that between 400,000and500,000 gay men in the United States carried the virus in 2009, the most recent year for which data are available. Chillingly, gay and bisexual men are the only demographic toexperienceariseinHIV infection rates.
These are astonishing facts. The AIDS epidemic is now over three decades old and has takenover600,000 lives in the U.S. alone. That’s more casualties than were seen in the entire Civil War. It’s also noteworthy that new infections in the U.S. are numerically stable overall, at roughly 50,000 a year over the last decade or so — a number seemingly impervious to public or private prevention efforts.
Considering the carnage AIDS has inflicted on gay men in particular, it’s urgent that we examine what, if anything, can be done to save lives and to prevent the widespread damage of another generation — today’s young men. The fewer than 1% of Americans who are gay or bisexual men between the ages of 13 and 29 comprise 27% of new infections.
Public health experts have been concerned about the rising rates among MSM for years now, viewing the current epidemic as the second wave — the first having occurred in the 1980s. Today’s infections, they say, are affecting a new generation of men who didn’t live through the initial devastation of AIDS’ early days, when there were no drug treatments and a diagnosis was a death sentence. Public health messages about safe sex practices and testing targeted to gay men have waned in the intervening years, and now, some experts say, a new generation of at-risk men have to be educated about the disease.
There is no single reason why HIV rates have been rising again among gay men for at least a decade, or one tool that could hinder the process. The best we can do is identify contributing factors (with limited hard data), consider approaches to reach vulnerable demographics and help change behaviors.
Effective HIV therapy has been around since 1996, in the form of HAART (Highly Active Antiretroviral Therapy) drugs. These drugs reduced mortality rates, previously near 100%, by 50% to 80%, and gave HIV patients a new lease on life.
An unintended side effect was that the drugs also reduced the visibility of the disease within the gay community. The “gay ghettos” of large cities were no longer the sole mournful province of the walking dead. The sense of urgency around the epidemic began to fade, whileindicatorsofunprotected sex, specifically the incidence of other sexually transmitted diseases, began to rise.