Issue Brief: Ending the HIV Epidemic Among Gay Men in the United States
AIDS continues to pose a threat of unprecedented magnitude to gay men in the United States. Though representing approximately 2% of the population aged >13 years, men who have sex with men (MSM), including those who inject drugs, comprise a majority of new HIV infections (64% in 2010) and represent nearly half of all persons living with HIV. The rate of new HIV diagnoses among MSM is more than 44 times that of other men and more than 40 times that of women. Since the epidemic began, almost 300,000 MSM in the U.S. have died from AIDS, including an estimated 6,863 in 2009.
Gay men of color are at particular risk. Among MSM, there are sharp differences in HIV incidence by race: In 2006, the risk for HIV infection was 4.97 times higher for black MSM (1,710:100,000) and 2.08 times higher for HispanicMSM (716:100,000) than for white MSM (344:100,000). But while historically MSM in the United States have always constituted the largest proportion of AIDS cases, they are the only group for which risk appears to be increasing.
Among black gay men, the crisis is especially dire. Both incidence and prevalence are disproportionately higher among black MSM than any other risk group. Particularly among young black MSM, increasing HIV incidence signals an urgent need for new measures to confront the epidemic. Between 2006 and 2009, while remaining stable or declining among all other racial and risk groups, HIV incidence increased by 21% among young people (ages 13–29), driven by a large increase (34%) among young MSM, which in turn was driven almost exclusively by a 48% increase among young African-American MSM.
We are at a crossroads. Current HIV incidence trends suggest that the epidemic among gay men could take a turn for the worse, reversing decades of efforts and threatening a new generation of young men.
For more than 30 years, the AIDS crisis has represented an incomparably grave threat to gay men, especially gay men of color. Recently, epidemiologic trends suggest that the epidemic may be worsening, particularly among young black gay men, threatening to reverse progress made to date and heralding a new catastrophe. Confronting this challenge will require measures that go beyond traditional risk reduction interventions, including programs to improve the health and well-being of gay men generally, and specific interventions to help HIV-positive gay men learn their status, connect to appropriate health care services, stay in care and maintain treatment adherence, and prevent transmission to others. Young gay men must be a priority.
While there are clearly unmet research needs related to ending the epidemic among gay men, there are also concrete steps that can be taken now. Consistent with its role throughout the epidemic, the LGBT community must assume a substantial leadership responsibility to renew the fight against AIDS among gay men, while successfully addressing the crisis will require the active participation of virtually every stakeholder, including government agencies, health care providers, public health officials, and insurers. There is no time to lose.