Important note: Information in this article was accurate in 2007. The state of the art may have changed since the publication date.
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Washington Blade - June 1, 2007
Ryan Lee
"The current rates of HIV infection among all [gay and bisexual men] are unacceptable," Robert Janssen, director of the CDC's division of HIV/AIDS prevention, said during a CDC webcast on May 17. "The HIV infection rates among African-American and Hispanic [gay and bisexual men] are especially alarming, and even more needs to be done to meet the needs of these disproportionately impacted communities."
The two-hour CDC webcast - entitled "Preventing HIV/AIDS among Men Who Have Sex with Men: Challenges & Innovations" - offered a bleak assessment of the progression of HIV through gay America, noting that unsafe sex is on the rise among gay and bisexual men, as are HIV infection rates after more than a decade of decline.
"From the earliest days of AIDS in the United States, [gay and bisexual men] have been at the center of the epidemic - they have been the risk group that has been most affected, by far, and they were the first to respond in the fight against HIV/AIDS," Janssen said.
"Social and economic factors including racism, homophobia, poverty, lack of access to health care - they're all significant barriers to receiving HIV prevention services, particularly for [gay and bisexual men] of minority races and ethnicities," he said.
More than 300,000 gay and bisexual men in the U.S. have died of AIDS, which represents half of all of this country's AIDS deaths, according to the CDC. In 2005, gay and bisexual men made up 53 percent of all new HIV cases in the U.S. and represented 72 percent of all HIV cases among men.
In the early '90s, one-third of gay and bisexual men reported engaging in unprotected anal intercourse, but now half of all gay men admit having anal sex without condoms.
"These data do not mean that [gay and bisexual men] are no longer concerned about HIV," Janssen said. "The majority of men continue to take action to protect themselves and their partners from HIV, but the strategies that some men are using have changed."
Changing strategies
Numb to the bi-polar debate about safe sex in America - either abstain forever or never have sex without a condom - many gay men are hoping more nuanced approaches to sex keep them safe. From "strategic positioning" (where HIV-negative men assume the insertive role during anal intercourse) to "serosorting" (sleeping only with men who have the same HIV status), gay men are taking calculated risks in an attempt to remain safe without condoms.
The CDC has adjusted its safe sex techniques as well - evolving from the wholesale distribution of condoms that defined the early years of HIV prevention, to efforts like the current "Diffusion of Effective Behavioral Interventions."
Like all DEBIs, the CDC says the five programs that target gay and bisexual men are "scientifically proven" to reduce HIV-infection rates, usually by concentrating on smaller groups of men who are then charged to disperse information to their friends and sex partners and help create a broader safer sex culture among gay men.
The Atlanta-based National AIDS Education & Services for Minorities implements the DEBI known as Many Men, Many Voices, which "gives CDC a measuring tool" to ensure prevention dollars are having an impact, said Patrick Kelly, NAESM community relations manager.
About 250 gay men per year participate in the "Prominent, Outgoing Opinion Leader" DEBI at AID-Atlanta, said Jay Dempsey, gay outreach program coordinator for the agency. Leaders participate in an hour-long workshop on the history of HIV, how it is spread and how they can share that information with their friends.
"It's so that when you're at a bar or party and [HIV/AIDS] comes up in conversation, you're prepared to disseminate the current and correct information," Dempsey said. "One of the challenges we're having is that maybe gay men aren't prone to talk about that anymore since we're not in crisis mode."
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