Miami Herald - June 14, 2005
Fred Tasker, tasker@herald.com

The number of people living with HIV in the United States has passed one million, the highest mark since the worst days of the epidemic in the 1980s. It's a reflection of people living longer with powerful drugs but also the failure to cut the chronic 40,000-case-a-year new infection rate.

"While treatment advances have been an obvious godsend to those living with the disease, it presents new challenges for prevention," Ronald O. Valdiserri, co-chair of the 2005 National HIV Prevention Conference, told delegates in Atlanta on Monday.

Also at the conference, a just-completed survey of men who have sex with men (MSM) in five U.S. metropolitan areas -- including the Miami area -- found that black men in this category were more than twice as likely to be infected with HIV as other such men, and much less likely to be aware of it.

The survey and HIV testing of 1,767 men, done at gay bars, book stores and street corners, found that 46 percent of black MSM were HIV-positive compared with 21 percent of white non-Hispanics and 17 percent of Hispanics. And among those infected, 67 percent of blacks, 48 percent of Hispanics and 18 percent of white non-Hispanics were unaware of it, the survey said.

"Undiagnosed HIV continues to play a significant role in transmittal in this population," said Valdiserri, deputy director of the Centers for Disease Control and Prevention's National Center for HIV, STD and TB Prevention.

In addition to the Miami area, the survey focused on Baltimore, Los Angeles, New York and San Francisco -- cities with high numbers of HIV cases. Results from the individual cities will be released later this year.

In Miami, Donovan Floyd, a black man who has sex with men, and who is HIV-negative, has himself tested every three to four months, and made himself totally knowledgeable about methods of protection.

"It only takes one time," he says.

A few years ago, Floyd started a grass-roots effort to persuade other black men to be tested and to protect themselves. But he says it's not easy. "Men of color still don't trust individuals or institutions that offer testing," he said. "And just because I'm a man of color and a man who has sex with men doesn't give me much credibility if people don't trust me.

"You can't just show up once a week and throw out condoms. I started my program in my local barber shop, where people knew me."

Blacks are at higher risk of HIV infection in part because there's a greater stigma on homosexuality in the black community, says Berris Morrison, a caseworker for Empower You, a Miami organization that fights HIV.

"You have to hide it, and that makes you an unknown infector more so than people who declare themselves and take precautions."

OPENING UP

The Rev. Tommie Watkins Jr., an openly gay, black minister, says he tries to be a role model for other gay black men in fighting HIV.

'I try to encourage them to be authentic as to who they are. But there's an undercurrent of 'don't ask, don't tell' in society -- especially in the church, especially if you're a minister."

That secrecy hurts efforts to inform some black men about the risks of and prevention of HIV, says Watkins, a member of St. Stephen's Episcopal Church in Coconut Grove.

At the national level, reaching the one million mark in 2003, the latest year the data was available, was both a defeat and a victory. In part, powerful new anti-HIV drugs are keeping HIV-positive people alive and healthy longer.

CHALLENGES

But the fact that more than 25 percent of all HIV-positive people in the U.S. may be unaware they are infected creates even bigger challenges.

It means the CDC has been unable to fulfill the pledge made in 2001 to "break the back" of the epidemic by cutting in half the estimated 40,000 new infections that have occurred every year since the 1990s. "It's clear we haven't achieved that goal," he said. "But we do think we're making progress."

Dr. Carlos del Rio, an Emory University professor of medicine, challenged even that, saying recent outbreaks in major cities hint that new infections may be growing. He blamed inadequate government funding for the CDC.

"The U.S. had had a clear failure in HIV prevention," he said.

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This report was supplemented with information from The Associated Press.

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