The Washington Blade - January 14, 2000
Peter Freiberg

The study, published in the Jan. 14 issue of the CDC's Morbidity and Mortality Weekly Report, says data suggest that the stigma of homosexuality is playing a key role in the spread of the disease among Gay men of color.

The study found that, in 1998, the proportion of men of color among Gay and bisexual men who were diagnosed with AIDS was 52 percent, compared to 31 percent in 1989.

African American and Latino Gay men and bisexuals apparently are being infected at a younger age than whites, the report said.

In 1998, whites made up almost 48 percent of the 18,153 Gay and bisexual men with AIDS, African Americans comprised 33 percent, Latinos 18 percent, Asian/Pacific Islanders 1 percent, and Native Americans/Alaskan Natives less than 1 percent.

In 1989, whites had comprised 69 percent of Gay and bisexual men diagnosed with AIDS.

The statistics for 1998, the last year for which they are available, continue a trend noted in recent years. In 1997, men of color accounted for about half the cases of Gay and bisexual men, according to Dr. Helene Gayle, director of the CDC's National Center for HIV, STD and TB Prevention.

But despite the trend, Gayle said CDC expects these statistics "will surprise many across the nation."

"Although, consistently, Gay men have accounted for the largest single category in AIDS cases ... the tendency to equate Gay with white has persisted," she said. The 1998 figures also bear out what many AIDS activists and social service providers have observed for years.

"These statistics," Mario Cooper, an African American AIDS and Gay activist and former board chair of AIDS Action, a national coalition of AIDS groups, told the Blade, "confirm what people in the field have been finding: If you visit almost any health service delivery facility, the population is [increasingly] people of color.

"There's certainly been an anxiousness, an edge, an anger among those of who are activists waiting for this to sink in," said Cooper. "Let's come up with a plan to address this, let's get on top of this."

Phill Wilson, director of the African American AIDS Policy and Training Institute at the University of Southern California, told a telephone news conference arranged by the CDC, "The tragedy is that this did not have to happen. The question now is: What are we going to do? We need to develop targeted, holistic, comprehensive ... approaches."

The new study indicated that Gay men of color had smaller declines in AIDS incidence and deaths than white Gay men from 1996 to 1998, a period when anti-retroviral therapy was intensified.

In pointing to the influence of homophobia in the disease's spread, the study noted that, in a CDC survey of 8,780 HIV-positive Gay and bisexual men, 24 percent of African Americans, 15 percent of Latinos, and 11 percent of Asian/Pacific Islanders identified themselves as heterosexual, compared with 6 percent of whites.

Those who do not identify themselves as Gay or bisexual, Gayle said, may decline to seek HIV prevention and treatment services, may not accept their own risk for HIV, and may be unintentionally putting female partners at risk.

Dr. Helene Gayle, director of the CDC's National Center for HIV, STD, and TB Prevention, said those who are reluctant to identify as Gay or bisexual may decline to seek HIV prevention and treatment services.

The study said HIV prevention programs must seek to reach these minority men who have sex with men but who may not identify themselves as Gay or bisexual.

Dr. Rafael Campo, a physician at Harvard Medical School, said the threat of homophobic bias or rejection affects the numbers of Latino Gay and bisexual men who seek services.

"This fear and self-loathing," Campo told the telephone news conference, "hampers education efforts, leads to HIV infection of ... wives and children, and [leads] too often to isolated, lonely deaths."

Campo said that, when he tried, with support from Harvard, to organize a summit conference for prominent Latinos on AIDS in the Latino community, "quite sadly, none ... with the exception of [entertainer] Rosie Perez, came to the summit. This included elected officials and prominent health and business leaders."

"It was really quite astonishing to see this kind of silence in action," Campo said.

In an effort to gauge new HIV infections, the CDC study also examined data collected from 1996 to 1998 in 25 states that report HIV diagnoses in addition to cases of full-blown AIDS. Data on HIV diagnoses among the youngest age group -- those 13 to 24 years old -- provide the best indication of infection trends, the CDC said.

Among Gay and bisexual men diagnosed with HIV during this 1996-98 period in these states, 16 percent of African Americans and 13 percent of Latinos were in the 13-to-24 age range, compared with 8 percent of white Gay and bisexual men, the CDC said. Comparable figures for Asian/Pacific Islanders and American Indians/Alaskan Natives were each 15 percent.

"These data," said Janet Blair, the study's author, "suggest that black and Hispanic men who have sex with men are being infected at younger ages than white men. It is imperative that men of color be reached early with comprehensive HIV prevention programs."

According to the report, the five metropolitan areas that accounted for the largest number of newly diagnosed AIDS cases between 1996 and 1998 among all Gay and bisexual men of color were New York, (3,673), Los Angeles (2,811), Miami (1,554), Washington, D.C. (1,251), and Chicago (1,075).

New York and Los Angeles had the largest number of AIDS cases among African American Gay and bisexual men, followed by Washington and Atlanta. Los Angeles had the highest number of cases among Latino Gay and bisexual men, followed by New York and Miami.

During 1996 to 1998, new diagnoses of AIDS declined among Gay and bisexual men of all racial and ethnic groups -- with smaller declines from 1997-98 than 1996-97. But the declines were less noticeable among African Americans and Latinos than whites.

New AIDS diagnoses during 1996-1998 dropped 43 percent among Asian/Pacific Islanders, 39 percent among whites, 35 percent among American Indians/Alaskan Natives, 26 percent for Latinos, and 23 percent for African Americans. Deaths also declined from 1996 to 1998 among Gay men and bisexuals with AIDS from all racial/ethnic groups, the study found -- again, with smaller declines in the 1997-98 period than 1996-1997 and with smaller drops among African Americans and Latinos.

From 1996 to 1998, AIDS deaths declined by 69 percent among Asian/Pacific Islanders, 65 percent among whites, 63 percent among American Indian/Alaskan Natives, 60 percent among Latinos, and 53 percent among African Americans. The CDC study said the findings highlighted the importance of increasing efforts to promote HIV prevention and treatment services in minority communities, particularly among African Americans and Hispanics.

"Young ... black and Hispanic men who have sex with men remain at high risk for HIV infection," said the study, which noted that in addition to homophobia, high rates of poverty and unemployment and lack of access to health care are associated with high rates of HIV risk behavior. These factors, the study said, are also barriers to receiving HIV prevention information or accessing testing, diagnosis and treatment.
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