Wall Street Journal - January 14, 2000
Michael Waldholz, Staff Reporter of the Wall Street Journal

The federal government will report Friday that, for the first time, men of color now represent the largest number of AIDS cases among men who have homosexual sex. As of the end of 1998, African-Americans, Latinos and other minorities represented 52% of AIDS cases in this group, up from 32% in 1989.

The report argues that the jump in AIDS cases among minority men having homosexual sex is due in large part to a pervasive cultural stigma attached to homosexuality and bisexuality in minority communities. This widespread "homophobia" among minorities, the report says, is inhibiting many men -- especially those below age 25 -- from being aware of the threat they face from unprotected sex with men. It also makes them less likely to seek services that might prevent them from spreading the disease and to get early treatment.

The new data, compiled by the Centers for Disease Control and Prevention, reveal a "striking" change in the disease's demographics in the U.S. that will "surprise many people across the nation who still think of the gay epidemic as white," says Helene Gayle, director of the CDC's National Center for HIV, STD, and TB Prevention.

Dr. Gayle says the new numbers show that 42% of AIDS in African-Americans and 46% of AIDS among Latinos results from homosexual contacts. This is at odds with the prevailing notion that the vast majority of AIDS in minorities stems from intravenous drug use, sex by women with IV drug users, and children born to those women.

AIDS among gay white men is still significant. The CDC says its surveys shows that 48% of AIDS cases resulting from sex between men are among gay white males, though that is down from 69% in 1989. The CDC figures document individuals with acquired immune deficiency syndrome, which is caused by HIV. The number of people who test positive for the virus but don't have AIDS is far larger.

The new numbers, contained in the CDC's Morbidity and Mortality Weekly Report, also contain troubling estimates about HIV infection rates. From 1996 to 1998, among gay and bisexual men diagnosed with HIV, 16% of blacks, 13% of Latinos and 9% of whites were between the ages of 13 and 24.

This suggests that sex-related preventive measures need to be focused on adolescents, something that isn't very common right now in black and Latino communities, or even among young gay white males, CDC officials and other experts say.

"This is a tragedy that did not have to happen," says Phill Wilson, who directs the African American AIDS Policy and Training Institute at the University of Southern California in Los Angeles. "The trend's been visible for a long time," Mr. Wilson says, noting that homosexuality among African-Americans and other minorities is considered much more of a taboo than among many whites. As a result, "we have had a lack of response to a major cause of HIV/AIDS" among minorities, Mr. Wilson says, "and that should not be happening, but it is."

Mr. Wilson and others are calling for federal and state government programs, and especially for local organizations, such as black community churches and inner-city health centers, to talk openly about homosexuality and bisexuality with young men as a way to warn these men of the risk they face. The community-wide denial about homosexuality "is a principle underlying and entrenched reason why African-Americans aren't doing as well as gay white men in confronting this disease," he says.

Since 1993, the majority of people in the U.S. living with AIDS have been people of color, according to the CDC. As of 1998, of the 297,000 people with AIDS in the U.S., 116,000 are white, but 118,500 are black and 58,200 are Hispanic. Of the estimated 40,000 new HIV infections occurring each year in the U.S., 50% of the men are black, 30% are white and 20% are Hispanic. Thirty% of all new infections occur in women, and 75% of those are infected as a result of heterosexual contacts.

But the rising number of minority men infected via sex with other men is a particularly daunting issue because, unlike in gay white circles, homosexual behavior by blacks and Latinos isn't widely discussed as a risk. Indeed, the CDC says that in a recent survey it conducted of 8,780 HIV-positive men who have sex with men, 24% of African-Americans and 15% of Latinos identified themselves as being heterosexual, compared with only 6% of white men.

"One of the biggest reasons AIDS has escalated in the African-American community is the silence there that is so pervasive about what puts our people at risk," says Leo Rennie, deputy director of the Harlem Directors' Group, a New York City-based coalition of black AIDS-related organizations. Mr. Rennie says that's because African-Americans are "ashamed" of the fact that substance abuse and homosexuality are prevalent. "You can be gay in a black community, but you can't say it. Everyone in a black church knows who is gay, but you can't speak about it," says Mr. Rennie, who describes himself as a "rarity, an openly gay black man."

Says Mr. Rennie: "Walk down the streets of Harlem, and you don't see or hear any references at all to this problem, despite its size."

Ravinia Hayes-Cozier, the Harlem Directors' Group's executive director, says the silence, especially among African-American leaders, has impeded the development of initiatives targeting young men. "Since it's not discussed and since men aren't encouraged to discuss their sexuality, they hide it, and they have no place to go to talk among themselves about how sex is putting them at risk," she says.

Ms. Hayes-Cozier, whose group is funded primarily by the CDC, says she could "easily spend twice our $1 million-a-year budget" on outreach and education. But, she says, "fund raising for prevention for all AIDS communities has been difficult lately." She and others say the advent of new drug therapy against HIV has created a shift, with most funding going to finance access to the medicines instead of toward prevention.

Dr. Gayle, of the CDC, has been instrumental in pushing the CDC to pay greater attention to the AIDS problem among minorities. In a press conference yesterday, she noted that additional funds for AIDS "secured" last year by the Congressional Black Caucus enabled the CDC to grant an "additional $7 million to innovative community-based programs to reach gay men of color." But she said that amount is "clearly a drop in the bucket."

Write to Michael Waldholz at mike.waldholz@wsj.com
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