Wall Street Journal - Monday, July 8, 2002
Ann Carrns, Staff Reporter

A new study indicates a simple explanation for the spread of AIDS among young gay men, and particularly those who are African-American: Most don't know they are infected with the HIV virus, and many don't even feel at risk.

The findings emerged from a federal study reported Monday at the International Aids Conference in Barcelona, Spain. That so many young gay men could unknowingly have the HIV virus, as the AIDS epidemic enters its third decade, has "alarming" implications for a potential resurgence of the disease in the U.S., says Duncan MacKellar, an epidemiologist with the Centers for Disease Control and Prevention who led the study.

Among other things, the findings indicate that prevention strategies aren't reaching a new generation of young men who were children at the start of the AIDS epidemic. And it can be particularly difficult to reach African-Americans.

Ninety-one percent of the young black gay men in the study who were HIV positive were unaware of their infection. Knowing one's HIV status is important so those infected can take steps to prevent spreading the virus to others and can seek early treatment. "The take-home message is, we have failed young black gay men," says Phill Wilson, executive director of the African-American Aids Policy and Training Institute in Los Angeles.

Overall, the number of new AIDS cases in the U.S. remains roughly stable, according to the latest data released at the conference. Between June 1998 and June 2001, roughly 10,000 people developed AIDS in each quarter. Before 1998, the number of new AIDS cases had fallen dramatically, due to the arrival of powerful antiretroviral drugs.

The latest HIV data show the overall numbers were fairly stable between 1998 and 2000, at about 16,600 infections annually. The data, however, aren't nationally representative because they include just 25 states that have long-term reporting of such infections. Moreover, those 25 states don't include California, Florida or New York, which have large gay populations. (Researchers use an array of data to estimate that there are 40,000 new infections nationally each year.) The numbers reflect a slight upturn in HIV among gay and bisexual men beginning in 2000, but at least another year of data is needed before a true trend emerges, the CDC says.

When considered, however, with recent studies showing an increase in sexually transmitted diseases in gay men in cities such as San Francisco and New York, the data are worrisome. Ron Valdiserri, deputy director of the CDC's AIDS-prevention programs, terms the overall HIV numbers "deceptively stable" because they may mask increases in infections among certain groups, including heterosexual African-Americans as well as gay men.

Young gay black men, in particular, have been known for several years to be at high risk for HIV. One study released last year, for example, found annual infection rates of nearly 15% in that group, meaning that for every 100 young, gay black men who aren't infected at the beginning of the year, 15 become infected by the end of the year. Now, Mr. MacKellar's study indicates that ignorance of HIV infection is a likely contributor to the high rates of HIV among this group.

The study, part of the CDC's Young Men's Survey, recruited 5,719 gay and bisexual men, ages 15 to 29, in six major cities between 1994 and 2000. A total of 573 tested positive for HIV. Of those who were positive, 77% were unaware of their infection -- meaning they hadn't been tested before, or previously had tested negative. Plus, 59% of the men who tested positive considered their risk to be "low or very low."

Most striking was the finding that nine out of 10 African-Americans in the study who tested positive didn't know they were infected. Young black men in the study were less likely to get tested than whites or Latinos; one in four had never previously been tested, and the vast majority had been tested only once or twice before. The two main reasons given for not getting tested, Mr. MacKellar says, were that they perceived themselves to be at low risk for infection, and that they were afraid to learn their status.

In Miami, the Rev. Tommie Watkins confronts the issues of high exposure and low rates of testing on a daily basis. Mr. Watkins, who directs an HIV-prevention program targeting young, gay black men, says that partly because of the strong influence of the church in African-American communities, homosexuality is very much a taboo topic. Many young black men don't identify themselves as gay even though they have sex with men, and are reluctant to get tested because that would mean confronting the stigma, he says. "It's going to take a large effort by politicians, clergy, and the community to become educated about homophobia," he says.

The CDC's Mr. MacKellar cites several outreach programs, in New York, New Jersey and Seattle, that are having some success in reaching young, gay blacks and Latinos for testing and counseling. These programs need to be studied and replicated, he says. The CDC recently has made about $7 million available for HIV programs targeting young gay minority men. "Clearly, we need to do more, and do it better," Mr. MacKellar says. "We've got to break that vicious cycle."

The new HIV data also show a 10% rise in HIV infections between 1998 and 2000 among heterosexuals, continuing a steady increase seen since 1994, with 75% of the infections occurring in African-Americans. Blacks overall are disproportionately affected by the epidemic, representing more than half of all new HIV infections, although they make up just 12% of the population.

Other factors that are believed to be behind the high infection rates among African-Americans include higher levels of poverty and lack of access to medical services. Blacks are also disproportionately represented in prisons, where HIV rates are much higher than in the general population, and may spread the infection to their sexual partners when they are released.

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