“The United States cannot reduce the number of HIV infections nationally without better addressing HIV among gay and bisexual men.”
So declares the National HIV/AIDS Strategy (NHAS), boldly and accurately. According to the Centers for Disease Control and Prevention, gay men make up approximately 2 percent of the U.S. population, but account for 53 percent of all new HIV infections. That translates into nearly 29,000 persons newly infected with HIV every year in the U.S. In fact, men who have sex with men1 (including both gay identified and non-gay identified men) are the only risk group in the U.S. in which new HIV infections are increasing. Gay men from all racial and ethnic backgrounds continue to be the risk group most severely affected by HIV in the U.S. White MSM represent the largest number of new HIV infections, but Black and Latino gay men are at disproportionate risk for infection. That is why the NHAS makes a clear statement on the need to improve HIV prevention services for gay and bisexual men and transgender individuals.
The Strategy also observes that “[t]he burden of addressing the HIV epidemic among gay and bisexual men and transgender individuals does not rest with the government alone.” As Jeffrey Crowley, Director of the Office of National AIDS Policy at the White House, has often noted, the Strategy is a national, and not a Federal, strategy. That means everyone has a role to play in achieving the goals of the NHAS, including community leaders, service providers, professional organizations, faith-based organizations, business leaders, and concerned citizens from all walks of life.
As part of our commitment to expand and strengthen efforts across the nation directed toward reducing new HIV infections among MSM and transgender women, the Department of Health and Human Services (HHS) convened a two-day meeting last week with dozens of representatives from national lesbian, gay, bisexual, and transgender (LGBT) organizations. Some of those organizations are engaged in HIV-related work, while others are not currently actively involved in that arena. Through a series of large and small group discussions, we explored ways to better promote HIV/AIDS awareness and actively engage the broad diversity of LGBT community leadership in raising awareness about the ongoing toll of HIV/AIDS and to strategize about ways to promote health.
Many complicated issues were raised during the meeting, reflecting the diversity of the various communities that fall under the heading of “LGBT”. In particular, concerns were raised about the need to improve surveillance systems so that we have an accurate estimate of the number of transgender individuals—especially transgender women—who are living with HIV/AIDS. Our discussions also surfaced the need to provide, in a timely manner, basic information to organizations and opinion leaders who may not be familiar with HIV/AIDS statistics in their communities. For example, how many HIV infections have occurred among American Indian/Alaska Native MSM and how many HIV infections have occurred among Native Hawaiian/Pacific Islander MSM? And several participants reminded us of the distinctive health needs of both younger and older gay men.
It wouldn’t be accurate to say that we were able to resolve all of the complex issues raised during our two-day discussion. But the free exchange of ideas and frank perspectives that were raised by participants helps pave the way for more targeted discussions in the future. As expressed by Christopher Bates, the Executive Director of the Presidential Advisory Council on HIV/AIDS, “This meeting was a significant milestone in our continued efforts to dialogue with gay, bisexual, lesbian and transgender communities about the critical subject of health.”
In addition to providing useful feedback to the Federal government, it is our hope that the consultation helped to foster new organizational alliances across the rich variety of organizations serving the LGBT communities. After all, everyone’s contribution will be necessary in order to achieve the goals of the NHAS.
What are your ideas about re-energizing LGBT community efforts around HIV prevention and health promotion for gay, lesbian, bisexual, and transgender persons? Share your thoughts in the comments section below.
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1The term “men who have sex with men” (MSM) is used in CDC public health surveillance systems. It indicates the behaviors that transmit HIV infection, rather than how individuals self-identify in terms of their sexuality. The term is inclusive of all men who have sex with men, even those who do not identify as gay or bisexual.
One of the best ways of re-energizing the LGBTQ community around HIV awareness would be to support and maintain stability for successful efforts already available while encouraging new efforts. Cutting off funding for established and successful programming creates instabilities within the community and may maintain an endemic and not a reduction of HIV infections.
I would add that looking at the various communities that make up ‘LGBTQ’ in a fresh way – how they interaction (or not) with each other that may (or not) contribute to HIV incidence and prevelance, evolving social values that are distinct and shared are important for how social messaging can be developed.
I’ve been an HIV/AIDS advocate for many years, and the largest part of my own website is dedicated to HIV/AIDs awareness. I’ve focused on the general complacency in testing & transmission for about a year, and here’s how I see it:
1. Overall HIV/AIDS reporting in mainstream media as well as LGBT blogs has decreased 70% in the last ten years. You have to work good and hard to find any mainstream coverage and there is virtually NO LGBT blog writing a single article about the subject. Sites that dedicate themselves exclusively to HIV/AIDS reporting (like POZ) do a fantastic job, but they have no general readership. Simply put; people don’t show up to those sites unless they’re looking for information on their own newly acquired seroconversion. LGBT blogs like Joe.My.God, Towleroad, Bilerco, etc write nothing on the subject at all. There’s so much focus on every other issue in the gay world that HIV has fallen by the wayside. To this particular point, there’s a huge communication gap.
2. That being said, the general interpretation from the population is that HIV isn’t that pressing of an issue anymore. “I’m not hearing about it with any frequency, maybe things are becoming more manageable. After all, it’s not a death sentence anymore and I just have to take a pill or two, right? Seems far-fetched, but that’s a direct quote given to me by a 30 year old man I just asked “What’s going on with HIV these days?”. I’m sitting here in a coffeeshop and he’s a total stranger. He also just admitted that he doesn’t know his HIV status.
There is a huge communication gap now that needs to be bridged in order to regenerate interest, care and concern around HIV and that’s one of the reasons I started my site. I don’t cover strictly HIV or LGBT issues, I reach across the huge spectrum of topics and cover everything I can. The topics I cover on HIV as well as the original content on the subject are some of the highest viewed materials I have on my site and in the course of a year I’ve gone from 20 readers a day to 3000+.
How do you take my success model and make it bigger? Tricky question, but the short answer is that I need help. I’m a one-man band, so it’s tough to keep the content constantly revolving and challenging enough to keep interest. Writers who understand and want to contribute to my content model would be a huge help. My audience has been grown and acquired solely on Twitter; I don’t have any other means of advertising my site.
On a national stage, sites like mine need support plain and simple – and exposure. There are no non-political LGBT websites on a national level, especially one that carries HIV/AIDS to the community in a forum they can understand without it being confrontational or too medical-based to hold their interest. This is a huge untapped avenue of communication that’s not being used. Is there room for more than one site like mine out here? You bet. I spend plenty of time dealing with emails sent to me from my site about HIV issues and pointing them in the right directions.
Once that communication gap is bridged, then things will turn around.
I believe that re-energizing LGBT community efforts around HIV prevention and health promotion for gay, lesbian, bisexual, and transgender persons has had enough time to recover from the early days of the epidemic. Ryan White is set to sunset again in 2013 and we need to pump some of our energy in to a program that does not sunset until the virus is curable.
I think asking the clubs/bars/discos to provide safe sex and condom on premises is something which should be mandatory. As well as providing more money to the non-profit as well as other providers who take time to educate and teach prevention.
One big, over-arching suggestion is to continue the move to placing HIV/AIDS in a holistic health construct. CDC is going the right direction with this – and it needs to continue.
Gay men’s health needs are more than HIV and STDs – our needs include more than the area between the navel and the knee (thanks Ron Stall for that line.)
Holistic health encompasses mental and emotional health, physical health, spiritual health, and sexual health. Until we place HIV/AIDS into the mix, and stop deferring to it as if it is the only health concern of gay men that matters, we will be stuck in the same trajectory we are in right now. Gay men are TIRED and TURNED OFF by only being seen in this light.
And in addressing our holistic health – let us look at the strengths, assets and resilience of individuals and our community as a whole. We are not simply broken things that need fixing.
If you are a researcher, ask yourself when the last time you studied gay men’s resilience was… If you are an HIV program developer, do you consider assets and strengths when creating and implementing your projects? If so, how do you do that – and please share with your colleagues around the country! Is your social marketing fear-based and stigmatizing, does it blame and shame? Or does your social marketing focus on providing accurate information in an empowering sort of way?
As for sexual health. It is much more than the absence, or presence of disease.
I suggest a close read of Eli Coleman’s article in a recent AIDS&Behavior called “What is Sexual Health? Articulating a Sexual Health Approach
to HIV Prevention for Men Who Have Sex with Men.”
In it he refers to a WHO working definition of sexual health:
“Sexual health is a state of physical, emotional, mental, and social well-being related to sexuality; it is not merely the absence of disease,
dysfunction, or infirmity. Sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the
possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination, and violence. For sexual health to be attained
and maintained, the sexual rights of all persons must be respected, protected, and fulfilled.”
Let this definition be our template as we move to better address HIV/AIDS in gay men.
And while we are at it, let’s, for the first time, insure the dollars follow the epi! CDC’s own data has proven otherwise over the years. We won’t be effective if the dollars are going to low-risk populations due to political expediency.
I am looking at the intersection of LGBTQ concerns with risk factors among other vulnerable populations under the administrative umbrella of teen pregnancy prevention. In addition to state formula programs, the ACF/ACYF Teen Pregnancy Prevention division supports research and demonstration projects. I am finding very few innovative R & D efforts targeting Men of Color–without regard to sexual orientation. Where they do exist there seems to be very little replication of effective programs among Black and Latino males. Further, efforts to rigorously evaluate such tailored efforts, even within new TP funding streams, appear sporadic at best. I hope
Dr. Valdisseri and CDC continue to try and disseminate strategies targeting these underserved populations. Are you aware of innovative efforts looking at pregnant or parenting older teens, LGBTQ, homelessness, and/or youths transitioning from foster care? Whether in the guise of STI or pregnancy prevention, these poulations seem to fall off everyone’s radar especially among poorly resourced agencies who serve African Americans.
I feel prisons contribute to a large population of HIV. When MSM are released into our communIty to patray a normal relationship with a women. Prisoners count for more than 90 percent of our po
Population. Mandated testing should be a part of the detention and realease process. Minors should not be detained in adult prisoner to have HIV forced on them threw rape. We must battle this to provide a safe future for our kids of tomorrow . Always concerned
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