HIV: Frustration on the Ground

By: DUNCAN OSBORNE
For Gay City News - click the original article here
06/21/2007


Bruce Kellerhouse led 72 gay men in three workshops earlier this year. The men, who gathered to discuss the mid-life experience of gay men in a "post-AIDS community," ranged in age from 28 to 66 and had some strong feelings.

"They're very angry about the rising infection rates, they're very angry about the lack of activism, and they're very angry about the lack of urgency about the spread of HIV," said Kellerhouse, a psychologist.

That anger is not unreasonable.

Using an HIV test that identifies recent infections, the city health department tested 3,464 blood samples that were collected at city clinics between 2000 and 2004. Among gay and bisexual men, the overall new HIV infection rate for the study period was just over three percent per year. It went from 3.79 percent at the start of the study to 2.84 percent at its end. That decline was not statistically significant.

Other groups saw large and statistically significant declines. The rate among heterosexuals went from 0.29 percent to 0.08, among women it went from 0.32 to 0.06, and, most dramatically, the rate among injecting drug users went from 2.54 percent to 1.04. Activists credit that large drop to the distribution of clean needles to injectors.

Previously, the city health department had estimated that gay and bisexual men were becoming infected at two to three percent per year from 1993 through 2003. While the city, state, and federal governments have spent tens of millions of dollars at dozens of AIDS groups since 1993 to deliver HIV prevention services to gay men, it is possible that the new infection rate among those men has remained unchanged for nearly 15 years.

Kellerhouse, along with Dan Carlson, organized a series of eight town meetings from 2003 into 2005 that collectively drew thousands to talk about gay men, drugs, and HIV. In 2005 interviews, both expressed anger that the town meetings had not provoked a response. In 2007, Kellerhouse made that point again.

"My big complaint and observation is that... HIV prevention isn't visible," he said. "I don't see it anywhere I go, I don't see it in any publications... I don't see any energy or innovation around HIV prevention in New York City."

Responding to the emergence of AIDS in the early '80s, gay men are credited with creating the first safe-sex campaigns and promoting condoms. In the late '90s, the Gay Men's Health Crisis (GMHC) was among those AIDS groups, if not the first, that recognized the link between drug and alcohol use and unsafe sex. GMHC's effort responding to that linkage was modest and likely did not have a broad impact. Activists say that pioneering has ended.

"There hasn't been innovation, there hasn't been piloting of new intervention programs, there hasn't been the kind of reinforcement that we saw in the early days of the epidemic," said Spencer Cox, executive director of the Medius Institute for Gay Men's Health. "People just stopped doing it."

Currently, just two groups - the Positive Health Project (PHP) and the Lower East Side Harm Reduction Center - are regularly in sex clubs that serve gay men talking about safe sex, condoms, and drug use.

Terry Evans, an outreach coordinator at PHP, estimated that he has been in 150 clubs over the past 18 months and visits 78 regularly. These clubs serve African-American and Latino men. PHP is funded to do this with a city contract. In a March interview, Ed Manchess, PHP's acting executive director, said they would like to expand the list of clubs they visit.

"We'd like to do that, but there's no funding for white gay men," he said.

Sam Orlando, a coordinator at the Harm Reduction Center, does HIV testing and counseling at two sex clubs every week, an effort that is not supported with government funds.

"I probably talk to, at these parties, anywhere between 20 and 40 guys and I'm testing around usually10 percent," he said. "It has not been the buzz kill that everyone anticipated it would be. Men have been really welcoming."

Other AIDS groups are funded to deliver HIV or drug prevention messages in posters, Web sites, and other materials. Some of those same groups get funds from the federal Centers for Disease Control and Prevention to deliver a limited number of HIV counseling programs, but they say the counseling reaches a small population.

"Too few people are reached by the funded programs," said Dennis deLeon, president of the Latino Commission on AIDS. "They are designed to reach per intervention cycle maybe 200 or 300 people. That's not very many when you look at the number of sexually active gay men in the city of New York."

Bill Stackhouse, director of GMHC's Institute for Gay Men's Health, agreed saying that, to have an impact, any intervention must reach 80 percent of its target population.

"To really have a change that's what you need," he said. "In the U.S., we're nowhere near that. What needs to happen is that kind of thinking needs to reach our federal officials and our local health department...W e need to seriously reach large numbers of gay men."

A major problem is the limited amount of money available to support HIV prevention services for gay men.

"I suspect one of the reasons there is not a stronger commitment to HIV prevention for gay men is because funding is very difficult to find," Cox said. "There's not a lot of money out there to provide services for gay men."

In recent years, AIDS groups have aggressively and successfully fought for more funding to serve African Americans and Latinos. In so far as gay and bisexual men are in those communities, they are served by those efforts, but, outside of funds for anti-crystal meth campaigns, there has been no equivalent effort on behalf of gay and bisexual men though they remain the group most affected by HIV in the U.S.

Among the men who worked with Kellerhouse, he said that many reported feeling abandoned by AIDS groups, by GMHC in particular, and by government.

Stackhouse said gay men were the "primary population among our clients" and, "They are our priority, they always have been."

Without naming any one group, Cox seconded the view of Kellerhouse's workshop participants.

"I absolutely believe that our AIDS organizations have neglected gay men," he said. For Cox, there is an "element of homophobia involved."

A drug user in the Bronx who becomes HIV-infected is seen by some as the victim of poverty or racism, but "when a middle-class gay man gets addicted to methamphetamine and gets HIV, at some level people think he did it to himself," Cox said.