A couple of days ago, the Centers for Disease Control and Prevention (CDC) released a new data analysis looking at the rates of HIV and syphilis among gay, bisexual, and other men who have sex with men.
And they aint pretty.
Below we share important context - thanks to friends of LifeLube - to help understand these numbers and move forward with some solutions. These points have a bit of Chicago flavor, but most apply from sea to shining sea.
REVIEW OF THE DATA
• On Wednesday, March 10, the Centers for Disease Control and Prevention (CDC) released new data that underscore the nation’s ongoing struggle to halt the spread of HIV and sexually transmitted diseases (STDs) in the United States.
• Rates of HIV infection among gay, bi men and other men who have sex with men (MSM) are more than 44 times higher than rates among heterosexual men and more than 40 times higher than women.
• Rates of syphilis, an STD that can facilitate HIV infection and if left untreated, may lead to sight loss and severe damage to the nervous system, are reported to be more than 46 times higher among gay, bi and other MSM than among heterosexual men and more than 71 times higher than among women.
HISTORICAL NEGLECT FOR GAY/BI MEN HAS PERPETUATED HIV DISPARITIES AMONG THIS POPULATION
• Rates of HIV and syphilis among gay and bisexual men in the United States are staggering and appalling.
• Since the beginning of the domestic epidemic, gay and bisexual men have remained the most impacted by HIV – yet investments in prevention have not matched the need.
• In 2007, gay men, bisexual men and other MSM accounted for 53% of new HIV/AIDS cases in the United States, even though this group makes up between 2.8 and 5.3% of the U.S. male population, according to the CDC.
NATIONALLY, PUBLIC HEALTH ENTITIES HAVE PROVIDED INADEQUATE HIV PREVENTION SERVICES FOR GAY/BI MEN
• CDC spends approximately $650 million per year on HIV prevention activities. Approximately $300 million of that goes to state and city health departments that have consistently under-funded services targeting gay and bisexual men. Between 2005-2007, only 29% of federal risk- reduction funding managed by state and local health departments supported services for gay/bi/MSM.
o For federally funded counseling, testing and referral services (CTR), state and local health departments directed only 11% of the total funds distributed during the same period toward gay/bi/MSM.
o Most of the CTR allocation went to the general population and the majority of that money was directed to low-risk heterosexuals, according to the CDC.
o In 2009, only 20% of gay/bi/MSM had access to HIV prevention services, according to the CDC.
CHICAGO’S HIV EPIDEMIC REFLECTS NATIONAL DISPARITIES AMONG GAY/BI MEN
• According to the Chicago Department of Public Health (CDPH), in 2006, there were 1,557 newly diagnosed infections, 62% of which were among gay/bi/MSM. Of those gay/bi/MSM, 42% were black, 36% were white, 17% were Hispanic, and the remainder were “other.”
o More than 22,000 people in Chicago are estimated to be living with HIV/AIDS and in 2008; CDPH reported 12,884 gay/bi/MSM living with HIV/AIDS.
CHICAGO FUNDING ALLOCATIONS ACCURATE LY REFLECT THE HIV EPIDEMIC
• 19 out of 39 CDPH HIV prevention projects targeting high-risk populations specifically focus on MSM.
• Approximately 60% of CDPH HIV prevention funds serve MSM.
• CDPH works closely with the HIV Prevention and Planning Group (HPPG) to ensure the prevention resources are in line with the HIV epidemic in Chicago. HPPG recommendations are implemented in CDPH’s distribution of prevention funds. The most recent HPPG allocation recommendations for high-risk groups (as of 2006) are as follows, based on geographical areas that divide the city into three clusters:
o Cluster A (receives 32% of high-risk population resources) -Percent of resources to be allocated to MSM: 100%
o Cluster B (receives 37% of high-risk population resources) -Percent of resources to be allocated to MSM: 77%
o Cluster C (receives 31% of high-risk population resources) - Percent of resources to be allocated to MSM: 68%
INTERVENTIONS MUST EXPAND FOCUS BEYOND INDIVIDUAL-LEVEL EMPHASIS
• Understanding the factors related to changing trends in the HIV epidemic among MSM in Chicago is complex and multifactorial, and cannot be attributed simply to individual-level behavior. Continued emphasis on prevention of individual-level risk behaviors will only have a limited impact on the disproportionate rates of HIV infection.
• Current data show that Black MSM in Chicago have higher rates of HIV prevalence than White or Hispanic MSM despite comparable levels of sexual and drug use risk behaviors and similar frequency of HIV testing.
• Historically inadequate, disproportionate resources directed toward gay/bi/MSM are a contributing factor to the general gay/bi/MSM disparities, and particularly impact gay/bi/MSM of color.
• Higher prevalence of HIV among gay/bi/MSM and relatively closed sexual networks – particularly among black gay/bi/MSM, increase the chance of exposure per unprotected sexual act.
• Unprotected anal intercourse is the most efficient means of transmitting HIV.
• Interventions must address structural issues such as institutionalized homophobia, stigma and discrimination, as well as human and civil rights, and lack of access to health care. Additionally, the role of community viral load and sexual networks requires further study.
• There is a pressing need for the development of new prevention methods such as topical and oral prevention as well as preventative and therapeutic vaccines.
SHORTCHANGING HIV SERVICES WILL ESCALATE DISPARITIES AND UNACCEPTABLE OUTCOMES
• Years of neglect and the federal emphasis on ineffective abstinence-only programs that negate the existence of gay/bi/MSM have taken their toll.
• Gay/bi/MSM must be prioritized in every community in the country, including Chicago, if the United States is to adequately address the HIV epidemic.
• Proportionate resources must be allocated to programs serving gay/bi/MSM and must include funding for culturally competent mental health and substance use programs. This includes federal, state and local funding.
ILLINOIS BUDGET CUTS WILL PUT MORE PEOPLE AT RISK
• In Illinois state budget cuts have resulted in a $4M cut to funding for HIV prevention programs (because of the need to maintain access to HIV medications through Illinois’ AIDS Drug Assistance Program.)
o In Chicago, as a result of this cut, programs funded by the Chicago Department of Public Health will unable to provide evidence-based interventions and counseling and testing for over 15,000 individuals at high-risk of HIV infection, including gay men and MSM.
o This funding cut will undoubtedly worsen the existing disparities among this population. At risk individuals, including gay men and MSM, will be impacted statewide by these cuts.
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