amfAR, The Foundation for AIDS Research

High Infection Rates Continue Among Gay Men

Most Remain Unaware They Are HIV-Infected

June 17, 2002—New research from the U.S. Centers for Disease Contol and Prevention (CDC) presented at the XIV International AIDS Conference provides further evidence of high rates of new HIV infection among gay and bisexual men in the United States and sheds light on factors underlying high-risk behavior among these men. Most notably, the CDC's studies revealed that a large majority of young gay men with HIV are unaware they are infected, particularly young African American men.

Infection Rates Nine Times Higher for Gay Men

CDC researchers examined anonymous blood samples from more than 40,000 high-risk patients of all ages at sexually transmitted disease clinics in five major U.S. cities and found the rate of new HIV infections among men who have sex with men (MSM) to be nine times higher than among women and heterosexual men. Researchers also found marked differences in infection rates between MSM of different racial groups. Among the 2,665 MSM in the study sample, estimated annual infection rates for African Americans and Latinos were 6.2 percent and 6.1 percent respectively, more than twice the 3 percent incidence for white MSM.

Understanding the Factors Underlying HIV Risk

Other CDC research presented at the International AIDS Conference offers new insight into the factors driving high HIV infection rates among men who have sex with men.

More than three-quarters of young gay and bisexual men infected with HIV were unaware they were HIV-positive, including 91 percent of African American MSM, 70 percent of Hispanic MSM, and 60 percent of white MSM. Among all racial groups, 60 percent of those surveyed perceived themselves to be at low or very low risk of being HIV-infected, despite having engaged in frequent high-risk behavior such as unprotected anal intercourse.

"[This] study shows that the very men who are at greatest risk of HIV infection are those who are least likely to think they are at risk. That's a direct call to develop not only new prevention messages, but also new messengers." —Phill Wilson, Executive Director, African-American AIDS Policy and Training Institute 

Experts caution that people who are unaware they are HIV-infected are less likely to take precautionary measures to avoid transmitting the virus and to protect themselves against re-infection or "super" infection with potentially drug-resistant strains of HIV.

The large number of African American MSM who are unaware of their HIV status is almost certainly driving the epidemic's spread in this community. African Americans represent just 12 percent of the U.S. population, but accounted for 47 percent of new AIDS cases and the majority (54%) of new HIV infections reported in 2000. Rampant homophobia leads many black MSM to remain closeted and engage in clandestine same-sex liaisons popularly described as "on the down low." For the most part, these are men who do not consider themselves gay and who also have sex with women. Black women accounted for nearly two-thirds (63%) of new AIDS cases reported among U.S. women in 2000.

"When is the last time you heard Al Sharpton call a press conference to denounce black apathy to the AIDS crisis or Julian Bond challenge black churches to reach out to gays?" —Cynthia Tucker, The Atlanta Journal-Constitution, July 10, 2002 

Another CDC study found that psychosocial health problems, including depression, multiple drug use, a history of childhood sexual abuse, and partner violence, interact to increase sexual risk behavior and HIV infection rates among gay and bisexual men in the U.S. A study of nearly 3,000 MSM in New York, Chicago, Los Angeles, and San Francisco found that the percentage of men reporting high-risk sex increased steadily from 7.1 percent among those with none of these four health problems to 33.3 percent for those suffering from all four. Similarly, reported HIV infection rates were 13 percent among those with none of these psychosocial health problems and 25 percent among those with all four health problems.

Finally, new CDC research found that gay and bisexual men are more likely to engage in high-risk sexual behavior with younger partners (56%) than with partners who are the same age or older (43%). Study authors stressed the need to better understand the elevated level of risk for younger MSM in order to target prevention efforts more effectively.

The CDC's findings struck a strong chord with public health experts and advocates who have been reporting disturbing signs of a resurgence of unsafe sexual behavior and HIV infections among gay men in this country. Hopefully, this new research will help inform better strategies for reaching MSM with prevention messages and counseling and testing services, particularly African American men. As Ronald Valdiserri, M.D., M.P.H., Deputy Director of CDC's HIV, STD, and TV Prevention Programs noted: "As we work to renew HIV prevention among gay men and others at high risk, this knowledge is critical to forging solutions that address the current realities of gay and bisexual men's lives."