The Face of HIV in USA by 2013
Poor Black and Hispanic Men Are the Face of H.I.V.
Nicole Bengiveno/The New York Times
Roderick, who is gay, came to New York after family ties became too strained, saying, “I’m just basically dead to my family now.”
Nicole Bengiveno/The New York Times
Roderick, who is gay, came to New York after family ties became too strained, saying, “I’m just basically dead to my family now.”
By DONALD G. McNEIL Jr.
Published: December 4, 2013 244 Comments
The AIDS epidemic in America is rapidly becoming concentrated among poor, young black and Hispanic men who have sex with men.
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Nicole Bengiveno/The New York Times
Alex, 20, says, “I have three strikes against me: I’m black, I’m gay, and I’m in a wheelchair.”
Alex, 20, says, “I have three strikes against me: I’m black, I’m gay, and I’m in a wheelchair.”
Readers’ Comments
"It is not easy being human, but what is clear is being alone is the most painful condition of all."
Howard Egger-Bovet, Sonoma, CA.
Despite years of progress in preventing and treating H.I.V. in the middle class, the number of new infections nationwide remains stubbornly stuck at 50,000 a year — more and more of them in these men, who make up less than 1 percent of the population.
Giselle, a homeless 23-year-old transgender woman with cafe-au-lait skin, could be called the new face of the epidemic.
“I tested positive about a year ago,” said Giselle, who was born male but now has a girlish hair spout, wears a T-shirt tight across a feminine chest and identifies herself as a woman. “I don’t know how, exactly. I was homeless. I was escorting. I’ve been raped.”
“Yes, I use condoms,” she added. “But I’m not going to lie. I slip sometimes. Trust me — everyone here who says, ‘I always use condoms’? They don’t always.”
Besides transgender people like Giselle, the affected group includes men who are openly gay, secretly gay or bisexual, and those who consider themselves heterosexual but have had sex with men, willingly or unwillingly, in shelters or prison or for money. (Most of those interviewed for this article spoke on the condition that only their first names be used.)
Nationally, 25 percent of new infections are in black and Hispanic men, and in New York City it is 45 percent, according to the Centers for Disease Control and Prevention and the city’s health department.
Nationally, when only men under 25 infected through gay sex are counted, 80 percent are black or Hispanic — even though they engage in less high-risk behavior than their white peers.
The prospects for change look grim. Critics say little is being done to save this group, and none of it with any great urgency.
“There wasn’t even an ad campaign aimed at young black men until last year — what’s that about?” said Krishna Stone, a spokeswoman for GMHC, which was founded in the 1980s as the Gay Men’s Health Crisis.
Phill Wilson, president of the Black AIDS Institute in Los Angeles, said there were “no models out there right now for reaching these men.”
Federal and state health officials agreed that it had taken years to shift prevention messages away from targets chosen 30 years ago: men who frequent gay bars, many of whom are white and middle-class, and heterosexual teenagers, who are at relatively low risk. Funding for health agencies has been flat, and there has been little political pressure to focus on young gay blacks and Hispanics.
Reaching those men “is the Holy Grail, and we’re working on it,” said Dr. Jonathan Mermin, director of H.I.V. prevention at the C.D.C. His agency created its Testing Makes Us Stronger campaign — the one Ms. Stone referred to — and has granted millions of dollars to local health departments and community groups to pay for testing.
But he could not name a city or state with proven success in lowering infection rates in young gay minority men.
“With more resources, we could make bigger strides,” he said.
Reaching Out
Gay black youths are hard to reach, experts say. Few are out to their families. Many live in places where gays are stigmatized and cannot afford to move. Few attend schools with gay pride clubs or gay guidance counselors.
“When we talked about H.I.V. in sex ed, the class started freaking out,” said Alex, 20, who was born in St. Croix but raised in New York. “One guy said, ‘We ain’t no faggots; why do we have to learn this stuff?’ So the teacher stopped and moved on to another topic.”
When those who are poor and homeless go to traditional gay hangouts, they become prey.
Kwame, a 20-year-old from Philadelphia, said that on his first day wandering around New York last year, he was propositioned by an older homeless man and by an older transgender person. The homeless man later admitted that he was infected, and added: “If you sit here long enough, you’re going to get some propositions — and that’s where you’re going to sleep tonight. It happened to me, and it’s going to happen to you.”
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"It is not easy being human, but what is clear is being alone is the most painful condition of all."Howard Egger-Bovet, Sonoma, CA.
Despite years of progress in preventing and treating H.I.V. in the middle class, the number of new infections nationwide remains stubbornly stuck at 50,000 a year — more and more of them in these men, who make up less than 1 percent of the population.
Giselle, a homeless 23-year-old transgender woman with cafe-au-lait skin, could be called the new face of the epidemic.
“I tested positive about a year ago,” said Giselle, who was born male but now has a girlish hair spout, wears a T-shirt tight across a feminine chest and identifies herself as a woman. “I don’t know how, exactly. I was homeless. I was escorting. I’ve been raped.”
“Yes, I use condoms,” she added. “But I’m not going to lie. I slip sometimes. Trust me — everyone here who says, ‘I always use condoms’? They don’t always.”
Besides transgender people like Giselle, the affected group includes men who are openly gay, secretly gay or bisexual, and those who consider themselves heterosexual but have had sex with men, willingly or unwillingly, in shelters or prison or for money. (Most of those interviewed for this article spoke on the condition that only their first names be used.)
Nationally, 25 percent of new infections are in black and Hispanic men, and in New York City it is 45 percent, according to the Centers for Disease Control and Prevention and the city’s health department.
Nationally, when only men under 25 infected through gay sex are counted, 80 percent are black or Hispanic — even though they engage in less high-risk behavior than their white peers.
The prospects for change look grim. Critics say little is being done to save this group, and none of it with any great urgency.
“There wasn’t even an ad campaign aimed at young black men until last year — what’s that about?” said Krishna Stone, a spokeswoman for GMHC, which was founded in the 1980s as the Gay Men’s Health Crisis.
Phill Wilson, president of the Black AIDS Institute in Los Angeles, said there were “no models out there right now for reaching these men.”
Federal and state health officials agreed that it had taken years to shift prevention messages away from targets chosen 30 years ago: men who frequent gay bars, many of whom are white and middle-class, and heterosexual teenagers, who are at relatively low risk. Funding for health agencies has been flat, and there has been little political pressure to focus on young gay blacks and Hispanics.
Reaching those men “is the Holy Grail, and we’re working on it,” said Dr. Jonathan Mermin, director of H.I.V. prevention at the C.D.C. His agency created its Testing Makes Us Stronger campaign — the one Ms. Stone referred to — and has granted millions of dollars to local health departments and community groups to pay for testing.
But he could not name a city or state with proven success in lowering infection rates in young gay minority men.
“With more resources, we could make bigger strides,” he said.
Reaching Out
Gay black youths are hard to reach, experts say. Few are out to their families. Many live in places where gays are stigmatized and cannot afford to move. Few attend schools with gay pride clubs or gay guidance counselors.
“When we talked about H.I.V. in sex ed, the class started freaking out,” said Alex, 20, who was born in St. Croix but raised in New York. “One guy said, ‘We ain’t no faggots; why do we have to learn this stuff?’ So the teacher stopped and moved on to another topic.”
When those who are poor and homeless go to traditional gay hangouts, they become prey.
Kwame, a 20-year-old from Philadelphia, said that on his first day wandering around New York last year, he was propositioned by an older homeless man and by an older transgender person. The homeless man later admitted that he was infected, and added: “If you sit here long enough, you’re going to get some propositions — and that’s where you’re going to sleep tonight. It happened to me, and it’s going to happen to you.”
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www.whamproject.org and video of Mandela about "HIV/AIDS is a human rights issue." Thanks Madiba for your 46664 and everything else, RIP.
Sorry, but Obama has dropped the ball here.
He and Michelle were HIV tested in 2005 in Kenya.
He should volunteer to be tested yearly in Washington, DC [HIV Central] on World AIDS Day - does he not realize that his position would save lives? Very simple and effective public health tool.
It would also help if some rappers came clean about their HIV status. Eazy-E was not the only rapper with HIV. Rap should also avoid further stigmatizing songs about HIV/AIDS. That would also save lives. It's not a coincidence that the genre has a lot of stigmatizing rap about people with HIV when the music is aimed at the people who are transmitting it the most.
Oh, and lastly, HIV/AIDS is a disease of poverty. The more this country downpresses people into poverty, no living wage, neocolonial neoslavery conditions, won't make a further dent in HIV/AIDS rates.
Respectfully, or perhaps not so respectfully Id have to disagree with you on a couple of points. How could you possibly attribute this statistic to President Obama? Symbolic gestures from the President won't change minds or deter the behaviors of those people who expose themselves to infection.
This disease has been on the scene for over 30 years now, so in terms of public awareness there isn't a lot of new information. Secondly, I would very much disagree with your comment on HIV/Aids being a disease of Poverty. Aids is a disease of behavior, unprotected sex, intravenous drug use (the two most common means of infection) have more to do with it's spread along with the secret subculture of 'down low' activities. It really doesn't have a lot to do with income disparities.
One point - GMHC's acting chief executive blames 'government indifference' to their cuts in programs without mentioning their chronic budget mismanagement, wasting money on their two former headquarters, and trying to be all things to all people by de-emphasizing the GAY in GMHC. I and many of my friends have not given to GMHC in ages due to the incompetent management.
GMHC must get back to its mission and we all need to demand more money for HIV Prevention (as opposed to just HIV Testing - a favorite with the Bloombergians).
Honestly, black men as a group seem like they are in free fall. Really depressing.
Read everyone else's comments above mine for a little enlightenment about the tragic circumstances of these kids' lives. They said it far better than I did.
These poor black and Hispanic men with HIV are mostly eligible for medicaid, and we need to begin to be mindful of costs, now that Obamacare is pushing a boatload of people into Medicaid.
A previous verse gives a broader warning, in verse 9-11,
" Or do you not know that the unrighteous will not inherit the kingdom of God? Do not be deceived; neither fornicators, nor idolaters, nor adulterers, nor effeminate, nor homosexuals, nor thieves, nor the covetous, nor drunkards, nor revilers, nor swindlers, will inherit the kingdom of God. Such were some of you; but you were washed, but you were sanctified, but you were justified in the name of the Lord Jesus Christ and in the Spirit of our God."
Why wouldnt you select another bible passage? Say, for instance: "I do not permit a woman to teach or to have authority over a man. She must be quiet." (1 Timothy 2:12)
or
"Slaves, be subject to your masters with all reverence, not only to those who are good and equitable but also to those who are perverse." (1 Peter 2:18)
Oh, these passages are relics of their time, right? Absolute nonsense.
What started as a "gay" disease, morphed into a more inclusive disease, but then de-morphed or re-morphed back into a "gay" disease.
Part of this is because of the success of treatment. In the beginning, AIDS was a death penalty. Now it's not. There are lots of people who simply don't care about the risk because they think medicine will help them. Some of them, but only some of them, are right.
FALSE. Anal intercourse is riskier than vaginal intercourse, period.
However, heterosexual women are more vulnerable to contracting AIDS than men are due to their receptive role.
It's hight time for the gay male community to stop perpetuating misinformation for their own ends. Speak the truth.
These CDC stats are telling:
http://www.cdc.gov/hiv/pdf/statistics_basics_factsheet.pdf
Two extracts:
"Blacks represent approximately 12% of the U.S. population, but accounted for an estimated 44% of new HIV infections in 2010. They also accounted for 44% of people living with HIV infection in 2009"
"Unless the course of the epidemic changes, at some point in their lifetime, an estimated 1 in 16 black men .... will be diagnosed with HIV infection"
This is not a case for being subtle.
The New York figures are out of control, though. It might be that some work to fight homophobia in the black and Hispanic populations would also reduce these numbers -- that kid who didn't want to learn about safe sex because he wasn't a "faggot" has issues that need to be addressed, and as long as those attitudes are prevalent, they'll stifle a serious discussion of HIV issues.
That 29% of the US population would include black and Hispanic women along with black and Hispanic heterosexual men. So, if 25% of the new cases are black or Hispanic gay men. Well, you do the math. I would argue the plague is very selective indeed.
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6247a4.htm?s_cid=mm6247a4_w#tab1
Almost 2/3 of gay men have sex without condoms although they know they have Aids. Being impoverished would only increase this statistic since condoms cost money.
I do agree, however, that trying to address bigotry within minority communities is not a good job for government. Popular culture, entertainment, celebrity role models, and the clergy will likely have a greater impact over time. But what government CAN do is to encourage HIV testing, and try to get the infected on treatment. Studies have shown that those with undetectable viral loads are 96% less likely to transmit the virus, even if sex isn't protected. And yes, condoms are equally effective and way cheaper, so continued effort must be put into promoting their use, as well.
Thanks for a great article, NYT.
The fact that the incidence is not changing for blacks and hispanic men is a non-story. It's not because they have been ignored, as this article would have us believe - they know about aids and how it's contracted. It's because a) the black and hispanic cultures do not recognize or sympathise with homosexuality. Both see it as a white problem. b) the black and hispanic communities to not like condoms - a problem healthcare providers deal with every day in black communities in the US and in Africa, as well as latin america. It's not considered manly to wear a condom.
Until the communities work together from within to change their culture, the prevalence of HIV within these two ethnic/race groups will not change.
A major factor is access to proper health care. Many HIV positive black and Latino men and transgender women are not getting proper treatment and are thus much more likely to spread the disease than someone who is treated properly and has an undetectable viral load. Some of this has to do with stigma (e.g. people not wanting to get tested because being HIV positive is considered shameful), but a lot of it is simply about poverty.
Preventative measures like condoms are very important, but it is also important to recognize that there are other issues at play here. If society as a whole invested in health care for low-income communities, I'm sure we would see a drop in HIV infections.
Don't make unprotected sex into a Black thing when there is no evidence that it is more common in that community.