The fifth annual National African American MSM Leadership Conference on HIV/AIDS took place January 22 to 25 in Atlanta. Sponsored by National AIDS Education & Services for Minorities (NAESM), the conference convened community leaders and health professionals to discuss the epidemic among black men who have sex with men (MSM). Our People, Our Work, Our Success was this year's theme.
|Kevin Fenton, MD, PhD|
James Wortman: Why was this year's conference important?
Fenton: HIV continues to pose a major threat to the health and well-being of MSM across the United States. And African-American MSM are particularly hard-hit. Nearly half—or 46 percent—of black MSM who were surveyed [by the CDC] in the community, urban settings, were HIV positive.
This is twice the proportion of white men in those jurisdictions. And we also know that black men who are HIV positive are more likely to be unaware of their HIV status than Hispanic and white men. And this level of unawareness is actually fueling the ongoing transmission of the disease.
We also know that African-American men in general face HIV infection rates many times higher than that for other races and ethnicities. For example, HIV incidence—the number of new HIV infections—occurring in black men is approximately six times that of white men and three times that of Hispanic men. And we know that the majority of infections among African-American men are actually occurring in MSM. MSM account for about two thirds of all HIV infections among African-American men.
This conference helped us focus on troubling signs of an increasing epidemic among young black MSM. We are seeing possible increases in infections in MSM ages 13 to 24 years in terms of new diagnoses, and we've seen increases in sexually transmitted diseases [STDs]—including syphilis and gonorrhea—among young black men [in general] and young black MSM.
What I thought was particularly important was the great sense of urgency that was clear among attendees to the conference. A great sense of, “We need to do more, and we need to do more faster” when it comes to catching up and getting ahead of the curve with African-American MSM. There was a great sense of urgency when it came to thinking about our interventions, and it was just amazing to see these young black gay men who are taking on board the leadership challenges and developing skill sets for HIV prevention within their own communities and with their peers.
What more can be done at the community level to prevent new infections, bolster HIV testing and promote treatment?
The magnitude of the problem really demands that there are more voices that are coming to the table to challenge our efforts on the epidemic. It can't just be black MSM who are doing this. It has to be all of us, everybody who is committed to stopping this epidemic.
[We can achieve this by] promoting leadership, promoting HIV testing efforts—particularly those targeting black MSM and those targeting young black MSM—and ensuring that we are supplementing the education on HIV prevention performed in schools, but also for young people in the community so that we are preparing our young people, when they become sexually active, to protect themselves from acquiring HIV.
We need to ensure that we do a much better job in linking people to care. Because we know that when anyone is diagnosed as HIV positive and is in treatment, then that has a tremendous impact on reducing the onward transmission of the disease.
We have to ensure that we expand the reach of our prevention interventions, which we know are effective—whether it's specific behavioral interventions with HIV testing, whether it's social marketing campaigns.
According to a new study published in the January 2009 issue of Social Science and Medicine, using the term “on the down low” to describe black MSM who identify as straight could harm HIV prevention efforts. What's your take on that?
One of the challenges that we continually have is dealing with stigma and homophobia in the black community. And labels such as being “on the down low” may not be helping communities or even individuals face their realities when it comes to what is driving the epidemic.
Our perspective here at the CDC is really more geared toward understanding the current risk behaviors, being clear about the factors which are or which are not driving HIV in the community and ensuring that we are targeting those through prevention interventions.
For example, we know among black gay men, there are factors such as the high rates of STDs within the black MSM community and the black community in general, which can be facilitating disease transmission. We know that black MSM tend to have partners that are a few years older compared to white MSM of the same age. Differences in age group mixing in the black MSM community can explain why we see younger black MSM becoming infected with HIV.
Should the HIV community itself be considered an HIV prevention tool?
Absolutely. A key element of our prevention strategy here at the CDC is to work with people who are living with the virus. They have an important role to play in raising awareness about this disease and its effects on the lives of people all over the country and all over the world, and a very strong role to play in advocacy for prevention.
I just want to acknowledge the work of colleagues at the National Association of People with AIDS (NAPWA) and other organizations for people who are living with HIV/AIDS. They've really done fantastic work in building a community for people living with HIV and building a voice for that community.
A voice that is advocating for prevention, advocating for research, advocating against stigma and discrimination and homophobia, as well as providing a source of support for people who are both HIV negative and HIV positive. I cannot underscore enough how important the community of people living with HIV is in our fight against the virus.