High Rates of HIV Infection & Unprotected Sex, &
Limited Access to Care Among African-American &
Hispanic Men Who Have Sex with Men

By Harvey S. Bartnof, MD and Jules Levin

Among 2,401 young (ages 23-29 years) gay/bisexual men in 6 US cities (Los Angeles, Miami, New York City, Seattle, Baltimore and Dallas) surveyed and tested for HIV from 1998-2000, the overall HIV infection rate was 12% (range for the 6 cities was 5% to 18%) (abstract 211). The rate increased with age from 10% among 23-25 year-olds to 14% among 26-29 year-olds in the non-random, cross-sectional study performed at "public venues." Among African-Americans the rate was 30%, 3% among Asians, 15% among Hispanics, 7% among whites, and 10% among "others." Interestingly, among 293 men with HIV, only 29% knew they had HIV before this testing, 23% were currently receiving medical care for HIV, and only 18% were taking anti-HIV therapy. Unprotected (no condom) anal sex during the previous 6 months was reported by 46% (range 41%-53% among the 6 cities). The lead author was Dr. L. Valleroy of the CDC, who classified some of the findings as "alarming."

Among 542 young (23-29 years) gay/bisexual men in New York City, HIV positivity rates were 33% of 146 Blacks, 14% of 195 Hispanics, 2% of 108 Whites, none of 38 Asian-Pacific Islanders, and 6% of "others" (abstract 212). The non-random cross-sectional, anonymous survey was undertaken in "public venues" during 1998-99. Unprotected (no condom) anal sex with a man in the previous 6 months was reported by 58%, while ever having sex with a woman was reported by 69%, including 60% of self-identified gay men and 96% of self-identified bisexual men. The lead author was Dr. L.V. Torian of the New York City Department of Health.

Persons With Acute HIV May Be Most Contagious
Sexual HIV transmission was shown to occur a median of 2 days before (range 7 days before to 7 days after) a source partner had symptoms (severe "flu") of acute HIV infection, according to Christopher D. Pilcher, MD of the University of North Carolina at Chapel Hill (abstract 411). A total of 5 couples were in the study, including transmission from 1 male to male, 3 males to females and 1 female to male. The authors also found that newly infected persons may be sexually contagious as early as 5-13 days after their sexual exposure. Persons with acute HIV infection (and prior to symptoms) are thought to be quite contagious sexually, due to very high HIV viral loads. Some experts believe that exposure to a person experiencing acute HIV infection, whether it be sexually or thru IVDU, is the major source for new infections.

Among 250 young (ages 23-29 years) gay/bisexual men in Los Angeles reporting unknown or HIV negative status, those reporting "confidence in HAART" were nearly 4-fold more likely than those without confidence to report unprotected (no condom) anal sex in the previous 6 months (abstract 213). The lead author was Dr. T. Bingham of the HIV Epidemiology program there.

SAFE: New CDC Program to Increase HIV Testing Health Care Access
Dr. Robert Janssen of the CDC (US Centers for Disease Control and Prevention) announced the new SAFE program, with a goal to increase the rate of people in the US who know their HIV status from 70% to 95% (abstract S20). This program will encourage people to seek testing through a new media campaign called "Know Now." The campaign will target neighborhoods with high HIV incidence by using radio and community-based organizations. It will begin later this year as a pilot program in 5 US cities. Through the use of HIV "rapid tests" (saliva or "Quick Stick"), the CDC also hopes to increase testing at emergency rooms and correctional facilities. Dr. Janssen said that SAFE would have "5 action steps" for HIV positive persons, including increasing their entry into health care and preventive services and helping with adherence to anti-HIV medication dosing. SAFE also will incorporate a prevention component for those who are HIV negative.