Earlier this week, the President released his budget proposal for FY 2011. Although the President’s budget proposes to freeze non-security spending, it provided an increase of $71 million in prevention and care for people living with and at risk for HIV/AIDS.
The budget makes clear that HIV/AIDS remains a priority. (More details about the budget can be found at on the FY2011 Budget HIV/AIDS Fact Sheet). One notable feature of the budget is a new initiative to prevent HIV infection among gay and bisexual men. This is welcome news. Thirty years into the domestic HIV epidemic, gay and bisexual men remain disproportionately affected by HIV. Although HIV diagnoses have remained flat or declined in most risk groups between 2004 and 2007, HIV diagnoses have increased among gay and bisexual men. The impact of the epidemic on this group is staggering. Last August, CDC released preliminary estimates showing that gay and bisexual men were 50 times more likely than all other risk groups to contract HIV. Although gay and bisexual men represent approximately three percent of the United States population, they account for 53% of new HIV infections. The distribution of HIV infection is not uniform across gay and bisexual men by race or ethnicity. White gay men comprise the greatest number of HIV diagnoses among all gay and bisexual men. However, blacks and Latinos are much more likely than white men to be infected with HIV and represent the greatest proportion of HIV diagnoses among younger gay men (ages 13-24).
This new initiative reflects a commitment to use epidemiological data to better target our HIV prevention resources to the populations at greatest risk for HIV infection. HIV prevention funds have never adequately targeted gay and bisexual men. The President’s budget devotes nearly $17 million to fund an HIV prevention initiative, and approximately $10 million for prevention of viral hepatitis and other STIs among gay and bisexual men. The initiative will scale up effective biomedical and behavioral interventions to reduce the risk of acquiring and transmitting HIV, as well as efforts to increase regular HIV testing among gay and bisexual men. Additionally, funds will be used to provide technical assistance to improve HIV case surveillance with all populations, including those with lower rates of HIV incidence such as Asian and Pacific Islander and Native American and Alaska Native communities. Last, the new initiative will direct resources to social marketing efforts and update risk reduction messages for gay and bisexual populations.
Gay and bisexual men are not the only sexual minorities impacted by HIV/AIDS. Transgender populations are also at elevated risk for HIV infection, but HIV prevention resources directed to this group have lagged historically. During the HIV/AIDS Community Discussions that the Office of National AIDS Policy) held across the country, we heard that transgender populations are rarely targeted for HIV prevention programs and are lumped with gay men, or even ignored altogether. This is unfortunate given that a significant proportion (as many as 27%) of transgender participants across various studies test HIV-positive. For this reason, part of the increase in HIV prevention funds will be used to support activities that target the transgender community.
Throughout his Administration, the President has attempted to ensure that our policies and programs are guided by the best data describing the challenges we face and the best evidence of what works effectively. As with our important investments in responding to HIV/AIDS in the African American and Latino communities through the Minority HIV/AIDS Initiative, investments in HIV prevention for gay and bisexual men are part of a concerted effort to focus our resources where they are most needed and deploy critical public resources where they will have the greatest effect.
Greg Millett is the Senior Policy Advisor in the Office of National AIDS Policy