In 1981, our nation and its public health system were grappling with a new disease that was taking the lives of gay men across the United States. Thirty years later, HIV/AIDS continues to be a crisis among gay and bisexual men. The latest data show men who have sex with men (MSM) remain most affected in this country. Although MSM represent 2% of the population, they account for 64% of all new infections (including 3% among MSM who are injection drug users [IDUs]). CDC estimates that there were more than 30,000 new HIV infections in 2009 among MSM, including MSM-IDU. Though the numbers have gone down dramatically, approximately 7,000 MSM with an AIDS diagnoses still die each year and nearly 300,000 MSM with AIDS have died since the beginning of the epidemic.
Today, we commemorate the fourth annual National Gay Men’s HIV/AIDS Awareness Day, an observance founded by the National Association of People with AIDS to raise awareness of the HIV/AIDS epidemic among gay and bisexual men. This annual observance is one way we are focusing attention and resources on those populations at highest risk for HIV infection, including gay and bisexual men. This focus is a top priority outlined in the National HIV/AIDS Strategy (NHAS).
To reach those at risk, CDC is pursuing High Impact Prevention to support the most effective and impactful programs to aggressively reach the goals of the National Strategy. The interventions are being implemented at the federal, state, and local levels to reach the right populations at a scale large enough to make a significant difference. These approaches include expanded testing efforts to ensure more gay and bisexual men get tested at least annually, more often if at increased risk;prevention programs for people living with HIV and their partners; condom distribution; demonstration projects that focus on the most heavily affected communities; and matching HIV prevention funding for health departments and community-based organizations in those locations with the highest HIV burden.
Biomedical tools also are being investigated. Treating people living with HIV with antiretroviral therapy (ART) early in their infection can reduce the risk of transmitting the virus to others by 96%, according to a recent clinical trial. In addition, a new approach called Pre-Exposure Prophylaxis (PrEP) has also been shown to significantly reduce the risk of contracting HIV in gay and bisexual men, as well as heterosexuals at high risk of infection, when it is combined with existing prevention measures.
For black gay and bisexual men at highest risk for HIV, a new campaign, ‘Testing Makes Us Stronger’, previewed at the 2011 National HIV Prevention Conference, will soon be released. This campaign is the latest phase of CDC’s five-year, multi-faceted communication campaign, Act Against AIDS. Of critical importance, is reaching young gay and bisexual men of color with prevention information and access to care. According to recent estimates, HIV infections among young, black MSM (aged 13 to 29) increased by 48 percent from 2006 to 2009. Latino MSM were also impacted severely by HIV, accounting for nearly two-thirds of all new infections among Latinos in 2009. Additionally, transgender persons are at high risk with 28 percent estimated to be HIV infected. These numbers are alarming.
In response, today CDC awarded $55 million over five years to 34 community-based organizations (CBOs) in 19 states and Puerto Rico to expand community-led HIV prevention for young MSM and transgender youth of color, and their partners. Thirty-four organizations will receive, on average, an award reaching $300,000 annually, expanding previous programs with an increase of $10 million to fund additional CBOs.
Funding local organizations is one of the most powerful and effective ways to deliver HIV prevention to those at greatest risk as they are better positioned and know firsthand the community and individual socioeconomic factors, stigma, access to and availability of health care services that effect young MSM and transgender persons’ ability to protect their health and get care if/when needed. Local organizations expand our national prevention efforts in a way that others cannot, and their impact can be profound in reaching those at highest risk.
These efforts emphasize holistic and integrated approaches that are our best response to changing disease trends. They are providing new ways to help to eliminate missed opportunities and meet the needs of communities and populations at risk for HIV as well as viral hepatitis and other sexually transmitted infections.
Today, right now, we desperately need new champions and leaders from the gay community and from all communities where MSM are heavily affected to take this information and these promising breakthroughs and help to nurture a movement that not only promotes awareness of the HIV epidemic and its toll on gay and bisexual men but access to education, prevention, and care to make full use of all of the tools we have at hand currently. The gay community’s leadership once drove the nation to act against AIDS – that same energy and commitment is needed today. We cannot allow the health and the lives of gay and bisexual men to be lost to a preventable disease.
Kevin A. Fenton, MD, PhD, FFPH is Director of the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention at the Centers for Disease Control and Prevention