HIV Infection in the U.S. Rise - Thoughts?

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    Jul 01, 2008 2:48 PM GMT
    I'm going to violate a little copyright and post the article here. So sad. That increase in the 13-24 age range is very scary. Is it carelessness? Is it the creeping influence of xtube and its ilk? Barebacking being fashionable? Lack of honest home and school sex ed? Makes my brain churn.


    Rapid rises in diagnoses in US gay men concentrated in black and younger men

    Monday, June 30, 2008
    By Roger Pebody

    The number of HIV diagnoses continues to rise in American gay men and other men who have sex with men (MSM), with especially rapid increases seen in young black men, according to figures released by
    the Centers for Disease Control and Prevention (CDC) in the June 27th edition of the Morbidity and Mortality Weekly Report.

    The CDC tracked new diagnoses of HIV from 2001-2006, and calculated the estimated annual percentage change in diagnoses. For gay men and other MSM, the annual rise was 1.5%.

    The analysis covers the 33 states that had a system of confidential, name-based HIV case reporting throughout the five year period. This includes a number of states with large gay populations, including New York, Florida and Texas, but not others such as California and Illinois.

    During this time, a total of 214,379 people were newly diagnosed with HIV, and 46% of the diagnoses were in gay men and other MSM. There were statistically significant decreases in diagnoses for all transmission categories apart from gay men and other MSM. For example, there was a 4.4% annual decrease for heterosexuals, and a 9.5% annual decrease for injecting drug users.

    However, diagnoses in gay men and other MSM increased by 1.5% each year (95% CI: 0.8 – 2.1), or 8.6% over the five year period. Moreover, there were marked variations in the increase in diagnoses in gay men and other MSM, according to race and to age.

    Annual increases in black men and in Hispanic men were both 1.9%, in contrast to 0.7% seen in white men. A total of 36% of all diagnoses were in black men, although only 12% of the US population is black.

    Moreover, the estimated annual increase in Asian and Pacific Island men was 12.1%. However as the total number of infections remains low in this group, the confidence intervals for this figure are relatively wide (95% CI: 5.0 – 19.6).

    In terms of age, there were particularly large increases in diagnoses amongst the youngest men in all ethnic groups. For men aged 13-24, looking at all ethnicities together, the increase each year was 12.4%. A particularly large annual increase was seen in young black men – 14.9%, amounting to 93.1% over the five years.

    Although the greatest increases were in the youngest men, this group only contributed 14% of the total number of diagnoses. As has long been the case, the majority of diagnoses occurred in the 25-44 age group. However the trends here are more encouraging, with an annual decrease of 1.1%, and decreases concentrated in both white and black men.

    Diagnoses increased amongst those aged over 45, however, rising by 2.7% each year. There was a particularly marked increase of 3.8% in white men of this age group (compared to the increase of 0.7% for white men of all ages).

    Finally, there were large variations according to region, with greater increases in the South and the Midwest.

    During this period, and in contrast to the UK, the US reporting system was not set up to provide accurate measures of HIV incidence (i.e. the rate of new infections in the population). However this data does strongly suggest that incidence is rising in many groups of American men who have sex with men, and may be higher than previously estimated.

    At the Conference on Retroviruses and Opportunistic Infections earlier this year, Ron Stall of the University of Pittsburgh had said that his systematic review of incidence studies concluded that incidence in community samples of American gay men was around 2.4% a year. Moreover, Stall went on to demonstrate the long term implications of such an incidence rate.

    Taking this figure as a starting point, Stall ran a mathematic model to see how this incidence in a group of 18 year-olds would translate into HIV prevalence as the group got older. The key assumptions of the model were that each year 2.4% of the group acquired HIV, and that mortality rates were the same as for equivalent age groups in the general population.

    By age 20, around 5% of the group would be HIV-positive; by age 25, around 15% would have HIV; by age 30, around 25% would be living with HIV, and when they were 40, 41% of the group would be HIV-positive.

    Moreover, Stall re-ran the model for black men, based on a “low” estimate of 4% incidence in this group. The results were even more alarming: by age 40, around 60% of the group would have HIV.

    Stall commented that he was “horrified” by these estimates. However he concluded that “at the HIV incidence rates we're already seeing in the published literature, we can expect an ongoing HIV epidemic among gay men that will yield high prevalence rates over time.”

    Commenting on the CDC figures to the New York Times, Jennifer Hecht of the Stop AIDS Project in San Francisco said: “The high rates we see among black men and other minorities indicate that it’s very much connected to larger issues like poverty and racism.”


    References
    Centers for Disease Control and Prevention. Trends in HIV/AIDS diagnoses among men who have sex with men – 33 states, 2001-2006. MMWR 57: 681-686, 2008.

    Stall R et al. What's driving the US epidemic in men who have sex with men. 15th Conference on Retroviruses and Opportunistic Infections, Boston, abstract 53, 2008.
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    Jul 01, 2008 4:17 PM GMT
    I just hope this topic does not start another outbreak of goyism!

    I think there are several factors at play:

    - success of the anti-HIV drugs has led to a tremendous decrease in the mortality rate among gay men. Young gays see this as a manageable disease, unlike my generation that saw it as a potential death sentence. Also young gay men do not see walking down there street people with AIDS, or do not have friends in an AIDS hospice dying. That is unlike my generation.

    - some people actually believe that HIV does not cause AIDS, hard to believe but true. This false information is latched onto by less educated gay men who are trying to find any reason not to practice safer sex.

    - increased popularity of barebacking in porn videos leads some gays to believe that it is safer then it actually is.

    - increased use of recreational drugs such ecstasy and crystal meth. has I believe led to an increase in risky behaviour.

    - the rise of the internet and hook-up sites has made easier then ever to have casual sex.

    - lack of proper, objective sex education in schools does not help. For someone reason parents equate teaching safer sex with encouraging sex among teens. Very strange and irrational.

    That is a few reasons. It is not only young gay men that are still contracting HIV. Gays in their 30's and 40's are still getting it. Partially that is due to the belief that oral sex is nearly 100% safe, it isn't unfortunately. Also some gay men as they get older and loneliness sets in they maybe more likely to be talked into engaging in riskier behaviour thinking that if they refuse they could lose a potential partner.
  • auryn

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    Jul 01, 2008 10:03 PM GMT
    They're not the only ones.

    HIV Cases Double Among Georgia Seniors
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    Jul 01, 2008 10:06 PM GMT
    Sorry to detour a bit here, but that article refers to people over 50 as seniors. No effing way!

    The tragedy of this hasn't really begun yet. These are black and hispanic youth/young men. There's not going to be any quilt, there won't be ribbons. Elton John won't throw a party. Liz Taylor doesn't know any black or hispanic people (michael jackson doesn't count). When they can't get through the hoops required by the U.S. medical maze, they'll suffer and die. No hospice. No memorial.
  • xKorix

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    Jul 01, 2008 10:13 PM GMT
    Unhappy people do careless things
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    Jul 02, 2008 10:41 AM GMT
    xKorix saidUnhappy people do careless things


    Wiser words were never spoken. When young gay gays ask me for advice about safer sex, one thing I always bring up is their mental/emotional state. Monitor how you are feeling. Are you depressed or sad, and if so how do you cope with those feelings? If you seek out comfort from other guys, then the risk of catching HIV could go up depending on how many guys you sleep with (e.g. going to bathhouses) and/or the sexual acts you engage in.

    We are human beings who have emotions, and they can and do play a big part in our lives.
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    Jul 02, 2008 11:07 AM GMT
    This is scary. People just dont get it. It scares me when I see guys profiles saying Sometimes or Most of the time in terms of practicing safe sex. Maybe they think they cant get it or they can just take some medicine and everything will be alright. Its very unfortunate.
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    Jul 02, 2008 12:03 PM GMT
    gymguy1 saidThis is scary. People just dont get it. It scares me when I see guys profiles saying Sometimes or Most of the time in terms of practicing safe sex.

    Well, some of that can be attributed to people being completely realistic about what constitutes safe sex. I would never put ALWAYS as my Safe Sex choice because I don't always wear a condom when oral sex is involved, which is in fact unsafe sex. I wish websites would make distinctions.

    Meanwhile the point about emotional states leading to poor decisions is so true. I know in my one super slutty period a few years ago...it was a direct result of some health stuff my family was going through as a whole and not dealing with/discussing at all. I poured my anger and hurt into the worst of outlets, desperate as I was to FEEL something and seek some sort of release from the pain I was experiencing. In retrospect, obviously foolish...but when the mind it blind with anger or hurt, common sense isn't always your keeper.
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    Jul 02, 2008 12:17 PM GMT
    I would say that people are just becoming dumber and if hiv worked faster I would just call it natural selection in action. Then again, I'd already be removed from the food chain if that were the caseicon_lol.gif Part of me is sympathetic, but another part of me recognizes that stupidity must have consequences.
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    Jul 02, 2008 12:22 PM GMT
    Well, stupid decision making is a root cause...but you can cure stupidity through education, communication and common sense. They don't even teach the straight kids how to put on a condom anymore...lord help the gay kid and what he needs to know about a condom and its important applications.

    That and the lines between fantasy (porn) and reality have blurred with the advent of the internet, particularly home video sites like xtube, etc. It's a tricky boundary, but one I think could be made less malleable with good, honest sex education.

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    Jul 02, 2008 12:38 PM GMT
    I'm not saying that the state of hiv/aids education in this country isn't a major factor in this Runinthecity. It just seems to me that if someone knows that a disease is out there, then they can find out everything they could ever want and more on how to avoid it with a few key-strokes and mouse clicks. I'm not absolving poor policy, I just think that it's a cop out for people to play the "nobody told me" card when it's even easier to find that information on your own in this day and age than it ever was before. So yes, I think it's critically important that there should be better education, but I think that something else is going on here too. There is something fundamentally broken about how people take responsibility for their own education and actions in certain matters in this country.
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    Jul 02, 2008 4:42 PM GMT
    RBY71 said There is something fundamentally broken about how people take responsibility for their own education and actions in certain matters in this country.


    This is the same collective mindset that manifested itself in the 2 elections of W, the rise of mindless cable news commentary, the expansion of Starbucks, the SUV, Paris Hilton and more.

    That said, the availability of information does not equal the proper application of it. (Knowledge does not equal wisdom.) As someone who works in an academic library system, I can attest: there's an overabundance of info in the world and most barely know how to approach it, let alone utilize it. That's not an excuse, to my mind, but the situation. I mean, I have to deal frequently with supposedly well-educated adults who can't work with a web browsing software - these same minds are going to understand all the nuances of safe sex? I wish.

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    Jul 02, 2008 4:43 PM GMT
    And to something muchmorethanmuscle said, I'm trying to avoid getting into the influence of religion on this all together. Do as I say, not as I do...and they all end up doing it and doing it WRONG. Hence....
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    Jul 02, 2008 4:50 PM GMT
    Is this really shocking or surprising to anyone? I mean really?
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    Jul 02, 2008 4:56 PM GMT
    Chizzad saidIs this really shocking or surprising to anyone? I mean really?


    I think for those of us who were around when everyone was dying, who lost friends, who volunteered to care for men who were abandoned and outcasts, YES, it is surprising.

    Taking a step backwards is unimaginable for those of us who remember how truly awful it was.
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    Jul 02, 2008 4:59 PM GMT
    And no one is carrying forward the horror that was/is HIV and AIDS to the newer generation(s). I often feel that many 'forces' - big pharma, government, Krazy Kristians - are working to conceal all that in the hopes that HIV will continue to spread. (I know that sounds conspiratorial, but c'mon, Reagan wouldn't even say "AIDS.")
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    Jul 02, 2008 4:59 PM GMT
    Yeah...stop barebacking. Shocker!
  • kinetic

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    Jul 02, 2008 5:08 PM GMT
    Maybe not shocking but really sad to realize.

    I definitely agree with others that people in unhealthy states of mind do careless things.
    Maybe if there was more an effort to provide better mental health services among among young people and/or campaigns for it, people would be making more sound decisions.
    Just a thought, but if there were more public service ads/announcements about the decisions people make when they are in certain states of mind (depressed, drunk, high) that show the negative consequences of poor decision making (STDs, death, etc) maybe more people would think twice. Wow, that was a run-on sentence!!

    I know in the gay world I see posters here and there in clubs or at a clinic preaching about the dangers of meth or something similar, but on a larger scale I don't really see things like that. All that sticks w/ me on a national level is 'Be above weed' and shit like that.
    Who knows maybe in a year or so, (once we have a new president) our focuses on health and the war on drugs in this country will be different.
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    Jul 02, 2008 5:13 PM GMT
    Chizzad saidIs this really shocking or surprising to anyone? I mean really?


    Not really. I mean, it should be, but it isn't and THAT is what is sad about the whole situation.

    I've lost friends, and i have friend "living" with HIV, and i even know a few people who are sick and you just look at how they sometimes bounce back from horrendous circumstances likw... whoa.

    But working in the bars and seeing what goes on... no... it's not shocking... it's... icon_cry.gif
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    Jul 02, 2008 5:19 PM GMT
    I think one of the challenges for gay men and mental health is not just serious issues like clinical depression due to being gay, but run of the mill problems like loneliness.

    There are a lot of forum topics on RJ where guys are lamenting their inability to find a bf who they can love and be loved by. Topics like this always get my emotions going because I was in the same mind space for years. It is not easy finding a guy to settle down with, and many guys are uncomfortable talking to you when you are down about your personal life.

    In 1992 I went to Provincetown with my best friend, and after yet another night of going to the bars and sitting outside Spiritus watching guys cruise, I felt so depressed and lonely I was practically in tears by the time I got back to the hotel room. My friend asked me what was wrong and when I (for once) said I am LONELY, he didn't know what to say or how to comfort me.

    I personally feel that is one of the reasons I became infected with HIV. I went through a period of my life where I was lonely, sick of the mind games at bars, and started going to bathhouses (despite my dislike of casual sex), just to be touched by someone. Even though I practiced safer sex, I still got infected. And I think it was with a 25 year old I met at a bathhouse. Why do I think that? Because something was bothering him but he would not tell me. I suspect he had found out he was HIV+.

    So giving gay men all the information you can about safer sex practices is important, but preventing HIV is also about dealing with people as physical, emotional and spiritual beings.
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    Jul 02, 2008 5:24 PM GMT
    JBE60 saidI think one of the challenges for gay men and mental health is not just serious issues like clinical depression due to being gay, but run of the mill problems like loneliness.

    There are a lot of forum topics on RJ where guys are lamenting their inability to find a bf who they can love and be loved by. Topics like this always get my emotions going because I was in the same mind space for years. It is not easy finding a guy to settle down with, and many guys are uncomfortable talking to you when you are down about your personal life.

    In 1992 I went to Provincetown ... preventing HIV is also about dealing with people as physical, emotional and spiritual beings.


    Dude...jeez. icon_cry.gif But you're right. The absence of love, compassion, concern, coupled with the selfishness inherent in the sexual drive. Yikes.

    And to kinetic's points...where are the safe sex posters in bars and clubs? Where are the safe sex banners on gay sites? Ads for the latest bareback gang bang flick or the new hydro-douche (implication being you want all the shit out before you put an unwrapped dick up there) aren't really encouraging safe sex. Yes I know they're ads to support the site. To make money. Money off the foolishness and weakness of others who while THEY SHOULD know better, don't always.

    The absence of compassion.
  • MisterT

    Posts: 1272

    Jul 02, 2008 5:40 PM GMT
    By Roger PebodyDuring this time, a total of 214,379 people were newly diagnosed with HIV, and 46% of the diagnoses were in gay men and other MSM. There were statistically significant decreases in diagnoses for all transmission categories apart from gay men and other MSM. For example, there was a 4.4% annual decrease for heterosexuals, and a 9.5% annual decrease for injecting drug users.


    If 46% of the diagnoses were from gay men and other men who have sex with men, I'm curious where the other 54% of diagnoses came from, since they say that heterosexuals and drug injectors diagnoses were on the decrease. Since 46% is less than half, where's the rest of the info, talk about a big gaping hole.

    As far as HIV being on the rise, I think part of it is carelessness and a lot of younger people not seeing it as a death sentence, so bare backing has seen an increase. Mortality rates from HIV/AIDS may have dropped in the US, but it doesn't mean I want to try my luck with it.

    I still get tested, and only go BB when in a monogamous relationship after a certain amount of time, when I feel I trust my partner isn't messing around, and we've both been tested. No guarantee, but certainly makes me a lot more comfortable.
  • kinetic

    Posts: 1125

    Jul 02, 2008 5:41 PM GMT
    RunintheCity you are right on, the lack of compassion and concern and they way people can treat each other just sucks.
    Sometimes when it gets me down I watch this video. ^_^



    So what should we do to change all this??
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    Jul 02, 2008 5:56 PM GMT
    kinetic said
    So what should we do to change all this??


    I wish I knew.

    I try to be nice to people, to listen to them when I can, give good advice and use my own bad decisions in life to illustrate better options.

    But I'm always reminded about the lack of compassion...last night at our HRC Political subcommittee meeting, I had to bite my tongue when a couple of the guys - only one of the women of the two showed up last night - started talking about not liking trans issues being part of the larger LGBT rights issues. I tried to launch into a little smart talk on gender identity/gender expression/sexual orientation links...but it fell to deaf ears. They were too 'disgusted' by the trans to even realize that that disgust is the same thing a lot of straight people feel about them.

    Oy, I'm babbling off topic again.

    I lecture guys who approach me online or in real life about having unsafe sex. Sometimes gently, sometimes rudely. Depends on the person and the situation. I talk about my uncle a lot, who died of ARC in 1992. I talk about his last few years, his mistakes, etc. Not to instill fear, but to engage people to think about the quality of life they want to have, which is tough in a society that has become accustomed to 'give me a pill and make me feel better,' even if one isn't really made well.
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    Jul 02, 2008 5:59 PM GMT
    Kinetic, I think sites like RJ are helping to change it a little bit. My talking to young gay men who are willing to listen has changed it a tiny bit. If there are enough of us that are willing to extend ourselves then maybe we can make a difference. Will it result in fewer HIV infections among gay men? Maybe not, but the increase might not be as high as it otherwise would have been.

    One of the things that I wish the gay "community" had more of was a mentoring program. I was lucky that I met some older gay men that were willing to befriend me and not ask for sexual favours in return. I know some young guys trust older men enough to ask for guidance, but many are reluctant because of the stereotype of the dirty old man. That is sad. If you only hang out with other guys your own age then it is like the blind leading the blind at times, and some guys get burned.

    My apologies for such an intense and serious post earlier, this topic brings back some bad memories. After I became diagnosed I started piecing together some of the factors that led up to my infection.