CDC Analysis Hikes Number of Black HIV Infections

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The National HIV Prevention Conference

By Keith Green

ATLANTA, Ga. — Nearly half of Black homosexual and bisexual men tested positive for HIV in a first-of-its-kind federal study. These men are among the U.S. Centers for Disease Control and Prevention’s newly-revised estimate of 1.1 million people living with HIV, of which 47 percent are African American.

Dr. Alan Greenberg, acting deputy director of the CDC’s Division of HIV/AIDS Prevention, presented the data at the 2005 National HIV Prevention Conference held in Atlanta yesterday.

The CDC developed the numbers through its first use of a 2004-2005 comprehensive national surveillance system. The analysis monitors the entire pathway of HIV, from high risk behaviors to HIV incidence and prevalence, to HIV illness, AIDS and death.

This data emerges in the midst of a dispute between AIDS activists and the Bush Administration over the federal HIV prevention budget. Congress has cut the CDC’s HIV and STD prevention budget each year since 2004, and the White House proposed another $4 million cut for the coming fiscal year. Congress has just begun deliberations over that budget.

In the study of homosexual and bisexual men, Greenberg announced that Black men were more than twice as likely to be infected with HIV as other racial and ethnic groups, and were much less likely to be aware of their HIV infection. The CDC surveyed 1,767 men over the age 18 at local bars, bookstores and other locations frequented by gay and bisexual men in Baltimore, Los Angeles, Miami, New York and San Francisco.

Of the participants surveyed, 46 percent of Black men, compared to 21 percent of white men and 17 percent of Hispanic men, were found to be HIV positive. Among those infected, 68 percent of Black men, 48 percent of Hispanic men and 18 percent of white men were unaware of their infection before participating in the study.

This latest study follows a much-discussed series of studies conducted in several cities throughout the 1990’s that estimated as many as one-third of Black gay and bisexual men under the age of 30 were HIV positive. It should be noted that these studies were considered controversial by many in the Black gay community because participants were recruited from HIV/STD clinics, bars and other “high risk” venues that may have skewed the findings.

The CDC typically uses its annual prevention conference to release new epidemiology of this sort, and in recent years the agency has found consistent increases in infection rates among both African Americans and men who have sex with men. These studies have renewed an old debate within the public health sector over whether HIV prevention actually works. CDC officials highlighted studies showing the efficacy of several community-based interventions designed to reduce the incidence of HIV infection in communities of color.

Dr. Taleria R. Fuller, an ORISE (Oak Ridge Institute for Science and Education) fellow at the CDC, noted the recent decline in new HIV infections amongst African American women. Dr. Fuller elaborated on current efforts that are underway to expand the use of four proven HIV-prevention programs for African American women, which the CDC officials said they hope will have an even greater impact on this high-risk population.

The interventions include programs for both HIV-negative and HIV-positive African American women. They focus on increasing women’s communications skills to refuse sex and negotiate condom use, enhancing their skills in correctly using condoms and building the self-worth and confidence needed for women to take control of their health. One intervention also enlists African American businesses in media campaigns that seek to alter community norms about safer sex.

Gary English, executive director of Brooklyn, N.Y.-based People of Color in Crisis, presented a group level intervention for Black gay men known as “Many Men, Many Voices (3MV).” 3MV is comprised of six weekly two- or three-hour facilitated discussion sessions for up to 25 men, which include HIV prevention information, role playing, group problem solving and discussions that address the attitudes and beliefs that impact African American men who have sex with men and their sexual practices.

Since 2003, the CDC has made it clear that it believes that the answers to effective prevention lie in targeting people who are already living with the virus. That has been an extremely controversial idea within the AIDS community.

Keith Folger, director of programs for the National Association of People with AIDS (NAPWA), argues that there is no scientific way to prove that an agency doing “Prevention with Positives” will be able to get those who are at highest risk for spreading HIV in for a counseling session. “I hate to say this,” says Folger, “but the majority of agencies doing ‘Prevention with Positives’ have no business doing it. For the most part, there are many well-meaning public health people involved who want to do prevention campaigns with positive people but never asked those people what would work for them. The biggest concern is that positive people have not been involved with the process and, unfortunately, they still aren’t.”

Colin Robinson, executive director of the New York State Black Gay Network, argues that much of this debate misses the bigger picture. “Many of the things that we label as prevention are things that we should be doing for our community regardless of the presence of HIV. HIV is a critical issue but there are so many other critical issues that we need to work on as a community,” says Robinson. “We must create spaces where black gay men can heal and then promote general community wholeness and wellness. There are lots of things that we can do to change the climate of HIV prevention. If you got rid of homophobia and unemployment and homelessness, you would see a change in the numbers.”

Keith Green is a BlackAIDS.org contributing writer and communications coordinator for Test Positive Aware Network/Postively Aware magazine.

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