Kenyon Farrow

New infections in Men

The US Conference on AIDS has begun in Fort Lauderdale, unfortunately I couldn’t afford to go, but just as well because I am going to see my southern friends at Southerners on New Ground’s 15th Anniversary. But given the CDC’s recent release of the of the subpopulation data of the new infections for 2006 (called incidence), I thought I’d share some of the data with you. If you click on the link above you’ll find a lot of other tools to help you understand the data including a fact sheet, a Q&A, and a podcast:

CDC’s August 2008 data showed that gay and bisexual men, referred to in CDC’s surveillance systems as men who have sex with men (MSM)², represented the majority of new infections in 2006 (53%, 28,720).

Now, in the more detailed analysis, CDC further examine new infections among whites, blacks, and

New Infections by Race

Hispanics/Latinos. The findings reveal that the ages at which MSM become infected vary by race:

• Young Black MSM: Among MSM overall, there were more new HIV infections in young black MSM (aged 13–29) than any other age/racial group of MSM. The number of new infections among young, black gay and bisexual men was roughly twice that of whites and of Hispanics/Latinos (5,220 infections in blacks vs. 3,330 among whites and 2,300 among Hispanics/Latinos).
• White MSM in their 30s and 40s: Among MSM in the analysis, white MSM accounted for close to half (46%) of HIV incidence in 2006. Most new infections among white MSM occurred in those aged 30–39 (4,670), followed by those aged 40–49 (3,740).
• Hispanic/Latino MSM: Among Hispanic/Latino MSM, most new infections occurred in the youngest (13-29) age group (2,300), though a substantial number of new HIV infections were among those aged 30–39 (1,870)

Walt Senterfitt, in this month’s HHS Watch (a publication of Community HIV/AIDS Mobilization Project (CHAMP)), writes about what the new data means for gay men in his piece called Where’s Our National Campaign Against Homophobia?

There has also been a consistent tendency over at least the last 15 years within much of the AIDS community itself – and certainly by the media and other institutions of civil society enlisted in the struggle against HIV/AIDS – to “de-gay-ify” HIV/AIDS. For example, messages stress that HIV is an “equal opportunity virus” and that anyone can be at risk, emphasize children and women at risk, and stress that HIV/AIDS is, in its majority, now an epidemic in communities of color (while simultaneously neglecting to stress that those most disproportionately impacted in communities of color are gay and bisexual men).

This direction in messaging was in part well intended, to combat the widespread assumption that if you are not a white gay man, AIDS is not your problem and you are not at risk. It was also meant to get beyond the intensified stigmatization of gay men and focus on the behaviors that put one at risk. This approach has been embraced by many HIV positive and other gay men who fear the added stigmatization of having “gay” remain widely associated with “HIV/AIDS” in public consciousness. Even from the start though, this approach was a capitulation to rather than a confrontation of societal stigma and prejudice against gay people, against transgender people, against all people who are sexually “non-normative.” And it didn’t work. Homophobia still is rampant, dollars have gone elsewhere, and, alone among the exposure categories, HIV infection rates among gay men are rising.

Here’s video from a panel CHAMP sponsored (that I moderated) back in February on the issue:

From AIDS2008.com

I just attended the press conference preceding the opening session of the IAC, which featured many of tonight’s speakers who will give (hopefully) rousing speeches about the state of AIDS, the movement, our successes and where we need to be going. The speakers at the conference gave the 2-minute version of their speech for tonight, and then took questions fromt the reporters in the audience.

Just when I was about to doze off or die of boredom, Peter Piot, Executive Director of UNAIDS was giving his final thoughts at the end of the Q&A, and he began to talk about what should be done globally. He said that “It is important for timely information to be released to the public. It’s like the CDC deciding to release this incidence data so late. I don’t understand why it took so long. They could have released it in an MMWR.”

CHAMP has been following the incidence story since last year when CHAMP executed the Prevention Justice Mobilization around the National HIV Prevention Conference. And I remember CHAMP and PJM allies catching a lot of flack for suggesting in the press that the CDC could have released the numbers sooner, and with their own internal process. It’s good to know we weren’t the only ones who thought this seemed to take much longer than was necessary.

In fact, when The Washington Blade broke the story on November 14th, 2007,they said in the lede that the CDC was “mulling over” when to release the data. They only talk about a peer-review process in their response further down in the article.

“The U.S. Centers for Disease Control & Prevention is mulling over when to release alarming new statistics showing that as many as 50 percent more people are being infected with HIV each year in the United States than originally reported by the government.

According to AIDS advocacy groups familiar with the CDC, middle level officials at the disease prevention agency have quietly confided in colleagues in professional and scientific circles that the number of new HIV infections now appears to be as high as 58,000 to 63,000 cases in the most recent 12-month period.”

If you want to watch the Opening Session live, Kaiser Family Foundation is webcasting it at 8pm EST.

If you’ve taken an HIV test, and have taken the 20 minute tests, you know there are two kinds: The finger prick test, and then the cheek-swab test. Well, NYC Department of Health has recently suspended use of the latter test because of a 3 year history of false-positives, according to the Centers for Disease Control and Prevention’s latest MMWR (Morbidity & Mortality Weekly Report). They write:

The cause for the episodic increases in false-positive oral fluid tests has not yet been determined. NYC DOHMH has again suspended the use of oral fluid testing in STD clinics, and finger-stick whole-blood testing is the only rapid HIV test being used in this setting. These findings underscore the importance of confirming all reactive HIV tests, both from oral fluid and whole-blood specimens. In addition, the results suggest that the NYC DOHMH strategy of following up reactive oral fluid test results with an immediate finger-stick whole-blood test reduced the number of apparent false-positive oral fluid test results and might be a useful strategy in other settings and locations.

Testing with blood is simply more reliable, but the CDC goes on to explain why they still recommend the use of the saliva based HIV test:

CDC continues to encourage the use of rapid HIV tests because they increase the number of persons who are tested and who receive their test results. Six rapid HIV tests have been approved by FDA since 2002 (10). The New York City data indicate that repeating a rapid test on finger-stick whole blood after receiving a reactive oral fluid test result allows clinic counselors to provide more accurate test-result information to patients while minimizing the number of finger-stick tests that must be performed. Regardless, confirmatory testing is required to confirm both oral fluid and whole-blood reactive rapid HIV tests. Before testing, all patients should be informed that reactive rapid HIV test results are preliminary and require confirmation. In general, testing with blood or serum specimens is more accurate than testing with oral fluid and is preferred when feasible, especially in settings where blood specimens already are obtained routinely.

Overall, oral fluid rapid tests have performed well and make HIV testing possible in many venues where performing phlebotomy or finger sticks is impractical for screening. However, users should be aware of the unexplained variability in the rate of false-positive test results. CDC will continue to work with FDA and the manufacturer to investigate the causes and extent of increases in false-positive oral fluid tests, monitor the performance of oral fluid and other rapid tests to ensure that they continue to perform as expected in testing programs, and investigate other combination test strategies to minimize false-positive test results.

I hate giving blood, but if you can help it, get the finger-prick test. It’s really not painful and seems to be more reliable. Getting blood drawn is probably still the best way, but waiting for days on end for lab results is nerve wrecking, so I only do those when I get an annual physical and blood work done with my doctor. Even if you get a positive result any of the rapid tests, they will always do a blood draw to confirm the results, which is why they know the saliva test was giving a higher rate of false positives.

(originally published on www.preventionjustice.org)

Today the New York Times published a batch of letters responding to their editorial on rising HIV rates in young gay men. Since they didn’t publish my letter written as CHAMP staff, I thought I’d do it here (This is why we love the Internet!):

The January 14th editorial, “HIV Rises in Young Gay Men,” spent a lot of energy blaming 19-year olds, and ignored core issues that hamper effective prevention efforts.

A recent Journal of Adolescent Health study counted youth homelessness as a major factor in HIV risk. The New York City Council commissioned a 2007 report showing that one-third of all homeless youth in NYC were gay.

Congress continues to bankroll abstinence-only education programs in spite of the proven increase risk behavior they cause. Though the HIV epidemic grows worse in black and Latino communities, the Centers for Disease Control & Prevention (CDC) budget has remained stagnant for a decade.

We still have no national HIV prevention plan, 27 years into the epidemic.

Young gay men are not to blame for the profound failure of government to provide comprehensive HIV prevention—nor for the media’s continued ignorance of the root causes of HIV.