By Matt Simonette

Staff writer

The AIDS Foundation of Chicago kicked off its HIV prevention conference last week with “Gay, Sexy and Healthy,” a discussion by Gregorio Millet, a behavioral scientist with the federal Centers for Disease Control and Prevention’s Division of HIV/AIDS Prevention, and Ronald Stall, chair of the Department of Behavioral and Community Health Sciences of the University of Pittsburgh.

At the Oct. 10 presentation, Millet and Stall discussed current HIV infection rates and the impact prevention efforts seem to be having on gay and bisexual men.

Millet said the epidemic has been decreasing in numbers among high-risk heterosexuals and injection drug users, but is still increasing among gay and bisexual men.

“When you take a look at the HIV/AIDS cases between 2001 to 2005, among men, by race and ethnicity, it’s very clear…men who have sex with men are most impacted by HIV and AIDS,” he said.

He added that Latino and African American gay and bisexual men comprise the largest proportion of HIV/AIDS diagnoses in 2005 and that African American and Latino men proportionally become infected at younger ages than their white counterparts.

Millet said the news was especially alarming for African American gay and bisexual men—between the ages of 15-22, the HIV prevalence rate is 14 percent, and between the ages of 23-29, it is 32 percent.

“By the time black MSM get to a median age of 32…nearly half the community is HIV positive,” he added. “It’s the only community in the United States where the prevalence rates are as bad as what you’d find in Sub-Saharan Africa.”

Millet said that data conversely showed that African American gay and bisexual men are less likely to use crystal meth, amyl nitrate or other drugs commonly associated with HIV infection. They are also less likely to report unsafe sex practices leading to infection. But African American gay and bisexual men are nine times more likely to be HIV-positive than their white or Latino peers. Latino gay and bisexual men are twice as likely to be HIV positive than whites.

Millet said a number of factors probably account for the converse relationship, but most are traceable to social networks. He said, for example, that people in communities with high levels of machismo are statistically more likely to become infected.

Stall’s discussion partially focused on how current rates on HIV infection will evolve over time.

“We’re trying to figure out if things are getting worse, not if things are just going to stay the same,” he said.

Stall set up his model to use very conservative numbers, but nevertheless produced alarming results.

“If you assume a rate of 1.9 percent a year, and you start with guys (who are) age 20…by age 30, about a quarter of the guys are going to be positive, by age 40 almost 40 percent and by age 50 almost half,” he said. “What this says is that at this 2-percent rate we’re looking at ongoing rates of catastrophic infection for generation after generation of gay men.”

“This is probably a phenomenon that is unfolding around us right now,” Stall added.

He said a study was published in the Journal of American Medical Association in 1987 with similar results.

“In other words, we’ve known for 20 years that this is the case, and we haven’t been able to put a dent in it,” he said.

HIV prevention efforts, according to Stall, have reduced risks by about 25 percent. He described planning and discussion that needs to take place in order for those efforts to be effective.

“It’s not about if you should put on a condom. It’s about how you put on a condom when the guy you’re with doesn’t want to wear one. How do you get your partner to wear a condom when you’re the guy who’s bottoming?” Stall said. “Bottom line, HIV preventions can work if they are well-funded and well-fielded. We know how to stop (infection), but we’re not doing it.”

Stall said researchers should look into placing HIV prevention into larger contexts, accounting for sex practices where the risks are still unclear, for example, or considering general attitudes towards specific safe sex practices. He also said they need to look at correlations between unsafe sex practices and other issues such as depression, drug abuse or domestic violence.

“These intertwining epidemics…are driving HIV risk and HIV infection itself,” Stall said.