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High HIV Rates in NYC & Among Black & MSM/W College Students; Men On The 'Down Low'
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Reported by Jules Levin
Nearly 4% of New York City Men In Their 40s Are Infected With HIV
Wall Street Journal - February 11, 2004
Marilyn Chase, Staff Reporter of The Wall Street Journal
SAN FRANCISCO -- Nearly 4% of New York City men aged 40 to 49, and almost 3% of all adult men residing in Manhattan, are infected with HIV or have full-blown AIDS, according to new data released by the New York City Department of Health and Mental Hygiene.
Harold Jaffe, who heads HIV prevention programs at the U.S. Centers for Disease Control and Prevention in Atlanta, called the numbers "quite overwhelming." The research was presented at the 11th Annual Retrovirus Conference here.
Overall, about 75,000 people, or about 1% of New York City residents, have been diagnosed and are living with HIV infection. However, that figure, which dates to 2001, doesn't include people who haven't been tested. CDC has said about one in four infected people are unaware they have the human immunodeficiency virus.
Previously, New York collected data only on people diagnosed with full-blown AIDS. But after June of 2000, the state mandated tracking of newly diagnosed cases of HIV infection as a way to envision the full spectrum of HIV disease, said Dennis Nash, a researcher with the New York City health department.
In 2001, the most recent year for which statistics are available, 6,662 New York City residents were newly diagnosed with HIV, of whom 27% already had AIDS, Dr. Nash said. Blacks faced five times greater risk, and Hispanics 2.5 times greater risk than whites.
Nationwide, about 900,000 Americans are living with HIV and AIDS, according to CDC researcher Irene Hall. Among targets of the virus, 65% are men and 35% are women, though women are growing as a risk group. Blacks and Hispanics are disproportionately affected. The lone bright spot was a slight decrease of 2.6% in annual cases diagnosed among black women. CDC cautioned that its data are extrapolated from cases diagnosed in 29 states representing 39% of AIDS cases nationwide.
One risk group causing considerable concern is black men with HIV described as "living on the down low." These are men who identify themselves as heterosexual, but who also have sex with men, and don't disclose that fact to their female partners.
CDC researcher Greg Millett said concern is heightened by the fact that black women face substantial risk of HIV through heterosexual relations.
Several physicians said the problem is one they face daily. Michael Hickson, a physician at Housing Works in New York's West Village, said that of approximately 3,000 men he has treated since 1990, about 75% "do not identify themselves as gay."
Another huge risk group not yet adequately reached by HIV testing are people in jails and prisons. About two million Americans are incarcerated, and HIV prevalence is about 17 times that of the general U.S. population, said Joe Bick, a researcher with the California Department of Corrections.
"Most correctional systems don't routinely offer HIV testing, many prisoners don't know their status, and many engage in high-risk activities," he said.
HIV Upsurge Seen in Black Male Students
Associated Press - February 10, 2004
Daniel Q. Haney, AP Medical Editor
SAN FRANCISCO - A sudden, surprising increase in HIV infections has been discovered among male black college students in North Carolina, and officials fear the same is probably happening across the South.
The upsurge is driven by young men having risky sexual encounters with other men. Typically they do not consider themselves to be gay or bisexual and may even have girlfriends, as well.
"It's a public health emergency. I don't know any other way to put it," said Dr. Peter Leone, HIV medical director at the state Health Department.
The increase was first noticed in late 2002, and officials now believe in began in mid-2001 and is still continuing.
The high rate of AIDS infection among U.S. blacks has been one of the most striking difficulties of AIDS prevention.
Blacks are 11 times more likely than white Americans to get AIDS. Even though they make up 12 percent of the population, they account for 39 percent of AIDS cases and 54 percent of new HIV infections.
Among black men, like whites, the leading cause of infection is sex with other men. Experts have long lamented the high rate of risky sex among gay black men. Poverty is often listed as a strong contributor, so the new findings among relatively well-off college students were unexpected.
"We are very concerned about it," said Dr. Ron Valdiserri, deputy HIV chief at the federal Centers for Disease Control and Prevention. "Most Americans would not think about college students as a high-risk group."
Indeed, a CDC study on 10 campuses in the 1990s found a very low infection rate.
The North Carolina data were presented Tuesday in San Francisco at the 11th Annual Retrovirus Conference.
Also at the conference, officials presented newly gathered data on HIV infections in New York City. Overall, 1 percent of the city's population carries the virus, including 4 percent of men in their 40s.
Nationwide, an estimated 900,000 people have HIV. The CDC says that in recent years infections have risen somewhat among gay men of all races and fallen slightly among women.
The North Carolina researchers found 84 newly infected male college students over the past three years, 73 of them black. Only one black student admitted using injected drugs, and just two said they had sex only with women. The rest apparently were infected through sex with men.
"The concern is this is our best and brightest within the minority population who are coming down with a lifelong and potentially lethal infection," Leone said.
The researchers said they suspect a similar upsurge may be occurring among black male college students across the South.
"We have no reason to think this is limited to North Carolina," said the CDC's Dr. Lisa Fitzpatrick.
Leone said HIV appears to have been recently introduced among black college students. People are much more likely than usual to pass on the virus through sex during their first weeks of infection, and this might explain why so many students have caught it.
When the students were questioned, three-quarters said they thought they were not at high risk of HIV, despite frequent anal intercourse without condoms with different male partners.
"Part of it is message fatigue," Leone said. "They've grown up hearing this thing. It's old stuff to them. They just ignore it."
Another possible factor may be an especially intense stigma against HIV and homosexuality in the South, making the students less likely to discuss their sexual identity or consider themselves gay.
"We have a very marginalized group," he said. "They don't identify with the messages targeted to gay white men."
Men on the 'Down Low': More Questions than Answers
Greg Millett from the CDC presented an oral talk on this topic. Men "on the 'down low,'" a subgroup of bisexually active black men has become a focal point of interest in the HIV prevention community in the past several years. One of the primary reasons for this is the question of whether men on the down low function as an HIV transmission bridge to the heterosexual population.
There are several popular characterizations of men on the down low, some of which may have a basis in truth, while others have no empirical foundation. These include: hypermasculinity that masks any suspicion of homosexual behavior; a man with a steady female partner who will sleep with, but not date, other men; a disdain for being labeled "gay" or "bisexual" and a distancing from the primarily white mainstream gay subculture; someone who has unprotected sex with both female and male sex partners; and someone who has either not been tested for HIV, or who has been tested but does not disclose his HIV status to his sexual partners.
While men on the down low are an emerging topic of public discourse and speculation, no scientific data have been published on this specific population. However, several studies of heterosexually or bisexually identified black men who have sex with men (MSM) indicate that there is a complex interplay of sexual identity, orientation, and behavior that merits further study.
Both qualitative and quantitative studies should be undertaken specifically to examine the HIV behavioral risks of men of color on the down low. Future research should standardize what characterizes the down low, examine the sexual networks of men on the down low, and determine the role of such HIV-positive men in ongoing HIV transmission.
Transmission on Campus: Insights from Tracking HIV Incidence in North Carolina
Peter Leone and colleagues from the University of North Carolina at Chapel Hill reported results from this study at the Retrovirus Conference.
Surveillance for HIV has been limited to monitoring HIV seroprevalence populations. This method has limited ability to detect increasing incidence or clustering within specific risk groups or geographic areas. Beginning in November 2002, North Carolina's Screening and Tracing Active Transmission (STAT) Program added HIV RNA screening to all public voluntary counseling and testing for detection of HIV antibody-negative acute HIV infections. Of 5 acute infections detected in less than 3 months, 2 were in male students attending different colleges in the same city.
To investigate HIV infection among college attendees in North Carolina we reviewed state HIV surveillance records for all new diagnoses of HIV infection in males younger than 30 years old living in 34 counties throughout North Carolina. Information was characterized about all patients diagnosed with HIV infection between January 1, 2001 and May 1, 2003 and their contacts. A cross sectional comparison of risk behavior and demographic information of newly diagnosed HIV-infected male college enrollees (college males) to newly diagnosed HIV-infected males who were not currently enrolled in college (non-college males) was conducted.
Of 423 newly reported HIV+ men in North Carolina, 56 (13%) attended 28 colleges. Of the 56 newly reported HIV+ students (17 with documented seroconversion while in college), 88% were African American and 91% were men who have sex with men (MSM) or men or who have sex with men and women (MSM/W). Compared with other newly reported HIV+ individuals, college men were 3 times more likely to be actively bisexual, 2 times more likely to meet sex partners at gay clubs, or 4 times more likely to meet partners over the Internet, or 5 times more likely to use ecstasy/club drugs. Compared with other newly reported HIV+ individuals, college men were less likely to report only women as sex partners or to have exchanged sex for drugs or money.
By linking North Carolina's enhanced HIV-screening program with focused epidemiologic investigation, we detected and rapidly described an epidemic in college students primarily involving African American MSM and MSM/W. Active monitoring of HIV transmission, based on real-time identification of incidence of HIV infection, can illuminate emerging sexual networks with active HIV transmission providing focus for limited prevention resources.
High Rates of HIV In New York City Among Blacks & Hispanics; 3% of Men in Manhattan Have HIV
Nash and colleagues from the New York City Dept. of Health. and Mental Hygiene, HIV Surveillance and Epidemiology Program reported this newinformation at the Retrovirus Conference.
Prior to the implementation of regulations in June 2000 requiring New York health care providers and laboratories to report newly diagnosed HIV infection (non-AIDS), the HIV epidemic in New York City was monitored primarily through AIDS-case reporting. We report on the descriptive epidemiology of HIV/AIDS in New York City, including newly available population-based epidemiologic data on persons diagnosed with HIV (non-AIDS).
The study population included New York City residents diagnosed with HIV (non-AIDS) and AIDS during 2001, and persons living with HIV/AIDS (PLWHA) as of December 31, 2001. Rates of incident HIV diagnoses, prevalence of diagnosed PLWHA, and HIV-related and all-cause death rates among PLWHA were estimated using 2000 census data.
During 2001, 6478 persons in New York City (81/100,000) had incident HIV diagnoses. Among these, 4207 (65%) were male and 2271 (35%) were female. Rates of new HIV diagnoses were 5 times higher among non-Hispanic blacks and 2.5 times higher among Hispanics compared with non-Hispanic whites.
Among those new HIV diagnoses in 2001, 1770 (27%) persons were concurrently diagnosed with AIDS. As of December 31, 2001, 75,550 persons were diagnosed, reported, and known to be living with HIV/AIDS. This includes an estimated 3.9% of all males aged 40 to 49 years, 2.8% of males residing in Manhattan, and 2.3% of non-Hispanic black males. The age-adjusted, all-cause mortality rate among diagnosed PLWHA was 4.1 times higher than that of the general population of New York City in 2001. The population distribution of persons diagnosed with HIV in 2001 differs from that of PLWHA; specifically, a higher proportion of persons diagnosed in 2001 are female (35% versus 30%), non-Hispanic black (53% versus 44%), and aged 30 to 39 years (36% versus 29%) compared with PLWHA.
Newly available population-based surveillance data on persons diagnosed with HIV (non-AIDS) are an important adjunct to AIDS surveillance data. These data can be used to more accurately describe the current status of the HIV epidemic and to redirect HIV prevention efforts to better target persons at greatest risk of acquiring HIV infection. The large proportion of persons diagnosed concurrently with HIV and AIDS represent missed opportunities to reduce the transmission of HIV and the morbidity associated with HIV infection.
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