Federal health officials presented findings March 2 from an investigation into Milwaukee’s rising HIV-infection rate among young African-American men who have sex with other men.
Representatives of local HIV/AIDS service organizations who attended the presentation at the Wisconsin African American Women’s Center said they will use the information to try heading off a potential new wave of the epidemic in the city.
That task will be challenging, they said.
Investigators from the U.S. Centers for Disease Control and Prevention first looked into whether the rising rate of reported infections represented an actual increase in new cases or was the result of an aggressive HIV-testing program that brought to light previously undiagnosed cases. They concluded that the increase was real, said the CDC’s William Jeffries.
The CDC found evidence suggesting the increase was fueled by a preceding rise in syphilis cases. The presence of syphilis makes it easier to spread and acquire HIV, due to abrasions on the genitals.
The investigation also yielded data surrounding possible social and environmental factors behind the increase in transmission. The CDC offered a glimpse of these factors, which will be detailed in a report published later this month.
While the HIV transmission rate is increasing nationally among young MSMs as a whole, young African-American men are disproportionately affected.
In Milwaukee, the rate for this group tripled between 2001 and 2008, compared with a 143 percent increase among young non-black males. Meanwhile, the transmission rate for other demographic groups leveled off or fell during that period.
Differences that could explain the disparity appear to be more social than behavioral. The CDC’s Milwaukee investigation found that behavioral risk factors – such as having sex without a condom – were similar for both young white and black MSMs.
“Black MSMs often had fewer risk behaviors than their white counterparts, so risk behaviors don’t explain the increase,” said a CDC investigator.
On the other hand, black MSMs face greater stigmatization in their community. For instance, half of the young African-American MSMs said they thought sex with men was a sin, and 60 percent said they sometimes wished they weren’t attracted to men. Only 12 percent said they could be open about their sexual orientation in their churches.
This sort of marginalization leads to higher rates of HIV, said Dr. Andrew Petroll, an assistant professor at the Medical College of Wisconsin who specializes in HIV.
“If people are highly stigmatized, they’re not going to discuss HIV with anybody,” he said. Thus, stigmatization can result in failing to ask or disclose HIV status with a sex partner.
Another difference between the two groups is the higher rate of HIV among Milwaukee’s African-American community as a whole.
“The prevalence rate (of HIV among black MSMs) is somewhere between 28 and 41 percent,” Petroll said. “That’s huge. That could be almost half of all black MSMs. Of course, that only begets more infection, because if you’re having sex with that population, then the chances of being exposed to HIV are really high.”
Of the young black MSMs interviewed by the CDC, 42 percent reported having sex exclusively with other African Americans. Fifty-five percent said they’d had sex with men 10 or more years older than they were within a year of their HIV diagnoses, which also increases the risk of exposure: Older men are more likely to be infected.
While factors such as these are illuminating from an epidemiologic standpoint, they have little practical value for HIV/AIDS service providers.
“These are big factors that influence what’s happening, but there is nothing public health can do about (issues such as) homophobia in the community,” said Timothy Pilcher, of the Wisconsin Department of Health Services HIV/AIDS Program.
Still, service providers said they must find ways to work with and around these issues.
Tim Medley, of the AIDS Resource Center of Wisconsin, said one important way to address the problem overall is to establish a greater presence of HIV/AIDS organizations within African-American areas of the community and to enlist the support of black churches and other grassroots institutions.
“There are two keys to making a business successful – that’s marketing and location,” Medley said. “We need to have better marketing and be in better locations. The people we’re trying to reach are not coming to us. We have to go to them.”
Petroll said although the increasing rate of new HIV cases among young black MSMs is alarming, the absolute numbers “are still pretty small – under 30 per year.” That means providers still have an opportunity to curb the trend.
But, he warned, “Numerically, as the proportion goes up, there’s a tipping point in every epidemic where if you have the same level of activities, it’s going to feed itself.”