In recent years, HIV/AIDS has receded from the headlines as the rate of infection in the United States has fallen and effective medications have turned the disease from a death sentence into a manageable condition.
But the epidemic has continued to smolder in many places, costing lives and resources and causing preventable suffering.
Milwaukee is one of several places where the disease continues to take a toll on young African-American men who engage in same-sex relations.
In mid-March, the nation was riveted by news that a “cluster” of 127 Milwaukeeans had contracted HIV and/or syphilis. But locals who work with organizations and agencies that provide HIV/AIDS services were not surprised.
“This has been going on in Milwaukee for a long time,” said Gerry Coons, president and CEO of Diverse & Resilient. “Milwaukee has really high rates of STDs among teenagers. While this is shocking, it’s about trends that we’ve actually seen.”
In fact, Milwaukee has one of the nation’s highest sexually transmitted infection rates. The city ranks first in the rate of gonorrhea and fourth in chlamydia rates. And Milwaukee has one of the nation’s highest rates of HIV among men of color under 25 years old.
STI rates correlate strongly with HIV infections. Both indicate engagement in unsafe sexual practices, and syphilis sores provide an easy entry for HIV.
Instead of feeling surprised by the “cluster” report, Coons felt empowered that so many people showed up for a March 13 news conference at City Hall announcing the findings.
“The news conference was really remarkable, and it was really wonderful seeing all these organizations get together,” he said. “My takeaway is that it was a call for action.”
Michael Gifford, president of AIDS Research Center of Wisconsin, had a similar response, saying the report calls for renewed efforts.
“This report tells us we have to do more,” he said. “What we’re doing right now is not enough.”
Some initial media accounts about Milwaukee’s cluster of HIV and STI cases misinterpreted the data.
In epidemiological jargon, a “cluster” refers to people closely grouped in time and place who have the same health-related condition. The 127 people in the Milwaukee cluster had contracted HIV and/or syphilis from another person in the group.
The statistic is not limited to a specific period of time, and it’s not static. The number will probably grow, Gifford said, as more diagnosed cases are traced back to members of the group.
In fact, the number of people who already are part of the group is probably larger than 127. Some people are unwilling to report all of their sexual contacts, and others are afraid to get tested, due to fear, shame, culture and denial of their sexual orientation.
Infected individuals who are unaware of their HIV status pose the most danger to the community and the most persistent challenge to health professionals.
Many people in the Milwaukee cluster are young. A dozen of them are high school students, which isn’t unusual considering STIs among people between 15 and 24 have been steadily climbing in Milwaukee.
Melissa Ugland, a public health consultant, has been quoted as saying half of all sexually active Milwaukeeans are diagnosed with an STI before they reach the age of 25.
Realities of teen sex
“We’ve got to get beyond this idea that 16- to 18-year-olds aren’t having sex,” Gifford said. Statistics show that 40 to 50 percent of Wisconsin teenagers are sexually active.
It’s not easy in Wisconsin to overcome the denial of teen sex, which is ensconced in the highest levels of state government — and on the national level.
Scott Walker in 2012 signed a law requiring schools to promote abstinence as the only reliable way to prevent STIs and pregnancies. Young people in the state are not allowed to purchase condoms, and they must ask teachers and school health providers for sexual-health information.
At the federal level, the Trump administration is working to restrict Title X funding for family planning and sexual-health services to organizations that focus on abstinence.
To further complicate matters, HIV/AIDS funding that Milwaukee used to receive from the U.S. Centers for Disease Control has been reallocated to the rural South, due to growing needs there.
Even without the help of GOP-controlled government, a number of programs targeting minority youth in Milwaukee are flourishing.
Diverse & Resilient provides condoms to Milwaukee schools, taking advantage of the fact that condoms can be given free of charge to students who request them from MPS nursing staff.
“Kids can go to a nurse in any high school and request a condom, and they can get three,” Coons said. “The nurse will also give them instruction.”
D & R also has a program called “Healthy Youth,” which takes experts into schools to give presentations about teen sexuality and reproductive health. The program includes school assemblies and the training of youth counselors who can provide accurate information to their peers.
“We’re welcome in many high schools,” Coons said.
D & R also reaches out to youth with creative programs in conjunction with other organizations, such as the Boys & Girls Clubs of America.
Other groups have a similar mission. At the March 13 news conference, reporters were told that the Black Health Coalition is working with youth on a music event where kids will be offered testing and receive a premium for participating — a $10 gift card to McDonald’s.
On another front in the battle, ARCW has a social media and advertising campaign promoting awareness of the benefits of PrEP, which stands for pre-exposure prophylaxis (ads appear regularly in this publication). By taking a single pill each day, sexually active people are able to prevent infection, even if they fail to wear a condom.
A vigorous nationwide campaign to promote the strategy also is underway by Gilead, the company that makes the pill, whose brand name is Truvada (ads for the pill regularly appear in Wisconsin Gazette).
Theoretically, the HIV/AIDS pandemic could be vanquished. To accomplish that, a sizable number of uninfected individuals would have to be on PrEP, and already-infected patients would have to be receiving treatment that lowered their viral load to a point at which they’re no longer able to infect others.
But despite the aggressive campaigns to achieve that golden goal, only 77,000 people nationally are on PrEP as of 2016. In order to begin seeing significant value from the strategy, about 1 million sexually active people would have to be taking the medicine regularly.
What’s responsible for the resistance to PrEP? Gifford compares it to the difficulty of getting people to change bad habits.
“What does it take to have somebody to stop smoking or drinking?” he asked. “You just have to keep going, you have to continue the hard work.
“We can’t give up. We’ve got to keep trying and we’ve got to create new ways.”