Local activists and health officials this week called for new approaches in HIV prevention following a city study that shows 14 percent of tested gay and bisexual men were HIV positive and 25 percent of black gay male participants were positive.
During a March 29 town hall meeting organized by the D.C. Center for the LGBT community to discuss the study’s findings, a number of AIDS activists noted the study included a sample of just 500 male respondents and did not cover the full demographics of all men who have sex with men.
But most activists speaking at the forum said the study reveals a number of important new findings showing high-risk behavior among those sampled and should not be dismissed because it’s less than perfect.
“Because we’ve determined that it is not a truly representative sample due to methodological limitations of the research, we can’t say that 14 percent of D.C.’s gay [and men who have sex with men] population is HIV positive,” said Daniel O’Neill, chair of the D.C. Center’s HIV Prevention Working Group.
“The reality: It’s probably far worse than 14 percent, as the data is both dated and under-represents some of the most at-risk subgroups.”
Dr. Shannon Hader, director of the D.C. HIV/AIDS Administration, opened the town hall meeting with a 45-minute presentation explaining the study’s findings and comparing it to existing city data on HIV prevalence among MSM, homosexuals and injection drug users, the three key groups used by researchers to measure the AIDS epidemic.
Hader and O’Neill were among five panelists who spoke at the town hall meeting and fielded questions from about 50 people who attended. The other panelists included Jose Gutierrez, a gay Latino activist affiliated with La Clinica Del Pueblo, a D.C. clinic that provides services to people with HIV/AIDS; Ken Pettigrew, director of programs for Us Helping Us, a local AIDS advocacy group that provides services for mostly black gay men; and Calvin Gerald, an organizer with the D.C. Center’s HIV Prevention Working Group.
Hader’s presentation followed the city’s release of the study’s findings March 26 at a news conference outside the Wanda Alston House for LGBT youth in Northeast D.C.
A first-of-its-kind look into the behavior of men who have sex with men in the District of Columbia, the study’s main finding was that 14 percent of those sampled were HIV positive. The figure represents an HIV-positive rate nearly five times higher than the 3 percent HIV infection rate among all adults and teens in the city, according to separate data gathered by the HIV/AIDS Administration.
The MSM study also found that black men who have sex with men, who participated in the study, had an HIV infection rate of 25 percent, compared to an 8 percent infection rate among white MSM who participated in the study.
“The numbers are staggering, but they are changeable,” says a report accompanying the study, which was conducted for the city by George Washington University’s School of Public Health and Health Services. “We are convinced that there are no foregone conclusions to getting HIV for men who have sex with men.”
Although gay and AIDS activists attending Monday’s town hall meeting said the high HIV positive rate findings among MSM did not surprise them, some expressed surprise and puzzlement over other findings. Among them are that men under age 30 “generally had safer sex behaviors” while men over 30 “got tested less and used condoms less and had more sex partners.”
The study also found that more than 40 percent of the men participating did not use a condom at the time of their last sexual encounter and more than one-third did not know the HIV status of their last sex partner.
Another development that came as a surprise to many activists, more than half of the study’s participants reported an annual income of $50,000 or greater, an education significantly higher than a high school degree, and were believed to be “socially connected” with the LGBT community.
Hader and some of the AIDS activists attending the town hall meeting said this suggests that many gay men who should be aware of the need for greater condom use and overall less risky behaviors were nevertheless continuing to engage in risky behavior.
In a finding said to highlight a seeming paradox among black MSM, the study found that black MSM of all ages used condoms more frequently than whites. Yet the infection rate for black MSM remains high, the report says, most likely because the number of infected black MSM is significantly higher than white MSM, increasing the chance of infection even if safer sex is practiced most of the time.
“Though white men were more likely to engage in higher risk sexual behavior, more men of color were impacted by HIV,” says the report.
The report also notes that, “Contrary to some perceptions, younger men generally had safer sex behaviors, while older men got tested less and used condoms less and had more sex partners.”
The study found that about 66 percent of black MSM reported using a condom during their most recent instance of anal sex, compared to about 47 percent of white MSM.
Hader said the study was conducted using protocols established by the U.S. Centers for Disease Control & Prevention for similar studies in other cities.
She said that similar MSM studies will be conducted every three years, alternating with studies of HIV-related heterosexual sexual behavior and studies of injection drug users conducted.
“The data are the data are the data,” she said at the town hall meeting. “They’re not the whole picture or the only picture, but they’re really useful information.
“And they’re not the answers So my hope is our data is to be used to start to come up with the answers, to reinforce anything we think we’re on the right track on, to bring up new ideas.”
‘We have more work to do’
D.C. Mayor Adrian Fenty joined Hader and other officials with the Department of Health and its HIV/AIDS Administration at the news conference March 26 announcing the release of the study.
D.C. Council member David Catania (I-At Large), who chairs the D.C. City Council’s Committee on Health, also participated in the news conference. He praised Fenty and Hader for working hard during the past three years to transform what he called a highly flawed public health data gathering system into a “world class” system recognized and praised by health departments in other cities and states.
Fenty joined Hader and Dr. Pierre Vigilance, director of the D.C. Department of Health, in noting that the study’s troubling findings of high HIV infection rates among MSM were offset by what they said were highly useful new data generated by the study.
“Knowing the facts about our HIV/AIDS epidemic improves how we fight this disease,” Fenty said.
Pointing to a separate study released last week, he noted that, “we’ve already shown that we can make progress against HIV by reducing AIDS cases and deaths and increasing people getting into medical care.”
“This study shows that we have more work to do to fight HIV/AIDS among men who have sex with men,” he said.
The D.C. MSM study consisted of 500 participants who were recruited “at open air venues, gyms, bars, restaurants, and clubs where men who have sex with men tend to frequent,” says the study report. “Participants were interviewed at these venues, which were located in Wards 1, 2, 5, 6 and 8.”
The study, which was conducted in 2008, doesn’t identify the specific venues, and representatives of the GWU team that conducted the survey declined at the news conference to disclose the names of the venues.
The report acknowledges that the study did not reach all MSM and most likely under-represents some groups, including MSM who don’t identify as gay or bisexual, and younger white MSM.
It notes that of the nearly 100 white men under age 30 who participated in the study, none were found to be HIV positive.
Vigilance and Hader said that while most of the MSM participants in the study reported having been tested for HIV, 40 percent did not know they were HIV positive until they were tested at the time of the study. Among those who tested positive during the study, nearly three-quarters had seen a doctor or other health care provider at least once in the previous 12 months, but were not tested.
Vigilance and Hader noted that a D.C. public health policy established four years ago calls for all adults in the city to be tested routinely for HIV during regular doctor visits, just as they are tested for high blood pressure and diabetes.
As a result of the study’s findings, Vigilance said the health department is calling on MSM to be tested for HIV twice a year instead of the once-a-year recommendation made four years ago.
Hader also announced at the press conference that the Department of Health is launching a new MSM HIV screening project in partnership with the Whitman-Walker Clinic and the Crew Club, a gay male gym and social venue.
According to Hader, the yearlong project will screen about 500 men at the Crew Club considered to be at high risk for HIV. She said pharmaceutical company Gilead Sciences, Inc., is contributing $40,000 to the project and the Crew Club is contributing more than $5,000 along with special accommodations on its premises to conduct the screening.
She said that while the 14 percent HIV infection rate among MSM in D.C. is too high, previous MSM studies in Baltimore, Los Angeles, Miami, New York and San Francisco found a combined infection rate of 25 percent in 2005. She noted that in Baltimore, the MSM infection rate was found to be 40 percent.
‘What are we doing wrong?’
The panelists who joined Hader at the town hall meeting and members of the audience expressed differing views on whether existing HIV prevention programs in the city, including those operated by community organizations like Us Helping Us and the Whitman-Walker Clinic, have been effective in their mission.
“There is a notion to say what are we doing wrong?” said Pettigrew of Us Helping Us. “But you can also ask, ‘What are we doing right?’”
He noted that one of the key findings in the MSM study was that men under 30 years old had a lower rate of HIV infection and were engaging in less risky behavior.
Ernest Hopkins, a veteran AIDS activist involved with programs in D.C. and San Francisco, said the D.C. government has been less aggressive and less visible in its AIDS prevention messages than in the past. He and D.C. Center Executive Director David Mariner called for greater city funding for community based HIV programs, including programs organized by the Center.
AIDS activist Chris Lane, a former official with the Sexual Minority Youth Assistance League, noted that a mental health component appeared to be missing from the MSM study.
Hader said the full scientific report on the study, which is to be published soon on the Department of Health’s web site, discusses mental health-related issues and that the city would pursue these issues when its reviews its overall HIV prevention programs in the next few months.
Gerald of the Center’s HIV Prevention Working Group cautioned against placing all the responsibility of HIV prevention on the city. He expressed concern that not enough black gay men have attended meetings and planning sessions to address the issue.
“We should not just wait for the government to do something,” he said. “We should educate our own people in the black community. We can let the government go so far, but we have to take it up from there.”
The study, titled “MSM in D.C.: A Life Long Commitment to Stay HIV Free,” is available through the Department of Health’s website, www.doh.dc.gov.