Gay/bi black men in the US have the highest rate of HIV in the world

June 7, 2017 1:13 PM

Why? (SLNYT) Last year, the Centers for Disease Control and Prevention, using the first comprehensive national estimates of lifetime risk of H.I.V. for several key populations, predicted that if current rates continue, one in two African-American gay and bisexual men will be infected with the virus. That compares with a lifetime risk of one in 99 for all Americans and one in 11 for white gay and bisexual men. To offer more perspective: Swaziland, a tiny African nation, has the world’s highest rate of H.I.V., at 28.8 percent of the population. If gay and bisexual African-American men made up a country, its rate would surpass that of this impoverished African nation — and all other nations.
posted by stillmoving (25 comments total)

Black MSM in the US have the highest rate of HIV in the world

MSM: Men who have sex with men. (I had to look it up, and figure other folks might not know either.)
posted by zamboni at 1:35 PM on June 7, 2017 [7 favorites]

Great article, especially the part in the middle section about dispelling a lot of ingrained myths about the epidemiology of HIV in "developed" nations (in this case the U.S.), that's stuff more people should about.
posted by polymodus at 2:02 PM on June 7, 2017

Mod note: Edited post title to be clearer to folks who don't know MSM acronym, per poster request.
posted by LobsterMitten (staff) at 2:04 PM on June 7, 2017 [2 favorites]

From the article: "Only a small percentage of black people use PrEP to prevent contracting the virus, accounting for only 10 percent of prescriptions; the vast majority of users are white. Many black gay and bisexual men either can’t afford PrEP or don’t know about it — they may not see a doctor regularly at all, and many medical providers haven’t even heard of PrEP."

From a New York Times article from November 2015: "Even though taking a daily pill can protect almost completely against getting H.I.V., a third of primary care doctors and nurses in the United States have never heard of it, federal health officials said this week."

Here is a primer on PrEP. Read it, even if you are not at risk, and get the word out. Support funding for the populations that can't afford it. This is a medication that can save lives.
posted by roger ackroyd at 2:09 PM on June 7, 2017 [19 favorites]

Since black MSM are a hard group to census, and one way you might find out someone belongs in that group is when they are diagnosed as HIV positive I wonder if that statistic is skewed high. You can pin down the numerator of the ratio a lot better than the denominator. A crisis certainly, but you can see how the shocking statistic moves attention from Africa to America in the blurb itself.
posted by forgettable at 2:13 PM on June 7, 2017 [5 favorites]

Read this yesterday, and it was pretty shocking and depressing.
posted by infinitywaltz at 2:36 PM on June 7, 2017

But I'm shocked!
"Nobody dies because they don’t have access to health care."
posted by BlueHorse at 2:38 PM on June 7, 2017 [4 favorites]

"Gay/bi men" is not an appropriate "substitute" for "MSM". If you're going to fucking replace the title, replace it with something accurate.
posted by adrienneleigh at 3:03 PM on June 7, 2017 [16 favorites]

Meanwhile, The Clarion-Ledger reported this yesterday : "In the midst of an HIV epidemic, the state Department of Health will begin charging for HIV and sexually transmitted diseases testing.

Effective July 1, the Health Department will begin charging a $25 fee for all STD and HIV tests and lab work at all of its clinics. That includes the department's Five Points Clinic, which is home to Crossroads Clinic, the state's STD clinic. The tests have been free.

In the wake of legislative budget cuts, the increase is hitting at the same time Mississippi is suffering from sharp rises in sexually transmitted diseases, including syphilis."
posted by roger ackroyd at 3:19 PM on June 7, 2017 [3 favorites]

I'm from Mississippi.

There is no point below which the state cannot sink.
posted by uberchet at 3:20 PM on June 7, 2017 [1 favorite]

"Gay/bi men" is not an appropriate "substitute" for "MSM". If you're going to fucking replace the title, replace it with something accurate.

Just to be clear, "MSM" isn't what the article is using, so, per the poster's request, we changed it (because yeah, they're *not* interchangeable terms.)
posted by restless_nomad at 3:23 PM on June 7, 2017 [3 favorites]

While 1 in 11 is really high and while AIDS is not the death sentence that it used to be, it is still a very serious diagnosis, I have a small statistical question that I somehow am not understanding. Swaziland has a rate of infection of 28.8% but 1/11 = 9%. What am I missing about this statistic? Both are too high but I don't see how the African-American male population has a higher rate of infection than Swazis.
posted by koavf at 3:27 PM on June 7, 2017

"Gay/bi men" is not an appropriate "substitute" for "MSM"

While I agree with you in theory, in the context of the article, the change is correct. The article is about gay and bisexual Black men and identifying them as MSM would actually be MORE offensive.
posted by elsietheeel at 3:28 PM on June 7, 2017

koavf: 1/11 is for white gay/bi American men.
posted by spaceman_spiff at 3:45 PM on June 7, 2017

WHOA—it's one in two! Wow.
posted by koavf at 3:47 PM on June 7, 2017

It looks like the CDC report itself is treating "gay and bisexual men" as synonymous with "men who have sex with men", and the NYT article only used "gay and bisexual men".
posted by J.K. Seazer at 3:50 PM on June 7, 2017

koavf : The article and the quote above states that one in eleven white gay and bisexual men will become HIV positive within their lifetime. (I don't mean to wade into the MSM versus and gay and bisexual controversy, but while the text says "gay and bisexual men" the researchers who came up with that statistic almost certainly were working with the label MSM, which is what's used in HIV epidemiological research.)

That snippet of text is a bit confusing because it is comparing lifetime risk of HIV infection among gay and bisexual men in the U.S. to HIV prevalence in the population at large in Swaziland. I wouldn't say it's misleading, however. Forgettable brought up the denominator problem -- the difficulty of knowing how many men who have sex with men there are. This 2012 article by the CDC addresses that issue. It found 21% of black/African American MSM were diagnosed with HIV as of 2008. That doesn't count the undiagnosed and it doesn't take into account possible increases in HIV prevalence in this population since then. I understand why this information may feel hard to believe, but I don't think the article is remotely sensationalistic.
posted by reren at 3:52 PM on June 7, 2017 [3 favorites]

Agree with all above that gay/bi and MSM are not the same, and in fact are quite different. As a nurse who works with HIV positive persons, I reflexively used clinical shorthand to fit the character requirements of the title and edit was requested for clarity (per zamboni's comment) and it seemed to make more sense as that's also the terminology the article uses. Apologies if anything else was inferred by the request/edit.
posted by stillmoving at 3:59 PM on June 7, 2017 [2 favorites]

I had never heard of PrEP. I'm not in a demo that it would be recommended to, but that doesn't matter -- how is a drug that prevents HIV transmission not something we all hear about, all the time??
posted by kittens for breakfast at 6:22 PM on June 7, 2017 [6 favorites]

I had never heard of PrEP.

Spread the word. Post something on Facebook. Talk about it with friends and coworkers. PrEP is not a cure, but it has the power to be as big of a game changer as birth control. There's a good overview here: Why Aren't HIV Prevention Pills Going to the People Who Need Them?
posted by roger ackroyd at 7:22 PM on June 7, 2017 [4 favorites]

I'm really not in the target demographic (queer woman & monogamous), but I've been hearing about PrEP for a while. Dan Savage was talking about it when it came out; I think I saw ads in queer magazines.

But yes: it needs to be free and widely available.
posted by jb at 7:27 PM on June 7, 2017 [3 favorites]

It's a really good article. My immediate thought on reading it was that it belonged here, but I wasn't sure how best to frame it, so I am glad to see the FPP. I do wish, though, that Linda Villarosa, as the author of an article that is powerful, well-written, and nuanced, had been given the credit and recognition that she deserves.

One of the minor but interesting moments in it for me was when they were at the nightclub and there was the reference to J-Setting ("dancing in the exuberant style that pays homage to the Prancing J-Settes — Jackson State University’s famous all-female dance squad"). I'd never heard of it before, but the videos are amazing.

Overall it is a heartbreaking article about something that should be a national shame but mostly gets completely ignored. I'd be curious about the author's perspective on the MSM/gay terminology question. She obviously knows the subject well, and MSM is defined partway through the article -- it makes me wonder if the terminology was chosen by the editors, by the author, or by the subjects, and what the thinking was behind that choice.
posted by Dip Flash at 7:38 PM on June 7, 2017 [1 favorite]

JK Seazer - Welp. Dammit, the CDC absolutely should know better than to use those terms as synonyms, but you're right, that's definitely not the poster's fault.

elsietheeel - I do not believe that identifying gay/bisexual men as (a subset of) MSM is likely to offend them? That's why public health folks use the term, because it is the most inclusive. But i am not a gay or bisexual man so i'll defer to any who have an opinion.
posted by adrienneleigh at 8:35 PM on June 7, 2017

It was only in the context of THIS specific article that I thought the change would be offensive. As I said, I agree it is the most inclusive, especially in terms of public health research, but this article goes beyond public health and more into social justice, community, and pride and the absolutely soul crushing bullshit that gay and bisexual men, especially men of color, often have to deal with in the South.

Acknowledging that there are gay and bisexual Black men in the South and that they are subject to an epidemic that is seeming to be less and less of a concern to the rich white gay men who are aware of and can afford PrEP and/or PEP is critical to providing them with the support and assistance they desperately need.

Ta-Nehisi Coates jumped into the fray in a 2007 essay for Slate that questioned why the myth of the “on-the-down-low brother” refused to die, referencing a controversial 2003 cover story in this magazine by a white writer who went into the scene to uncover closeted black men who lead double lives.

Keith Boykin, a former Clinton White House aide, became so incensed by the down-low hysteria that he wrote a 2005 best-selling book, “Beyond the Down Low: Sex, Lies and Denial in Black America.” “Because the whole down-low story was doing a disservice to the black gay community and creating a racially troubling narrative that black men who have sex with men were villains, I felt I had to step in and correct the record,” said Boykin, a CNN commentator who teaches at Columbia University’s Institute for Research in African-American Studies. “I think the near-decade-long obsession with the down low diverted our attention into what was really a side issue.”

In 2010, after Oprah Winfrey ran her second show about the down low, again featuring King, Dr. David J. Malebranche, a black physician and one of the country’s foremost experts on H.I.V. and black gay and bisexual men, wrote a heartfelt open letter to the talk-show host. “We are not all self-loathing, secretive, unprotected-sex-having, disease-ridden liars,”Malebranche wrote. He posted the letter on Oprah’s website, and after it was removed, posted it on his own Facebook page. People all over the world shared the post, and it received hundreds of comments.

In the end, the organized H.I.V. outreach and education that proved successful to black women never translated to black gay men — and the excessive focus on the down low sucked away critical time, energy and resources. Between 2005 and 2014, new H.I.V. diagnoses among African-American women plummeted 42 percent, though the number of new infections remains unconscionably high — 16 times as high as that of white women. During the same time period, the number of new H.I.V. cases among young African-American gay and bisexual men surged by 87 percent.
posted by elsietheeel at 10:45 PM on June 7, 2017 [3 favorites]

In case anyone is not reading the article, one of the most important elements it covers is that the rates of HIV for Black MSM has NOTHING to do with risky sex practices (what most people (esp. white ppl) assume when it comes to this topic). Multiple major studies have shown that Black MSM are no more likely to engage in risky sex practices than any other group of MSM-- it is just that the viral load in their communities is so much higher, that the risks inevitably are too.

Add that to white supremacy, the unbelievable racism of the south, lack of medical care, poverty, the gutting of public health, the missing generation of activists who died in the 80s and 90s-- it is just horrifying.
posted by a fiendish thingy at 5:27 AM on June 9, 2017 [2 favorites]