Alarming Numbers Of Men Don't Know HIV Status

HIV/AIDS continues to ravage urban America as one in five men who engage in sex with men are infected with the virus. Host Michel Martin speaks to Dr. Kevin Fenton, director of the Center for Disease Control's National Center of HIV/AIDS, Viral Hepititis, STD and TB prevention; and Phil Wilson, founder and executive director of the Black AIDS Institute about the new report.

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MICHEL MARTIN, host:

I'm Michel Martin, and this is TELL ME MORE from NPR News.

We're going to spend some time talking about issues in health care. And we should mention that the next few minutes might include some conversation about sensitive topics.

In a few minutes, we'll hear about why the Conference of Catholic Bishops is lobbying against requiring health plans to cover contraception as part of the new health-care law. That is later.

First, though, we turn to a troubling new study on the subject of HIV/AIDS. In 21 major cities across the country, according to the Centers for Disease Control, among men who engage in sex with other men, one in five has HIV, and nearly half are unaware of it.

Black men are the most affected, as nearly 28 percent of that group carry the virus, and 59 percent of the men with HIV are unaware of it. Among Latinos, the infection rate is 18 percent; among whites, 16 percent; and nearly half of infected Latinos do not know that they are infected. Gay men are the only group in America where the risk of HIV is actually increasing.

We wanted to talk more about this, so we have called Dr. Kevin Fenton. He is director of the National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, which is part of the Centers for Disease Control. Also with us, Mr. Phil Wilson. He's the founder and executive director of the Black AIDS Institute. Thank you so much for talking to us once again.

Dr. KEVIN FENTON (Director, National Center of HIV/AIDS, Viral Hepatitis, STD and TB Prevention): Great, thank you for having us.

Mr. PHIL WILSON (Founder, Executive Director, Black AIDS Institute): Thank you, Michel, it's great to be able to talk to you today.

MARTIN: But of course, we want to know - why do we think this is happening? So Dr. Fenton, I'll start with you, since the CDC generated these numbers. First of all, are you surprised by this?

Dr. FENTON: Well, we are not surprised, but we remain disappointed because this is clear evidence that we're continuing to fail in the fight against HIV with gay and bisexual men.

The study also showed that we see tremendous variations not only across racial and ethnic groups, but also across age groups. A prevalence of HIV increases as men get older, but we see these very high prevalences of undiagnosed infection especially among young, gay men.

And this study also showed tremendous variations across socioeconomic status. So if you're poor, or if you have lower educational attainment, you're much more likely to have higher HIV.

MARTIN: But Phil Wilson, maybe I'm wrong here, but the fact is groups like yours have been working to educate specific groups for going on two decades now. So I'd like to ask you, why do you think that is - that these numbers are still so high, particularly for men of color?

Mr. WILSON: Well, there are a number of reasons. Now number one, we have policies still in place that limit our ability to be effective with gay and bisexual men, particularly black gay and bisexual men - and especially young, black gay and bisexual men.

Now, we still have policies like HIV prevention messages, that require abstinence until marriage. We have policies, like no promo homo, that prohibits our ability to develop effective messages targeting gay and bisexual men.

So you put those two things together - that we do not provide young, black gay and bisexual men the tools they need to protect themselves and their partners with effective messages. And then to make things even worse, no promo homo means that there's a limitation on federal dollars being used now for programs that are allegedly promo homosexuality. Often, that is translated to mean explicit messages targeting gay and bisexual men.

MARTIN: And so how does that play out on the ground? Are you saying that young men are missing these messages because they're not aimed at them? Are they saying that they tune them out?

Mr. WILSON: The messages are not aimed at them. Even worse, the messages tell them that there is nothing that they can do to protect themselves, and encourage them not to pay attention to the HIV/AIDS epidemic.

And so why should a young, black, gay man, for example, get tested? And one of the driving engines of this is that among young men under 30, 63 percent of those who are HIV positive didn't know their HIV status.

MARTIN: Dr. Fenton, let me just clarify something. How did the survey figure out that men were unaware of their status, who were already infected? Because by definition, if you knew that they were infected, how could they not know?

Dr. FENTON: That's right. So the survey actually used computer-assisted questionnaires. And men were actually asked on the questionnaire whether they knew their HIV status, and what their HIV status was.

And then men who answered the questionnaire were then invited to provide a sample for testing for HIV. So we were able to match up, so to speak, the reported HIV status with the actual status, which was diagnosed anonymously from these men. And that's methodology that's used for many of our behavioral surveys.

MARTIN: What is your reaction to Phil Wilson's perspective?

Dr. FENTON: I think Phil is entirely on the mark. But I also think that there are individual-level factors, things that are happening to young, gay men that really - places them at risk.

So for example, the very high level of undiagnosed HIV infection means that these young men are having sexual intercourse, not aware of their HIV status and then therefore, unwittingly transmitting the disease.

We also know that especially among young, gay men, acute HIV infection - that's early HIV infection, which is very infectious - means that these men are more likely to be transmitting it to others.

We are also very concerned about issues such as intergenerational sex, where younger gay men may be having partners who are five or 10 years older than they are, and they are more likely to be HIV infected - the older partners. And so, you have the seeding of the younger generation, so to speak, with HIV.

MARTIN: Phil, can you just help me, though? This younger people today are among the most media savvy in history. I mean - and perhaps my perspective is skewed by living in a major urban area, where I feel that I do see messages targeted to - specifically, young, gay men of color, and that may not be the case around the country.

But I guess I'm still having a hard time seeing as - how is it that two decades into this epidemic, young, gay men could not know - particularly young, gay men of color - could not know they're at risk? Can you just help me see how that works on the ground?

Mr. WILSON: Absolutely. Well, I think that you are right, that certainly there are exceptions that prove the rule. Now, in - particularly large, urban cities, in recent, recent times, there has been increased efforts to reach this population.

But nationally, the CDC just launched its first national public service campaign in 20 years, and that campaign did not start with gay and bisexual men. It was a generalized campaign. And yet young people come into their sexuality every day.

And so you're right about young people being media savvy, but there has to be source material that specifically and explicitly speak to them.

MARTIN: And is part of the problem, Dr. Fenton, that young people today think of HIV/AIDS as not a serious disease or something like diabetes, which is manageable?

Dr. FENTON: I think that's absolutely part of it. And in fact, data from the Kaiser Family Foundation shows that across the U.S. population in general, the sense of urgency about HIV is actually declining, and complacency for HIV is actually increasing.

Also, we mustn't forget that for young people, there is that sense of invincibility as well. So, sexual risk behaviors and sexual risk-taking will be a part of this period of adolescence and of growth. And when that is combined with lack of comprehensive information to young people to help them to make informed choices, then we end up with high rates of STDs; you end up with the increasing HIV incidence - especially among the minority and poor gay men - that we're seeing today.

MARTIN: And finally, Dr. Fenton, we heard Phil Wilson say that more specific, targeted messages are needed that are specifically directed to the groups that are most likely to be affected. What is your sense of what needs to happen?

Dr. FENTON: This is absolutely correct, and the recently released National AIDS Strategy makes it very, very clear that if we are going to get ahead of this epidemic in the United States, then we have to do a much better job of focusing our efforts and being honest about where the epidemic is occurring in the U.S. today.

The strategy makes it clear that we need to focus on gay and bisexual men, high-risk heterosexuals, injecting drug users, and provide them with important information to help them to protect themselves. Increase and scale-up HIV testing in these groups, and link individuals to effective treatment and care -because we know that effective care not only benefits the individual, but it reduces infectiousness and therefore, helps to reduce the transmission of the infection to the community.

MARTIN: Phil Wilson, final thought from you. You've been working on this an awfully long time. Did you think this is where we'd be by now? And what do you think needs to happen next, along with what you've already told us?

Mr. WILSON: Certainly, I would have hoped we would be further along than we are right now. I am not surprised. I think the lesson of this MMWR is that we really are our brother's keeper and that for all of Americans, now if we're going to be successful around ending the AIDS epidemic, we really need to deal with many of the social determinants.

We really need to make sure that we're reaching out to our young people -including young, gay and bisexual men - with messages that work for them, that speak to them. And I'm hopeful, particularly with the new, national AIDS strategy, that we will focus our attention on the AIDS epidemic in an appropriate way.

MARTIN: Phil Wilson is the founder and the executive director of the Black AIDS Institute. He was with us on the phone from Jackson, Mississippi, where he is, in fact, conducting HIV education workshops.

And Dr. Kevin Fenton is the director of the National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention with the Centers for Disease Control. And he happened to be in Washington today, and joined us here.

Thank you both so much for speaking with us.

Dr. FENTON: Thank you.

Mr. WILSON: Thank you, Michel.

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