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Introduction Since the beginning of the HIV/AIDS epidemic in the United States (U.S.), gay men and other MSM have been disproportionately impacted by the disease. The Centers for Disease Control and Prevention (CDC) estimates that, in 2006, gay men and other MSM represented more than half of all new HIV infections in the U.S. While other at-risk populations have seen declining numbers of new infections over time, new cases among gay men and MSM continue to rise. More recent calculations presented by CDC at the 2009 National HIV Prevention Conference indicate that gay men and other MSM have rates of new infections 50 times higher than women and heterosexual men. Given this stunning disparity, efforts to prevent new HIV infections among gay men and other MSM must remain the nation's top HIV prevention priority. back to top > Underlying Factors to HIV Transmission The staggering rates of HIV infection among gay men and other MSM demand that public health and health care professionals acknowledge and address a complex and inter-related set of factors underlying this crisis. Since the beginning of the domestic HIV/AIDS epidemic, funding for and, as a result, coverage of HIV prevention activities and services have been woefully inadequate. With limited resources available on the federal, state and local levels, health departments and their community partners—the primary providers of HIV prevention services in the U.S.—have been forced to piece together strategies to fight the epidemic among gay men and other MSM. In their efforts to strengthen HIV prevention, CDC and other federal institutions have, at times, complicated delivery of services with the introduction of new strategies and requirements that shift emphasis and resources. While health departments and their community partners welcome new and effective strategies, the imposition of these strategies has often come with unfunded mandates, a redirection of already limited resources and a decrease in the flexibility necessary to mount comprehensive and coordinated services to fight the epidemic among gay men and other MSM. The lack of funding for HIV prevention in the U.S. likely stems from the relative indifference held by government and the public-at-large toward HIV/AIDS, prevention (in general) and marginalized populations, including gay men and other MSM. This is no better exemplified than by the silence that ushered in the beginning of the domestic epidemic in the early 1980s. Even today, most Americans offer little more than sympathy for a crisis that continues to claim thousands of gay men's lives each and every year. This indifference and shallow support find root and nourishment in the oftentimes invisible oppression that is pervasive in American culture. This oppression manifests as covert and overt discrimination and stigma and is aligned with markers of difference, including race/ethnicity, sexual identity, gender, age and immigration status. Because oppression is frequently institutionalized in our society, it remains a specter whose effects are difficult to mitigate. Gay men and other MSM, particularly men of color, feel the acute and sustained effects of oppression, despite any progress that is being made toward equality. Oppression also breeds tacit acceptance of prevailing ideological arguments that demonize the lives of gay men and other MSM and thwart strategies proven to prevent HIV transmission, including the promotion of condom use and the provision of sterile needles and syringes. It is imperative that the factors underlying the domestic HIV/AIDS epidemic be acknowledged and addressed. Even with additional funding, new tools and increased flexibility, the ability of providers to deliver effective services is significantly compromised by these issues. Progress toward making changes in these areas will take time, so attention must be given at every opportunity. back to top > Priniciples To Reduce Hiv Incidence Among Gay Men And Other Msm Despite the many challenges we face, there are principles that can lead to a reduction in HIV incidence among gay men and other MSM and other at-risk populations. Services that are scientifically proven to prevent transmission must be provided with sufficient coverage to both HIV-negative and HIV-positive gay men and other MSM. Condoms, sterile needles and syringes and treatment for sexually transmitted diseases (STD) must be made available to all who choose to access them and through venues that gay men and other MSM frequent, including the Internet. Behavioral interventions that intend to change knowledge, skills and attitudes must be broadly available, as should comprehensive sexuality education for young gay men and other MSM. Beyond providing full coverage of existing tools, new behavioral and biomedical strategies, such as pre-exposure prophylaxis, must be identified and made widely available when deemed effective. All gay men and other MSM must be encouraged to learn their HIV status through testing. Those found to be HIV-positive must be provided with partner services, including services provided through the Internet, and linked to quality care and treatment, both to support their own health and to reduce the likelihood of transmission to HIV-negative individuals. While the homophobia, racism and other discrimination associated with oppression remain difficult challenges, health departments and their community partners must actively work to eliminate disparities that result from these issues. To help, structural-level concerns, such as policies and bureaucratic systems, must be examined. Those found to create disparities must be revised, and those that honor the assets of the gay community must be leveraged. Similarly, HIV prevention strategies and services must acknowledge the real-life issues that gay men and other MSM face, including substance use/abuse, mental health concerns, housing-related concerns and other diseases, such as STD and viral hepatitis. Finally, to support broader acceptance of HIV/AIDS, gay men and other MSM and the importance of prevention, the public at large must be continually educated about these topics. back to top > NASTAD's Commitment to Reducing HIV Incidence Among Gay Men and Other MSM In support of these principles, NASTAD actively works with health departments to implement effective programming that serves gay men and other MSM on the state and local level. Over the past year, NASTAD's work has focused on Black gay men and using the Internet as a mechanism to reach gay men and other MSM. Earlier this year, NASTAD launched a podcast series, Connecting the Dots, that explores the complexities that shape our understanding of the HIV/AIDS epidemic in the U.S. The podcast series features structured interviews with experts and examines topics through multiple lenses, including the behavioral, social, political and structural contexts in which behaviors occur, in which programs and services are delivered and in which policies are made. The first installment of the series focuses on Black gay men's sexuality and features Patrick Wilson from the Mailman School of Public Health at Columbia University and Terrance Moore, Associate Director of NASTAD's Racial and Ethnic Health Disparities Program. Because of the complexity of this topic, the podcast was released in four parts. Part one explores the influences of identity, masculinity and femininity and sexual objectification and mystique. Part two explores race and racism, gender identity and sexual roles. Part three explores pop culture and media. Part four (forthcoming) explores self-value and power and privilege and discusses how the issues discussed in the podcast work directly and indirectly to influence the health and wellness of black gay men. NASTAD also released an issue brief earlier this year, HIV/AIDS: Crisis among Young Black and Latino Gay Men and Other Men Who Have Sex with Men (MSM). The issue brief highlights the HIV/AIDS epidemic among young Black and Latino gay men and other MSM and reviews challenges and barriers faced by these men. The issue brief concludes with recommendations for effective public health strategies To support the use of the Internet and other new technologies, NASTAD, in partnership with the National Coalition of STD Directors (NCSD), convened a technical assistance (TA) meeting for health department HIV/AIDS and sexually transmitted disease (STD) programs and their community partners earlier this year. The meeting focused on using Internet Partner Services (IPS) to reach gay men and other MSM and brought together colleagues from across the country to dialogue about IPS and other Internet interventions, including outreach and health communication. [A full meeting report is available on NASTAD's website. Meeting presentations are also available on NASTAD's website.] To make the information shared during the meeting as widely accessible as possible, NASTAD filmed presentations and informal interviews with participants. The film footage was edited into a four-part web-film. Part one provides an introduction to IPS. Part two discusses challenges related to IPS. Part three identifies solutions to challenges, and part four looks to the future of using the Internet and other new technologies to reach gay men and other MSM. [The web-film is available on NASTAD's website and NASTAD's YouTube page.] back to top > Closing In addition to the aforementioned work, NASTAD continues to support health departments with tailored technical assistance and other support. NASTAD also advocates for supportive policies and adequate funding for HIV prevention. NASTAD remains committed to being a national leader in efforts to reduce HIV incidence among gay men and other MSM, as well as all at-risk populations. For more information about NASTAD's work, please visit our website and our weblog. back to top > Meeting and Planning Calendar October 15, 2009 National Latino AIDS Awareness Day October 29-31, 2009 United States Conference on AIDS, San Francisco, CA. Abstracts due April 24, 2009. November 7-11, 2009 American Public Health Association 137th Meeting and Expo,Philadelphia, PA December 1, 2009 World AIDS Day |
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Credits, Feedback and Input The NASTAD Prevention Bulletin is edited by NASTAD staff and is written by staff and prevention experts from around the country. This publication was supported by Cooperative Agreement Number 5U62PS323958-05 from the Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention. If you have an idea or program that you would like to include in the Bulletin, please contact Dave Kern or Lynne Greabell (202/434-8090). NASTAD welcomes feedback to issues presented in Bulletin. To submit commentary, please e-mail us at NASTAD@NASTAD.org. Electronic versions of the Bulletin are available on our webpage. |
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