Higher rates of HIV among Black MSM

Dear Dr. Eva,

Can you tell me whether it is true that more Blacks, and especially Black gay men, are infected with HIV than whites? If it is true, what do you think are the reasons for this? I’m a young Black guy who wants to stay negative. From what I’ve seen, I don’t think that Black gay men have more risky sex than white gay men, in fact I think Black guys may be more conservative (have fewer partners). BJ

Dear BJ,

Despite some spread in the heterosexual population, HIV remains mainly a disease of men who have sex with men (MSM). MSM make up about 2 percent of the United States population, but they have 61 percent of all new HIV infections. MSM in the United States are 19 times more likely to have HIV than people in the general population.

African-Americans in general (not just gay and bisexual men) also have a disproportionate burden of HIV infection. Although only 14 percent of the United States population is African-American, African-Americans make up 44 percent of all people newly diagnosed with HIV.

Unfortunately, it is true that young African-American MSM have the highest rates of HIV infection of any group, and it is even worse in Baltimore where I practice than in the rest of the country. A 2008 Johns Hopkins study in Baltimore showed that 45 percent of a sample of Black MSM were HIV-positive. The Centers for Disease Control (CDC) announced last August that more than 25 percent of all new cases of HIV are in young black MSM, even though this group makes up less than 0.5 percent of the population.

Nationally, 28 percent of African-American men (one in 3) who have sex with men (MSM) are positive, and 59 percent of these HIV positive African-American men do not know they are infected. By comparison, 16 percent of white MSM (one in 6) are positive and 26 percent of them do not know that they are positive. Among HIV-positive African-American MSM under age 30, the most sexually active group, 71 percent do not know they are infected.

As far as the reasons for the higher rates of infection in African-American MSM:

You are correct that African-American MSM do not have more risky sex than white MSM. Some studies show that African-American MSM have fewer sexual partners than white MSM. African-American and white MSM have the same rates of unsafe sexual behaviors, such as failure to use condoms and having anal intercourse.

Gays and bisexuals, like heterosexuals, most often choose sex partners (and life partners) of their own ethnic group. African-American MSM make up a smaller group than white MSM. Infections spread more quickly in small groups.

There is (still) greater stigma related to being gay or bisexual in the African-American community than in the white community. The General Social Survey, a survey that asks people their opinions about homosexuality, found in 2008 that 72 percent of Blacks thought “homosexuality is always wrong” as compared with 52 percent of whites. Even MSM often agreed that “homosexuality is always wrong.” Fifty-seven percent of African American MSM and 27 percent of white MSM agreed with that statement. People who believe their sexuality is wrong are likely to have low self-esteem, especially related to their sexuality, and less likely to take precautions to protect themselves and their partners.

There is (still) greater stigma attached to HIV infection in the African-American community than in the white community. People who may be cut off from family and friends if they become infected with HIV are less likely to get tested.

Perhaps because of the stigma, African-American MSM get tested for HIV less frequently than white MSM. Because of this, African-Americans find out about their HIV positive status later in their disease. Once people are aware that they are HIV-positive, they take more precautions to prevent transmitting the disease to their partners. If they do not know until later in the disease that they are HIV-positive, infected people go on transmitting the virus to others for a longer period of time.

Once they are aware of being infected, African-Americans with HIV tend to wait longer to start on HIV medications. Once on a successful HIV medication regimen, people have far fewer HIV virus particles in their bodies and so are much less likely to pass on the virus. The longer a person with HIV goes untreated, the more their virus count (viral load) rises and the more likely they are to pass infection on to others.

A May 2011 interview study of young African-American MSM, done by researchers from Johns Hopkins, found that these young men preferred masculine partners and believed that masculine appearing men were most likely to be free of HIV.

Ask Dr. Eva is distributed by Healthy Living News. Email comments and questions to dreva@healthylivingnews.org.