We Owe It to Our Young People and Our Future

On September 27, the nation will observe National Gay Men’s HIV/AIDS Awareness Day. Some may wonder why there is a need to raise awareness about HIV among gay men. The reality is that HIV has fallen off the radar for many in the community who view HIV and HIV-related deaths as a thing of the past.

However, this is not the case. While we’ve made tremendous progress in fighting HIV, gay and bisexual men continue to bear the greatest burden of HIV infections and deaths.

In the U.S. as a whole, new HIV diagnoses declined 19% during the decade from 2005 to 2014. Even greater declines were seen among people who inject drugs (PWID) and heterosexuals. New HIV diagnoses dropped 63% among PWID and 35% among heterosexuals.

Yet we did not see a corresponding reduction in new diagnoses among gay, bisexual, and other men who have sex with men (MSM). In fact, we saw the opposite. The number of new HIV diagnoses increased by about 6% from 2005-2014. Most alarmingly, these increases were driven by increases among young MSM between the ages of 13-24. Among young gay, bisexual, and other MSM new diagnoses increased about 87% for African Americans and Latinos and 56% for whites.

We’ve made tremendous progress treating HIV, and deaths among people with HIV have dropped dramatically as a result. But far too many people are still dying in the United States. CDC has estimated that 16,281 people with HIV died in 2013. Half of those deaths were among gay, bisexual, and other MSM, including those who injected drugs.

Trends in HIV diagnoses and risk behavior among young MSM stood in stark contrast to progress on most other indicators used to monitor the National HIV/AIDS Strategy. In July, the White House Office of National AIDS Policy reported that progress had been made on 9 out of 14 indicators. As a nation, we did not see progress on any of the indicators that were focused specifically on gay or bisexual men. HIV-risk behavior among young gay and bisexual males increased. Disparities in HIV diagnoses increased for gay and bisexual men overall as well as for young black gay and bisexual men.

These data do not mean that gay and bisexual men don’t care whether or not they get HIV. The data also do not mean that we do not have the tools or the ability to make things better. A large body of research and the experiences of communities like San Francisco that have mobilized to mount strategic responses at the right scale show us the possibility of what could be achieved.

These trends do mean that we need to ask ourselves some serious questions about what we’re doing in our efforts to prevent new HIV infections and deaths among gay and bisexual men:

Why are the trends going in the opposite direction for gay and bisexual men?

How can we do better at making effective prevention interventions more easily and widely available?

How can we shift more efforts away from activities that are not having the impact that is needed to those that can achieve the desired results?

How can the gay community better mobilize and re-engage around HIV-related issues?

How can the broader community better mobilize and re-engage around HIV-related issues and address the roles that homophobia and other types of stigma play in driving HIV risk and access to effective prevention and care?

These questions can be answered. We already have at least some of the answers. But we should not be too quick to accept them as complete as or unchangeable over time. The real test of whether these answers are right or wrong will be borne out in the results—in the numbers of new infections and in the numbers of deaths. Too many of us are already living with HIV and far too many are no longer with us. We owe it to them. We owe it to ourselves. And we owe it to our young people to turn around these alarming trends and create a future in which new HIV infections are rare and that everyone has unfettered access to high quality, life-extending care, free from stigma and discrimination.To learn more about National Gay Men’s HIV/AIDS Awareness Day, please visit HIV.gov’s webpage on the observance.