HIV/AIDS, Maryland, and MSM: The Continued Need for Adapted Prevention

by

Photo courtesy of CDC

 

MSM refers to men, regardless of their identified sexual orientation, who engage in sexual behavior with other men.  In the Unites States,  HIV/AIDS  disproportionately affects this population and high risk sexual behaviors including unprotected anal intercourse appear to be the major risk factor.  According to the CDC, over two-thirds of all men living with HIV are MSM.  Maryland has the 19th largest number of AIDS cases among the 50 states and the District of Columbia.  Additionally, the proportion of MSM living with HIV rose from 19.2% to 31.2% between 2001 and 2007; African-Americans made up 59% of that total. The following graphs from the Maryland AIDS Administration depict these trends.   

Graph 1.  Reported HIV diagnosis trends by exposure.  The red curve represents MSM diagnoses.   

  Graph 2.  Reported HIV Diagnosis Trends in MSM according to Race and ethnicity.  The blue line reflects the number in non-Hispanic Blacks.                                                                                                   

Additional funding is required to examine targeted interventions for reducing unprotected anal intercourse in this subpopulation e.g. improved condom based strategies and  HIV testing availability as well as safer sex promotion on internet dating sites .  One example of an effective intervention took place in North Carolina .    

The early years of the AIDS epidemic saw a significant drop in HIV incidence among homosexual men.  Recent diagnostic trends suggest the continued importance of adapted sustainable risk reduction.  Efforts by faith based organizations, nonprofits such as Us Helping Us based out of D.C.,  the Baltimore City Dept. of Health, and the GLBT Community Center of Baltimore and Central Maryland have not gone unnoticed, but additional resources must be allocated if we are to successfully reduce disease incidence.

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4 Responses to “HIV/AIDS, Maryland, and MSM: The Continued Need for Adapted Prevention”

  1. julierwan Says:

    You bring to light an interesting issue of how MSMs in the US continue to have an increase in HIV incidence. As we have seen in the last decade, individual level interventions may not be enough to decrease HIV incidence in MSMs, especially as younger men engage in high risk behaviors despite having knowledge of risk reduction methods such as condom use. High risk behaviors can be linked to interpersonal, community and sociopolitical issues that impact a person’s ability to engage in protective behaviors. Perhaps targeting interventions at those levels would be more effective. As you mentioned, safer sex promotion on internet dating websites is one strategy for reducing risk.

    In a recent lecture that Chris Beyrer gave at JHSPH, Beyrer stated that the website owners needed to actively participate in promoting safe sex messages, in addition to banner ad placement from health departments or non-profits. For example, website owners could build in email prompts every 3 months to remind users to get an HIV test. Also, use of popular opinion leaders (highly influential dating site members) can sway other dating site members towards safer sex practices: http://www.cdc.gov/hiv/topics/prev_prog/rep/packages/pol.htm.

  2. jolionmcgreevy Says:

    As far as I know HIV is rising among young African American MSMs in Philadelphia, for example, because of the belief that it’s safer to have unprotected sex now than it was a decade ago. Interestingly I’ve spoken with a few African American MSMs lately who were recently diagnosed with HIV who got tested for HIV regularly (every couple months) but who didn’t always use condoms. What is it that would make someone more diligent about knowing their status than protecting themselves from infection?

  3. mernabrownie Says:

    HIV rates in young MSM have been raising since ART started and people starting living with HIV/AIDS instead of dropping like flies as in the late 1980’s.
    How do we appeal to the various cultures within the various MSM communities in the United States. What artistic media venues have already captured the attention of this young MSM generation? How about remaking “Long term Companion” to fit this culture with some of the current gay icons in the movie? Somehow get these guys to feel what it is like to see your friends, lovers , acquaintances get pale, cachectic, socially ostracized by their families and die alone like too many lovely men 2 decades ago. How about walking around afraid to get tested but fearing that every bruise is Karposi’s Sarcoma, every cold is Pneumocystis pneumonia and any out of focus moment is CMV retinitis. These guys need to be scared into recognizing reality.

  4. kdanfort Says:

    I have to disagree with the previous poster, as I’m not sure fear is the most effective answer. First of all, we can’t go back in time to the days before ART extended people’s healthy lives (nor would we want to) or even the days before the Ryan White CARE Act. That information about the manageability of HIV has already become social knowledge in many communities. Second, taking steps to prevent illness should be something that individuals do as part of a broader effort to lead healthy lives, not an action that is dictated by what they are afraid to die of. As people, we don’t necessarily make daily decisions based on a fear of the “worst case scenario”, which may be part of the reason why public health education campaigns that try to tap into that often have limited effects. MSM in Baltimore need strategies that are empowering (I particularly like the POL example), and some of these strategies will need to focus on much more than just sexual behavior choices. (As public health practitioners we often lament about the “silo-ing” that occurs in the field when different donor organizations provide aid for their own specific disease priorities – why are we so quick to encourage an individual health approach that does the same thing?)

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