Men of Color Who Have Sex with Men and HIV/AIDS in the United State

Men of Color Who Have Sex with Men and HIV/AIDS in the United States

Since the onset of the HIV/AIDS epidemic in the United States, HIV incidence has been highest among men who have sex with men (MSM). Most new AIDS cases for which MSM is the HIV exposure category are now among MSM of color, who face extraordinary barriers to HIV counseling and testing as well as to care.^1,2 Moreover, evidence suggests that AIDS surveillance data significantly underrepresent the rate of HIV/AIDS among men of color.

Surveillance

In 2004, an estimated 31,024 men were diagnosed with AIDS in the United States. MSM was the HIV exposure category in an estimated 57 percent of those cases.³ Men of color represented 52.7 percent of reported AIDS cases related to the MSM HIV exposure category.⁴ Men of color also accounted for 55.2 percent of reported AIDS cases related to the MSM/injection drug use exposure category.⁴
Evidence indicates extraordinarily high seroprevalence rates among some MSM populations. As part of the National HIV Behavioral Surveillance effort, the Centers for Disease Control and Prevention (CDC) surveyed MSM over age 18 who frequented certain venues in five cities; 25 percent of the study participants were HIV positive, and 48 percent were unaware of their serostatus.² Unrecognized seropositivity among the 217 MSM was 64 percent among Blacks and 18 percent among Hispanics, compared with 11 percent among Whites and 6 percent among multiracial groups.²

CRITICAL ISSUES

Like many racial and ethnic minorities, many minority MSM face poor access to health care because of poverty and lack of health insurance. In addition, MSM of color must cope with many types of stigma—for being a minority, for being an MSM, and for being HIV positive. MSM of color, therefore, may fear condemnation from many sectors: their family, community, and service providers.⁵

Many minority MSM do not self-identify as gay or bisexual. Thus, prevention and health outreach targeting sexual minorities may not be effective among this group—and MSM may be especially reluctant to seek services at organizations perceived to be gay oriented.^5-7 Many minority MSM identify with their racial identity more than their sexual identity; thus, messages aimed at the gay community often do not reach them.⁸

Minority MSM become infected at earlier ages than Whites and are more likely to learn that they are HIV positive later in the course of infection. Moreover, compared with Whites, a higher proportion of people of color have AIDS at initial diagnosis.^2,9

Some MSM harbor misconceptions about effective HIV treatment. Many are aware of the advancements in medical technology and in the effectiveness of highly active antiretroviral therapy (known as HAART), but they overestimate its power. Others believe that HIV infection is inevitable and may do little to prevent it.⁶

MSM of Color and the Ryan White CARE Act

Experiences of providers funded through the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act have revealed program components that are key to reaching MSM. Providers must cultivate and then provide high-quality, nonjudgmental services that help MSM acknowledge their risk, get tested, and remain in care over time. The use of peer educators can be critical.¹⁰

In collaboration with the African-American AIDS Policy and Training Institute, the Asian and Pacific Islander Health Forum, Bienstar, and the National Native American AIDS Prevention Center, the Health Resources and Services Administration (HRSA) conducted a research project involving key informant interviews and structured roundtable discussions to identify barriers to care for MSM of color and develop solutions. The results of the publication Improving Care for HIV-Positive Men of Color Who Have Sex With Men: Barriers and Recommendations are shaping the process through which HRSA and the Centers for Disease Control and Prevention (CDC) are collaboratively responding to the epidemic among young MSM of color.

To increase access to quality care for minorities and respond to the need for additional minority providers of state-of-the-art HIV/AIDS care in underserved communities, the CARE Act funds the National Minority AIDS Education and Training Center program to expand clinical expertise in minority communities. More information is available at www.nmaetc.org.

Capacity-building and planning grants have been targeted to underserved communities in order to expand the number of services available to vulnerable minority populations.

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MSM Reported AIDS Cases, by Race/Ethnicity 2004 This pie chart depicts MSM reported AIDS cases, by race/ethnicity, 2004. White 47.4%, Black 30.1%, Hispanic 20.6%, A/PI 1.5%, AI/AN .5% Estimated Proportion of Men Living With AIDS for Whom MSM Was the HIV Exposure Category for Race/Ethnicity 2004 This bar graph shows the estimated proportion of men living with AIDS for whom MSM was the HIV exposure category, by race/ethnicity, 2004. White 75.2%, A/PI 72.3%, AI/AN 56.5%, Hispanic 51.6%, Black 43.7%.

References

1 Centers for Disease Control and Prevention (CDC). HIV/AIDS Surveillance Supplemental Report. 2002;10(1): 12-13. Table 4.

2 CDC. HIV prevalence, unrecognized infection, and HIV testing among men who have sex with men-five U.S. cities, June 2004-April 2005. MMWR Morb Mortal Wkly Rept. 2005;54(24): 597-601.

3 CDC. HIV/AIDS Surveillance Report. 2004;16:12. Table 3.

4 CDC. HIV/AIDS Surveillance Report. 2004;16: 34. Table 19.

5 Miller M, et al. Drug-using men who have sex with men as bridges for HIV and other sexually transmitted infections: sexual diversity among black men who have sex with men in an inner-city community. J Urban Health. 2005;82(suppl 1);i26-i34.

6 HIV/AIDS Bureau. Improving Care for HIV-Positive Men of Color Who Have Sex With Men: Barriers and Recommendations. Rockville, MD: Health Resources and Services Administration; 2002.

7 MacKellar DA, et al. Unrecognized HIV infection, risk behaviors, and perceptions of risk among young men who have sex with men: opportunities for advancing HIV prevention in the third decade of HIV/AIDS. J Acquir Immune Defic Syndr. 2005;38(5):603-14.

8 Clarke-Tasker VA, et al. HIV risk behaviors in African American males. Assoc Black Nurs Faculty J. 2005;16(3):56-9.

9 CDC. HIV/AIDS among racial-ethnic minority men who have sex with men-United States, 1989-1998. MMWR Morb Mortal Wkly Rept. 2000;49(1):4-11.

10 Reaching men of color who have sex with men. HRSA CAREAction. June 2003. Available at: ftp: //ftp.hrsa.gov/hab/
june_2003_final.pdf.

11 CDC. HIV/AIDS Surveillance Report. 2004;16: 34. Table 11.

U.S. Department of Health and Human Services - Health Resources and Services Administration - HIV/AIDS Bureau
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