CDC Concerned About Resurgence of HIV Among Young MSM

On Nov. 21, leaders in the fields of HIV prevention among young gay and bisexual men came together for the CDC's webcast, "Combating a Resurgence of HIV Among Young Men." The panel, moderated by MSNBC's Thomas Roberts, featured the Center for Disease Control and Prevention's Jonathan "Jono" Mermin, HRC Vice President Jeff Krehely, National Black Gay Men's Advocacy Coalition Daniel Driffin and the Ali Forney's Center's Executive Director Carl Siciliano.

"In recent years, we have seen a decline in the sense of urgency around HIV. The headlines have disappeared, and complicated issues for many men have been oversimplified. But the threat is no less real. HIV is again on the rise in gay and bisexual men," said Mermin, the CDC's Director of the National HIV/AIDS, Viral Hepatitis, STD and TB Prevention.

Mermin said that today two-thirds of all new infections occur in gay and bisexual men. They are the only population in country where new infections are rising, more than 12 percent in past years. One in five gay and bisexual men is HIV-positive. And in some areas like Baltimore, 36 percent gay and bisexual men are infected with HIV. Gay men are at the center of the HIV epidemic, but youngest men face the biggest threat. Young MSM of color account for 1 in 3 new infections among MSM.

For many of these young MSM, coming out is what lands them in a situation to increase their risk of HIV infection. Siciliano, who founded the Ali Forney Center for homeless LGBT youth in 2002, said that, "they are thrown out of families who can't handle having an LGBT child. Homeless youth are ground zero in terms of HIV risk. So many kids have no way to survive except prostitution or survival sex, which puts them at a high risk of HIV." Protecting them requires commitment on part of our community to providing homes for these kids.

Social and Mental Health Challenges

Coming to terms with one's sexual orientation can cause emotional duress, like depression, suicide attempts and risk sexual behavior. The sweeping social changes that encourage young people to come out early are often not matched with the reality in some communities.

"We're giving the message to youth that it's safe to come out, that their families will be fine, their friends will be fine, their faith communities will be fine, and that's not always the case," said Krehely. "Shame on those places, but youth are still taking their cues from larger social change. They hear the message that it's safe to come out, but sometimes it's not.

"The experience of being driven from your home and told that being gay makes you unworthy of being loved is a devastating experience," said Siciliano. "Compound it with hundreds of thousands of kids out on the street trying to find beds. They get the message from larger society that they don't matter. These kids really struggle with hopelessness."

Race is also a large component in this issue. Driffin said that when he was coming out, there was no gay black face to serve as a role model. "No one ever looked like me, so I was only left to juxtapose it, if I was educated, maybe I could make it," he said.

Efforts to fight against the stigma of living with HIV have begun to help, but there is much to be done. We need to engage people in the issues around HIV like homophobia -- especially in the African-American community -- in order to address stigma. Living in the South or in the Bible Belt brings a heavy religious tint to things that cast a pallor around people who are gay or HIV-positive.

"But I do believe that in some communities, it is changing. There's the mother and father who have a gay kid who is not put out on the street, who are spreading education around this," said Driffin.

Siciliano said that we have to create a sex-positive and safe environment for kids to be "open and real about who they are," and combine that with HIV education and the message that their lives matter. To do this, he said, we must providing housing, food and medical care that shows youth that they are valued and loved members of the community. The result is a great reduction in risk behavior. But for those still on the streets, that message is lost. About 20 percent of Ali Forney's clients are HIV-positive; the risk is higher for those kids still on the streets.

Mermin said that health resources were welcomed much more among those who were empowered to believe that they had the self-efficacy to control their bodies and lives.

Roberts also asked whether the battle for marriage equality had subsumed the community's struggle for civil rights and protecting our youth. Krehely said that there was a lot of corporate support for the quick outcomes of legislation, much more than the challenges of HIV or homeless youth.

"It's time to start paying attention, donating time and resources and moving progress forward on these issues," said Krehely. "Marriage isn't always the silver bullet. It's inspiring, but it doesn't get us all the way down the road."

Our movement and LGBT media is so focused on legal advancement and rights, that we don't have enough focus on the homophobia and rejection that make young people destitute, said Siciliano, adding, "Less than 400 beds for more than 200,000 LGBT kids in this country shows we haven't been struggling enough to provide resources to the poor and destitute kids in our community."

Mermin said that while scientific advances like Post-Exposure Prophylaxis could help people who have had sex with someone they know may be infected with HIV, without larger societal changes, science will not be enough to stop the spread of HIV.

Educating About Risky Sexual Behaviors

When it comes to teaching youth about HIV prevention, there is some disagreement as to what the best message is, but no doubt about the best method to reach youth: via the Internet. Unfortunately, this is also where gay youth advertise themselves for sexual hook-ups.

"I don't know if we always have the best tools or messages but at HRC, campaigns targeted to youth have social media numbers off the charts," said Krehely, noting that social media provides a much higher access than ever before.

Siciliano said that they track risk factors of youth clients upon intake, but Mermin noted that many people dramatically underestimate their risk for HIV, and the prevalence of the virus in the community. This can put one at risk for HIV infection. He said people need to learn the basics about how to stay healthy, and then work from there.

"We should hold back from judging people for making decisions or being forced to be involved in unsafe sex when we don't understand everything that they are going through," said Mermin.

Krehely said that presenting an acceptable, sanitized version of what LGBT people are to the mainstream has hurt the reality of issues like substance abuse, mental health issues and HIV.

"Medicating depression and anxiety through substance use is something that is happening every day," said Siciliano. "It's not enough to address the substance issues without addressing the survival issues that compound both of those problems."

Siciliano cited conservative estimates that show that there are 500,000 homeless youth in country, and fewer than 50,000 were able to access any homeless. LGBT make up 40 percent of homeless youth population, and in New York, 40 percent of those youth identify as LGBT. That means there are about 200,000 LGBT youth in the U.S.

"For these youth, their sexuality is the one area in their lives that people want them for," said Siciliano, who said they flood their clients with daily HIV prevention workshops. "Having a stigma added to that like HIV, that is one more thing for people to reject."

Driffin said that among youth, safe-sex messages were sometimes misunderstood. When a partner is taking out a condom, it can signal to youth that they are a sexual risk in some way. But when their partner says they will have sex without a condom, youth can interpret that to mean that their partner is HIV-negative, and they do not need to use protection. These assumptions can have dangerous repercussions.

But as Roberts noted, the education and outreach around HIV is not being reflected in the rising rates of HIV among young MSM in the U.S. Mermin said that the CDC recommends MSM get tested for HIV every year.

Overcoming Barriers to Resources

"If we are not willing to provide housing to homeless youth, we are consenting to the fact that they will get infected by HIV," said Siciliano.
"We need to be protecting our youth, and so making sure there is an adequate safety net for LGBT people has to be one of the core parts of our LGBT movement. If we don't, we will not create the political pressure needed to make a change there."

With the already scant resources for LGBT youth, for those MSM who are not out as gay, accessing services can be a bigger problem. Driffin said that for those youth who are not out, having these discussions about safe sex is almost impossible. They also may not be willing to be seen entering places that are known through the community as resources for gay men.

Mermin said it was critical to keep trying to reach out to people with these messages, through the mainstream medical community. Krehely noted that widespread training on LGBT cultural competency could go far in creating points of contact in youth.

The media needs to continue providing youth with information on how to stay safe, said Mermin. And Krehely said that for HRC, putting this issue back on the map was critical, and "using the larger megaphone to reach the 2 million people we have at our disposal, we have a renewed commitment to doing that."

It also comes down to money, said Krehely. The fact that there are no beds or funds for services is linked to budget cuts in Washington, DC. We must realize that "the budget is a moral document. How our tax dollars are being spent matters. We need to start paying attention to those priorities. We're facing a lot of these challenges because of conservative budget climate in this country."

"I do have a lot of hope in our community in terms of social change," said Siciliano, saying that despite his bleak outlook, he was proud of the gains the LGBT community had made. "We haven't focused enough of how homophobia and poverty come together, with AIDS at the meeting point. Black people are not eight times more likely to be infected because of the color of their skin. Poverty causes this. How do we as a community challenge our power and influences to protect the most vulnerable members of our communities?"

Siciliano was encouraged by Mayor-Elect Bill de Blasio's commitment to add 100 shelter beds a year until the need was met, and wanted to work for a similar federal commitment, saying, "if we find homes for these kids, we will watch these HIV numbers go way down."

"We have to remember it's not about the 48 percent increase, but it's about those specific people, about remembering those people count," said Driffin.

Creating an AIDS-free generation is possible, said Merman, who called it "an aspiration and a necessity," but added, "it will take time, and a lot of effort... it is something I will spend my life working for."