On the 35th Anniversary of HIV/AIDS, Will Nation's HIV/AIDS Strategy Ever Reach Black MSM in the South?
Ready to take charge
In mid-May, new data from Emory University showed convincing evidence of the elevated rates of HIV among MSM, with the highest concentration among gay and bisexual men in the South.
This "new" data was surprising to exactly no one who has been following the country's HIV trends. The more shocking news arrived earlier this year when the Centers for Disease Control and Prevention (CDC) found that half of black gay and bisexual men in the United States will be diagnosed with HIV in their lifetimes if current trends continue. That compares with a lifetime risk of 1 in 99 for all Americans and 1 in 11 for white gay and bisexual men.
But the devil is in the details, and some of the specifics of the new research out of Emory had the power to stun. First, it is crystal clear that the U.S. HIV/AIDS epidemic is situated squarely on the shoulders of Black MSM in the South. The equation is straightforward: Twenty-one out of 25 metropolitan areas with the country's highest HIV burden for gay and bisexual men are located in Southern states—where the majority of African Americans reside.
According to the new data (pdf), here are the top 10 metro areas, along with their rates of gay and bisexual men diagnosed with HIV:
1. Jackson, Miss.: 39.49 percent
2. Columbia, S.C.: 29.65 percent
3. El Paso, Texas: 28.53 percent
4. Augusta-Richmond County, Ga.-S.C.: 26.56 percent
5. Baton Rouge, La.: 25.40 percent
6. Little Rock-North Little Rock-Conway, Ark.: 23.33 percent
7. Greensboro-High Point, N.C.: 20.98 percent
8. Charleston-North Charleston, S.C.: 20.08 percent
9. New Orleans-Metairie, La.: 19.71 percent
10. Memphis, Tenn.: 17.61 percent
Epidemiologist Eli Rosenberg, Ph.D., of Emory University, who directed the study, believes that his research provides a tool for policymakers and health practitioners. "MSM are a high-priority population, and the South is the area of greatest concern," Dr. Rosenberg said in a press conference just after the study was released. "We hope that this data can be used to allocate resources for the most effective prevention and care."
Although the New York City area has the most gay and bisexual men living with HIV in raw numbers—over 46,000—Jackson, the capital of Mississippi, has moved into the No.1 position regarding prevalence, with an infection rate just short of 40 percent. That rate is higher than those in Swaziland, Lesotho and Botswana, the impoverished nations in sub-Saharan Africa with the highest levels of HIV in the world.
Why has this city of just over 171, 000 residents—known for gospel, blues and R&B—shown such high rates of HIV? Jackson, 80 percent Black, grapples with limited access to health care, joblessness, poverty, housing insecurity, incarceration, homophobia, stigma and racism—which have fueled the epidemic across African American communities. To make matters worse, like a number of other Southern states, Mississippi refused to expand Medicaid under the Affordable Care Act, limiting access to prevention, care and treatment options for everyone, most pointedly PLWHA.
To seal the state's fate, in April, Mississippi Gov. Phil Bryant signed into law some of the country's most sweeping anti-LGBT legislation—sanctioning bigotry under the guise of religious freedom. It has been shown—ad nauseam—that this kind of stigma fuels the spread of HIV.
Terrance E. Moore, deputy executive director of the National Alliance of State and Territorial AIDS Directors, puts it simply: "We have a raging fire on our hands."
The U.S. government insists that it has not fallen asleep at the wheel and is working to tackle the problem. In 2015 the CDC directed $38 million to help health departments and community-based organizations expand access to PrEP and HIV care and treatment for gay and bisexual men and transgender individuals of color, according to Jonathan Mermin, M.D., MPH, who directs HIV/AIDS prevention for the CDC. Between 2010 and 2015, he says, the agency increased its overall support to Southern health departments and community-based health organizations by 22 percent.
"The Emory study tells us that our HIV/AIDS prevention strategy, with its focus on the communities where HIV is most heavily concentrated, is on the right path," Dr. Mermin says.
As we mark the 35th anniversary of the date the CDC reported the first case of AIDS in the United States, this approach, though well-intentioned, remains a day late and a dollar short. "In effect, HIV is a rite of passage for gay men no matter where we live in the U.S., and especially men of color," says Greg Millett, vice president and director of public policy at amfAR. "Resources must follow the epidemic."
People in some of the hardest-hit areas have taken matters into their own hands, mounting creative responses to the epidemic. In Louisiana—where two cities are on the list of highest infection rates among African American gay and bisexual men, and where 45 percent of African Americans live in poverty and 42 percent are uninsured—the core values of the state's HIV strategy (pdf) include addressing racism as well as increasing testing and linking PLWHA to care, treatment and prevention. In Jackson, organizations on the ground, like My Brother's Keeper and the Crossroads Clinic, the state's only publicly funded HIV facility, are working to make a difference. And Leandro Mena, M.D., MPH, recently cofounded the Open Arms Healthcare Center, Mississippi's only HIV/AIDS clinic focused on the needs of LGBT residents.
Millet calls for a collective approach. "We have great recent examples where Americans have banded together to address urgent issues," he says, citing anti-bullying initiatives and LGBT marriage equality. "Let's also turn a corner on the high rates of HIV among gay men by putting our resources and efforts where they are needed most."
Linda Villarosa runs the journalism program at City College in Harlem and writes frequently about health and social issues. You can follow her on Twitter.