WASHINGTON -- For years, there was a widespread perception that AIDS just affected gay, white men and heroin users.
The perception was never really accurate, but now a new report shows that, in fact, young, black gay and bisexual men are more likely to be infected with HIV than any other segment of the United States population. And each year, the number of infections is increasing.
The report presented at the International AIDS Conference this week in Washington D.C., by the Fenway Institute, shows that in the United States, black men who have sex with men are nearly twice as likely than their white counterparts to get infected; in the same category, those younger than 30 are more than three times as likely to get infected. Each year, the report found, nearly 6 percent of black gay or bisexual youth contract HIV.
At the conference, there were lengthy discussions about promising new HIV medications, but the hopefulness for some was diminished by the findings, which add to a mounting body of research painting the same picture. Young, black gay and bisexual men are also among the population least likely to have access to the groundbreaking new treatments.
Kenneth Mayer, the lead researcher on the study, said no one factor explained the higher rates of infection in this group. Rather, the researchers saw a confluence of factors like poverty, less education about safe sex, and less access to health care. "Obviously, there were some behavior risks," Mayer explained, referring to men who have unprotected anal sex.
Unprotected sex is even riskier when it occurs among a highly affected population group, like black, gay men. But independent of that poverty and unemployment influenced a person's chances of infection, too. "There are these overlapping epidemics that predispose people towards bad health outcomes," Mayer said.
Jahlove Serrano knows about overlapping epidemics. He's a black, gay, HIV-positive, 25-year-old AIDS activist and youth advocate. These days, with the help of medication, his health is under control. But for years, his life felt like chaos, and he got sicker and sicker. Sitting in the "Youth Pavilion" at the AIDS conference, Serrano explained that he was infected with HIV the night he lost his virginity, contrary to his expectations, in a one-night stand with an older man he met on Christopher Street, just a few days before his 16th birthday.
Before he lost his virginity, he had been living with his family in the Bronx, attending high school, and worrying about whether he could stay popular if he didn't have sex, like the rest of the cool kids at school. But then his mother found out he was gay and kicked him out of the house. He had to drop out of school and start working at McDonalds to get by. "So just days into my 16th year, I'm homeless, HIV positive, a high school drop out, and had no one to really turn to," Serrano summed up.
He didn't get tested for a year after he contracted HIV, even though he heard a rumor that the one-night stand was positive, and he didn't start regularly taking medication until four years later, after he was diagnosed with cancer and AIDS.
"I didn't want to get my results, I didn't want to know," Serrano said.
After he found out he was positive, he sunk into depression. For years, he said, he avoided health clinics, and when he did go to the doctor, he would wear a sweatshirt with the hood pulled up so he wouldn't be recognized. In those years, he didn't understand the health-care options available, and didn't see the point of seeking treatment. "I thought I was going to die," he said.
Researchers still don't know why young black men who sleep with men are at greater risk than their older counterparts, but as Mayer pointed out, not everyone who becomes infected at an early age engages in risky sex or has difficulty navigating the health care system.
"We know in general that there are some black gay men who are quite safe, and for them, it's the perils of love and monogamy," he said. "There are many different narratives."
Tony Ray, 26, a black activist at the Bronx AIDS Services, said some narratives are more difficult than others, and that can contribute to the ongoing stigma of the disease. Ray was infected when a condom broke during a one-night stand when he was 17. "In a really weird f---ed up way people judge you by this moral standard," he said. "It's like, 'Oh the condom broke? I'm so sorry'. 'Oh, you were having sex without condoms? Well, that was f---ing stupid'."
Phil Wilson, the director of the Black AIDS Institute, has written frequently about how the dominant narrative about HIV as a gay, white man's disease has contributed to rising rates of infection within the black community.
"Neither our national leaders, nor Black America itself, responded as they should have to the clear signs of an emerging health crisis among Black people. Few programs were put in place to address the HIV related needs of Black people in the epidemic’s early years," WIlson wrote in a recent report. "Only during the third decade of AIDS was the epidemic considered to pose a “state of emergency” in Black America. By this point, Black people were more than seven times more likely than whites to become infected."
In his outreach work with youth in the Bronx, Ray sees two dominant patterns among young people who are infected. Some think they are invincible, and that nothing can touch them, the others are defeatist.
"They think, 'all the data shows that a good number of people my age are going to get it, so I might as well go out and get it'," said Ray, who sees a doctor every three months, and has been on medication since 2008. "The only thing I can ask them is this: Why put yourself at risk when you can take care of yourself?"
CORRECTION: A previous version misidentified Bronx AIDS Services as "Bronx AIDS Institute." Language has been added to characterize Serrano's frame of mind when he lost his virginity.