While we have made incredible strides in addressing HIV/AIDS over the past 30 years, the disease remains devastatingly prevalent in America, especially among gay and bisexual men. This population accounts for 57 percent of new HIV infections and a gay man who is 18 years old faces a two in five chance of becoming infected with HIV by the time he is 40, as noted by a Trust for America's Health (TFAH) issue brief. In 2009, the estimated rates of new HIV infections among black men and Latino men were 6.5 times and 2.5 times as high, respectively, as that of their white counterparts. Disparities are most severe among young black gay and bisexual men.
The National HIV/AIDS Strategy (NHAS) provides a roadmap for national efforts to end the HIV/AIDS epidemic. The primary goals of the NHAS are to reduce HIV incidence, increase access to care, optimize health outcomes and reduce HIV-related health disparities. The NHAS describes priority areas in need of interventions, outlines steps for a coordinated national response to the HIV epidemic and identifies measurable outcomes. This strategy reinforces the importance of focusing efforts on those at greatest risk, and is paramount in addressing the prevalence of HIV/AIDS among gay and bisexual men, particularly among racial and ethnic minorities.
A critical step in achieving the goals of the National AIDS Strategy is increasing awareness of HIV status (or "serostatus") among gay and bisexual men. Almost 50 percent of HIV transmissions come from the 20 percent of HIV-positive individuals who are unaware of their status. Promoting HIV testing and early linkage to care helps suppress viral load, reinforces less risky behavior, and helps prevent the transmission of HIV.
Increasing knowledge of serostatus requires routine HIV testing in the clinical setting, which can be accomplished through changes to guidelines and reimbursements. This is incredibly important because most individuals who do not know their status have actually had a recent interaction with the health care system but, unfortunately, were not tested. In order to reach the highest-risk populations, including racial and ethnic minorities, there is a need to train providers on testing and creating culturally competent approaches to gay men's health in general.
Representative Maxine Waters recently introduced important legislation that would promote increased HIV testing by removing cost as an obstacle. The Waters bill, Routine HIV Screening Coverage Act of 2012 (HR4470), would require all individual, group and federal employee health insurance plans to reimburse for HIV testing. This bill would be a significant step toward encouraging those who are unaware of their status to get tested.
As noted by the NHAS, HIV testing is just one piece of a comprehensive set of services that are needed to end the HIV epidemic. Expanded knowledge of serostatus must be complemented by a supportive environment for the gay and bisexual community. HIV prevention and treatment efforts, especially for racial and ethnic minorities, can be compromised by stigma and the social determinants of health, including access to stable housing, education, health care, and other key resources. Resources must be provided to mobilize the gay and bisexual community and promote gay men's health at the national, state and local level.
We've come a long way in the battle against HIV/AIDS. However, we must remain vigilant: We cannot ignore the startling statistics of new HIV infections of gay and bisexual men, especially among black and Hispanic men. By pursuing the comprehensive approach to prevention and treatment outlined in the National HIV/AIDS Strategy, we can begin to end the HIV/AIDS epidemic.
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