Thirty-two years into the HIV/AIDS epidemic, the federal government continues to squander public prevention dollars by targeting exactly the wrong Americans.
Speaking at a meeting at Boston's Fenway Health, the world's largest LGBT health care and research organization, Gregorio Millett, a Centers for Disease Control and Prevention (CDC) senior scientist and liaison to the White House Office of National AIDS Policy (ONAP), said on Oct. 29 that gay and bisexual men (or MSM, "men who have sex with men," as CDC generically labels us) account for 63 percent of new HIV infections in the U.S..
Yet a 2012 Fenway Institute analysis found that in a 2009 Wisconsin case study, although male-to-male sex accounted for 58 percent of new HIV diagnoses among blacks, only 19 percent of prevention efforts targeted black gay/bisexual men, and black gay/bisexual men accounted for only 11 percent of prevention clients.
The Fenway Institute also reported that a CDC analysis found that only 27 percent of HIV education and risk reduction funding was targeted toward MSM, while 38 percent was targeted toward high-risk heterosexuals and 20 percent was targeted toward other groups. In addition, only 16 percent of National Institutes of Health funding for HIV targeted to a specific risk group was allotted to MSM, according to a 2011 report by ONAP.
In a March 30, 2012, interview with The Georgia Voice, Dr. Kevin Fenton, then the director of the CDC's National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), said that funding for prevention and research with gay men was "about half of what it should be."
"Our own stigma, our own homophobia, cascades down in our funding and allocations, intentionally or unintentionally resulting in underfunding of gay men's work across the country," said Fenton.
There you have it, on the record: the federal government's own top HIV prevention official, a gay man himself, admitting that gay and bisexual men continue to get infected with HIV and die from AIDS in shocking numbers because homophobia at the highest levels of the U.S. government keeps them from getting the targeted prevention interventions they need to support them in avoiding HIV.
Let's be clear: We are talking about a tremendous amount of taxpayers' money that is being wasted.
The Kaiser Family Foundation reports that even though domestic prevention is the smallest category of the federal government's HIV/AIDS budget (a mere 3 percent of the overall budget, and 4 percent of the domestic HIV/AIDS budget), the president's fiscal 2014 budget request includes $977.8 million for domestic HIV prevention across multiple agencies. Of that amount, the CDC would receive $836.1 million.
Gay and bisexual men are the only group among whom HIV is increasing; it is either stable or decreasing among other groups. Young black gay/bi men account for more new HIV infections than any other race or age group.
Millett said that MSM are more likely than heterosexual men or women to get infected because more of them practice anal, rather than vaginal, sex. These men also tend to be sexually versatile, meaning that tonight's "raw" bottom is tomorrow's HIV-positive top, much too often not even knowing he is infected.
"People who aren't aware of their HIV infection account for more new HIV infections," said Millett. The CDC estimates that one in five people with the virus isn't aware of his or her infection.
Not only that, but Millett pointed out that only one in four HIV-positive Americans who know they have the virus actually has his or her infection under control with medication that reduces the risk of infecting someone else to almost nothing.
"It's not enough to get MSM into care," said Millett. "How to keep them in care is the $64,000 question."
Another $64,000 question that demands an answer is this: When is the federal government finally going to allocate HIV prevention funding in proportion to the actual facts of the epidemic in this country?
The Obama administration's 2010 National HIV/AIDS Strategy, the country's first attempt in 30 years to coordinate its response to the deadly epidemic, makes it clear that the government expects the LGBT community to step back up to the plate in doing our own HIV prevention education work.
Page 14 of the strategy document says, in boldface type, "The United States cannot reduce the number of HIV infections nationally without better addressing HIV among gay and bisexual men." It continues, "Our national commitment to this population has not always reached a level of HIV prevention funding reflective of their risk." Further down the page it says, "The burden of addressing the HIV epidemic among gay and bisexual men and transgender individuals does not rest with the government alone. Early in the epidemic, the lesbian, gay, bisexual and transgender (LGBT) community developed its own education campaigns and institutions to reduce HIV infection in the wake of inaction by government and other institutions. Continuing these efforts is important to our success."
It is certainly fitting that the LGBT community should be the primary "owner" of the HIV prevention interventions aimed at our people, but it's essential to point out that in the early years of the epidemic, gay Americans were forced to create and pay for our own prevention brochures, public education, services, and even medical research precisely because neither the government nor most private sources of funds at the time considered the lives of gay men valuable enough to protect.
Emerging research makes it clear that interventions aimed at gay and bisexual men must address anti-gay and HIV stigma, as well as the mental health and substance abuse issues that undermine both self-protective behavior and treatment adherence for those with the virus.
To be effective, interventions aimed at MSM also must be designed with their audience in mind. Since the earliest years of the HIV/AIDS epidemic, public health experts have consistently said that effectiveness requires interventions that are culturally appropriate, targeted, and explicit. This means using messages with words and images that gay and bisexual men relate to. Ideally it will include explicit images that show and tell MSM what is and isn't safe and encourage them to take control of their own health.
For the CDC's Sept. 27 National Gay Men's HIV/AIDS Awareness Day, the current prevention chief, Dr. Jonathan Mermin, said, "As CDC reaffirms its commitment to reducing HIV's impact among gay and bisexual men, today, we call on the entire gay community to re-engage in this fight and put HIV prevention back on the agenda."
Gay America must turn the challenge around to the nation's political and public health leaders: Are you finally willing to provide proportionate federal support for prevention initiatives proven to be effective for gay and bisexual men?
Will the president, who has spoken so eloquently about gay Americans' equality, direct the public health scientists who work for him to finally protect our lives as if he actually believed that they are every bit as valuable as those of non-gay Americans?
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