Gay black men have disproportionate rates of HIV

A recent article in JAMA (Jan 23, 2008) tries to sort through the puzzling statistics of HIV among gay black men. Try as she might, Ms. Voelker can't link poverty or lack of health care, although she tries. Like most of the other health problems among Americans, it's behavior.

"Studies Illuminate HIV’s Inequalities," Rebecca Voelker, JAMA. 2008;299(3):269-275.

Here's my take away from reading the article:

1) They have unprotected sex with men, as do many gay men, and report less than other groups since 1990--before that it was much higher.
2) They are more likely to have sex with other black men who are also likely to be infected. This could result in co-infections.
3) They have numerous sex partners, although this is common for gay men in general, so is not an unusual trait for their race, and they report fewer than other groups.
4) They "don't disclose their sexual orientation [to researchers]", i.e. they lie about being gay (called down low), or don't consider themselves gay even if having sex with men. I would think this could affect the results of #1 and #3.
5) Because they don't think they are gay, they don't seek antiretroviral treatment, which means they have high levels of the virus in their blood, and if having sex with other black men, are more likely to transmit it.
6) More likely to have other current STDs which lowers their immunity--gonorrhea incidence among HIV-positive men is soaring and there is an ongoing syphilis epidemic among gay men.

The presenter of the statistics, Greg Millett, MPH, a CDC behavioral scientist, will probably get into trouble for pointing out these racial differences. Or, maybe he'll just get more grant money to study the behavior more closely. But for every dollar spent focusing on social problems like race and income, that's one less dollar focusing on the virus.

The only reason to even report on HIV/AIDS is because of the attention it gets from the media, the President (see the outrage over the 2009 budget that he didn't fund it at higher levels), the ex-President and Bill Gates. Only about 5% to 7% of male adults and adolescents in the United States identify themselves as men who have sex with men, but they have 71% of the AIDS/HIV. One of the unintended consequences of improved treatment has been a growing carelessness about protection and casual sex.

Auto accidents are still far and away the big killer of young people and we could save thousands and thousands of lives of our children just by raising the legal driving age to 18. No one has been able to figure out a poverty, gender or race angle for this common sense move, so we'd rather shower research dollars on a behavior we can't control.