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The Face of HIV in USA by 2013

Poor Black and Hispanic Men Are the Face of H.I.V.

Nicole Bengiveno/The New York Times
Roderick, who is gay, came to New York after family ties became too strained, saying, “I’m just basically dead to my family now.”

The AIDS epidemic in America is rapidly becoming concentrated among poor, young black and Hispanic men who have sex with men.
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Nicole Bengiveno/The New York Times

Alex, 20, says, “I have three strikes against me: I’m black, I’m gay, and I’m in a wheelchair.”

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Despite years of progress in preventing and treating H.I.V. in the middle class, the number of new infections nationwide remains stubbornly stuck at 50,000 a year — more and more of them in these men, who make up less than 1 percent of the population.
Giselle, a homeless 23-year-old transgender woman with cafe-au-lait skin, could be called the new face of the epidemic.
“I tested positive about a year ago,” said Giselle, who was born male but now has a girlish hair spout, wears a T-shirt tight across a feminine chest and identifies herself as a woman. “I don’t know how, exactly. I was homeless. I was escorting. I’ve been raped.”
“Yes, I use condoms,” she added. “But I’m not going to lie. I slip sometimes. Trust me — everyone here who says, ‘I always use condoms’? They don’t always.”
Besides transgender people like Giselle, the affected group includes men who are openly gay, secretly gay or bisexual, and those who consider themselves heterosexual but have had sex with men, willingly or unwillingly, in shelters or prison or for money. (Most of those interviewed for this article spoke on the condition that only their first names be used.)
Nationally, 25 percent of new infections are in black and Hispanic men, and in New York City it is 45 percent, according to the Centers for Disease Control and Prevention and the city’s health department.
Nationally, when only men under 25 infected through gay sex are counted, 80 percent are black or Hispanic — even though they engage in less high-risk behavior than their white peers.
The prospects for change look grim. Critics say little is being done to save this group, and none of it with any great urgency.
“There wasn’t even an ad campaign aimed at young black men until last year — what’s that about?” said Krishna Stone, a spokeswoman for GMHC, which was founded in the 1980s as the Gay Men’s Health Crisis.
Phill Wilson, president of the Black AIDS Institute in Los Angeles, said there were “no models out there right now for reaching these men.”
Federal and state health officials agreed that it had taken years to shift prevention messages away from targets chosen 30 years ago: men who frequent gay bars, many of whom are white and middle-class, and heterosexual teenagers, who are at relatively low risk. Funding for health agencies has been flat, and there has been little political pressure to focus on young gay blacks and Hispanics.
Reaching those men “is the Holy Grail, and we’re working on it,” said Dr. Jonathan Mermin, director of H.I.V. prevention at the C.D.C. His agency created its Testing Makes Us Stronger campaign — the one Ms. Stone referred to — and has granted millions of dollars to local health departments and community groups to pay for testing.
But he could not name a city or state with proven success in lowering infection rates in young gay minority men.
“With more resources, we could make bigger strides,” he said.
Reaching Out
Gay black youths are hard to reach, experts say. Few are out to their families. Many live in places where gays are stigmatized and cannot afford to move. Few attend schools with gay pride clubs or gay guidance counselors.
“When we talked about H.I.V. in sex ed, the class started freaking out,” said Alex, 20, who was born in St. Croix but raised in New York. “One guy said, ‘We ain’t no faggots; why do we have to learn this stuff?’ So the teacher stopped and moved on to another topic.”
When those who are poor and homeless go to traditional gay hangouts, they become prey.
Kwame, a 20-year-old from Philadelphia, said that on his first day wandering around New York last year, he was propositioned by an older homeless man and by an older transgender person. The homeless man later admitted that he was infected, and added: “If you sit here long enough, you’re going to get some propositions — and that’s where you’re going to sleep tonight. It happened to me, and it’s going to happen to you.”

A version of this article appears in print on December 5, 2013, on page A1 of the New York edition with the headline: Poor Black and Hispanic Men Are Face of H.I.V..

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244 Comments

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    • ES
    • New York
    The article does state that a study showed these young men engaged in less risky behavior than their Caucasian peers, but don't forget that this is a self reported statistic. I don't doubt that a large part of this is access to healthcare and the availability of medication to quell viral load, but I think a bigger part is the fatalistic attitude that lack of hope brings that was briefly touched on in the article. These young men know better, but they don't always feel that they have choices or care because of the situation they are in. That is a deeper and more problematic issue and harder to address than merely educating them about the dangers of HIV and infection. Because chances are, they have the knowledge. That's not the problem.
      • Derek S.
      • New Orleans
      Check out
      www.whamproject.org and video of Mandela about "HIV/AIDS is a human rights issue." Thanks Madiba for your 46664 and everything else, RIP.

      Sorry, but Obama has dropped the ball here.
      He and Michelle were HIV tested in 2005 in Kenya.
      He should volunteer to be tested yearly in Washington, DC [HIV Central] on World AIDS Day - does he not realize that his position would save lives? Very simple and effective public health tool.

      It would also help if some rappers came clean about their HIV status. Eazy-E was not the only rapper with HIV. Rap should also avoid further stigmatizing songs about HIV/AIDS. That would also save lives. It's not a coincidence that the genre has a lot of stigmatizing rap about people with HIV when the music is aimed at the people who are transmitting it the most.

      Oh, and lastly, HIV/AIDS is a disease of poverty. The more this country downpresses people into poverty, no living wage, neocolonial neoslavery conditions, won't make a further dent in HIV/AIDS rates.
        • Sly
        • Florid
        Derick:

        Respectfully, or perhaps not so respectfully Id have to disagree with you on a couple of points. How could you possibly attribute this statistic to President Obama? Symbolic gestures from the President won't change minds or deter the behaviors of those people who expose themselves to infection.

        This disease has been on the scene for over 30 years now, so in terms of public awareness there isn't a lot of new information. Secondly, I would very much disagree with your comment on HIV/Aids being a disease of Poverty. Aids is a disease of behavior, unprotected sex, intravenous drug use (the two most common means of infection) have more to do with it's spread along with the secret subculture of 'down low' activities. It really doesn't have a lot to do with income disparities.
      • LittlebearNYC
      • NYC
      Excellent article- and incredibly frustrating and sad.

      One point - GMHC's acting chief executive blames 'government indifference' to their cuts in programs without mentioning their chronic budget mismanagement, wasting money on their two former headquarters, and trying to be all things to all people by de-emphasizing the GAY in GMHC. I and many of my friends have not given to GMHC in ages due to the incompetent management.

      GMHC must get back to its mission and we all need to demand more money for HIV Prevention (as opposed to just HIV Testing - a favorite with the Bloombergians).
        • hen3ry
        • New York
        • Verified
        I read Randy Shilts's two books about AIDS. Both of them are heartbreaking because of what they are about. AIDS is a disease that may have started in the gay population but it was not God's divine wrath for a person's sins. It's a disease and it has no interest in a person's sexual preferences, drugs of choice, etc. All it "cares" about is spreading and if sex is the easiest way to spread it uses that. Reagan didn't want to be known as the AIDS president. He tried to ignore it but his surgeon general, C. Everett Koop, an old fashioned man if there ever was one, knew better. Judging people's morality by their sexuality is wrong. And telling them that their sexual preferences are against the laws of God is also wrong. No one asks to be gay or lesbian or straight. We don't ask to be black, white, yellow, or brown. Yet everyone is prone to various diseases by virtue of their genes, lifestyle, etc. AIDS is a very "opportunistic" disease. Give it enough chances and you will get it. Therefore the face of AIDS is not just gay, young, rich, poor, black or anything else. We are all the face of AIDS. Therefore we all ought to be able to be tested for it, learn how to prevent it, and, if we get it, be treated for it.
          • BeachcomberT
          • Daytona Beach Fl.
          As I read the statistics about the infection trends, I keep wondering why President Obama hasn't filmed a video aimed at the young blacks who hero-worship him. The message can be simple: get educated, get tested, get protected. And Mrs. Obama could give an equally effective message to the black women.
            • Henry
            • Petaluma, CA
            Black women, who are closing the gap with white men and women, are doing better. But black men are falling further behind - now there is a significant gap (employment, schooling, prison, etc.) growing between black men and women.

            Honestly, black men as a group seem like they are in free fall. Really depressing.
          • Ted White
          • Seattle
          If consistently healthy behavior were easy, we'd all be thin. Please remember that in your comments.
            • Katie
            • Oregon
            @Doug from San Francisco

            Read everyone else's comments above mine for a little enlightenment about the tragic circumstances of these kids' lives. They said it far better than I did.
              • Arthur Leonard
              • New York City
              As somebody who has been writing about the legal aspects of the AIDS epidemic since the early 1980s (I authored the chapter on discrimination in Lambda Legal's AIDS Legal Guide, published in 1984, and the first law review article about AIDS discrimination in 1985), I want to commend reporter Donald G. McNeil, Jr., and the NY Times for this very important article. The HIV/AIDS epidemic is not over, alarms need to be sounded, and the government needs to wake up to the kinds of public health campaigns necessary to reach those most at risk for acquiring HIV infection. This article can help to be that wake-up call.
                • Sonny Pitchumani
                • Manhattan, NY
                Two men in a loving relationship, sharing love, is a good thing. But the same two men sharing anal sex are taking huge risks. In our eagerness to be politically correct, are we giving short shrift to our collective responsibility to ensure that risky sexual behavior is avoided?

                These poor black and Hispanic men with HIV are mostly eligible for medicaid, and we need to begin to be mindful of costs, now that Obamacare is pushing a boatload of people into Medicaid.
                  • Random Thought
                  • Brooklyn
                  I am not sure that I understand the use of the term "politically correct" (which seems to be a throw away term that is used whenever people don't know what else to say) in this context. When has anyone ever advocated unsafe sex when encouraging others to support gay men?
                • Mike
                • Chicago
                I am reminded of a bible verse from 1 Corinthians 6:18 which would apply here and to all who practice fornication, "Flee from sexual immorality. All other sins a person commits are outside the body, but whoever sins sexually, sins against their own body."

                A previous verse gives a broader warning, in verse 9-11,
                " Or do you not know that the unrighteous will not inherit the kingdom of God? Do not be deceived; neither fornicators, nor idolaters, nor adulterers, nor effeminate, nor homosexuals, nor thieves, nor the covetous, nor drunkards, nor revilers, nor swindlers, will inherit the kingdom of God. Such were some of you; but you were washed, but you were sanctified, but you were justified in the name of the Lord Jesus Christ and in the Spirit of our God."
                  • Marcos
                  • New York City
                  Quoting Bible verses literally and out of context with Christ's own words does very little to bring about understanding of what it means to be a Christian.
                  • James
                  • Philadelphia
                  And a post like this reminds me that, in the words of Christopher Hitchens, religion poisons everything.

                  Why wouldnt you select another bible passage? Say, for instance: "I do not permit a woman to teach or to have authority over a man. She must be quiet." (1 Timothy 2:12)

                  or

                  "Slaves, be subject to your masters with all reverence, not only to those who are good and equitable but also to those who are perverse." (1 Peter 2:18)

                  Oh, these passages are relics of their time, right? Absolute nonsense.
                • frugalfish
                • rio de janeiro
                What goes around, comes around.
                What started as a "gay" disease, morphed into a more inclusive disease, but then de-morphed or re-morphed back into a "gay" disease.
                Part of this is because of the success of treatment. In the beginning, AIDS was a death penalty. Now it's not. There are lots of people who simply don't care about the risk because they think medicine will help them. Some of them, but only some of them, are right.
                  • Seagulls
                  • Virginia
                  None of that sounds accurate at all. The people profiled in this article sound like they've had very hard lives, and when you're cut loose from your family and have no sense of self-worth, and no place safer to go, you do what you must to survive, even if it puts you in unsafe situations where rape is likely. At least some of these profiled were almost children when they got sick!. Have some compassion.
                • Eilat
                • New York
                "Two men in a monogamous relationship has the same chance of getting AIDS as a man-woman couple in a monogamous relationship, namely zero."

                FALSE. Anal intercourse is riskier than vaginal intercourse, period.

                However, heterosexual women are more vulnerable to contracting AIDS than men are due to their receptive role.

                It's hight time for the gay male community to stop perpetuating misinformation for their own ends. Speak the truth.
                  • Lucas
                  • Washington, DC
                  HIV does not spontaneously generate. Two HIV-negative men in a monogamous relationship could have unprotected anal sex every single day and neither one will acquire HIV.
                  • elotrolado
                  • central california coast
                  Eilat, you are wrong and it is more complicated. If the virus is not present in a monogomous relationship, regardless of gender or body parts, it is impossible to acquire HIV, unless through shared needles or some freak accident involving blood exchange. People with HIV whose viral loads are suppressed by taking their meds as prescribed are highly unlikely to transmit HIV, again regardless of gender or type of sex.
                • Michael F
                • Yonkers, NY
                HIV is a disease caused by a specific behavior. End the behavior and you end the disease. The problem is that gay men do not wish to do this in sufficient numbers. Their race or ethnicity has nothing to do with it.
                  • Sam Kelly
                  • Dc
                  And what about the women who get HIV? What about the children who are born to infected mothers who then become HIV positive themselves? What about those who used blood transfusions before they were screened, or hemophiliacs who used tainted factor 8 (again, before it was screened). HIV is not a "gay only" disease, it affects men AND women of ALL ages, from infants all the way up to those who are in their golden years. According to the CDC, 25% of new infections are in heterosexuals. That means 12,000 heterosexual individuals were diagnosed in 2011. One other correction, HIV is caused by a special type of virus that is able to attack the immune system and shut it down if left untreated (full blown AIDS), NOT a specific behavior. It is transferred by the same body fluids that transmit other blood-borne illnesses.
                  • elotrolado
                  • central california coast
                  HIV transmission is caused by a range and combination of many factors, including the sociological ones pointed out in the article you are commenting on. Human behavior is complex. For example, any youth who has been bullied in school and rejected by their parents and are living on the streets, are susceptible to drug use that temporarily makes one feel good and turns off the negative thoughts which in turn increases the risk for unprotected sex. If only human behavior were as simple as a wish.
                  • jzzy55
                  • undefined
                  • Verified
                  Heterosexual sex also passes it on. That''s not exactly news.
                • Alan
                • Livermore, CA
                Disease has always spread fastest among the impoverished in any society. This is no exception. Poverty generates desperation. Desperation produces risk taking. Drugs and alcohol, also more prevalent among the impoverished, depress your recognition of dangerous behavior. It's like the bell on a horn, it's not too steep and slippery at the top but the sides get steeper and steeper as you slide down.
                  • Matt Nadler
                  • NJ
                  To "J", I think the message is less of "responsibility", and more of "risk". Letting people know their odds are much greater of contracting aids is not "lecturing" in a pejorative sense.

                  These CDC stats are telling:

                  http://www.cdc.gov/hiv/pdf/statistics_basics_factsheet.pdf

                  Two extracts:

                  "Blacks represent approximately 12% of the U.S. population, but accounted for an estimated 44% of new HIV infections in 2010. They also accounted for 44% of people living with HIV infection in 2009"

                  "Unless the course of the epidemic changes, at some point in their lifetime, an estimated 1 in 16 black men .... will be diagnosed with HIV infection"

                  This is not a case for being subtle.
                    • elotrolado
                    • central california coast
                    Compassion and help would serve these folks far better than judgment.
                  • Thallinan
                  • Los Angeles
                  Not to downplay the individual tragedies these numbers represent, blacks and Hispanics combined represent 29% of the U.S. population. To say that 25% of all new infections are among blacks and Hispanics does not exactly suggest a selective plague.

                  The New York figures are out of control, though. It might be that some work to fight homophobia in the black and Hispanic populations would also reduce these numbers -- that kid who didn't want to learn about safe sex because he wasn't a "faggot" has issues that need to be addressed, and as long as those attitudes are prevalent, they'll stifle a serious discussion of HIV issues.
                    • Changed and Changed Back
                    • San Francisco CA
                    Hmm ... Just taking your figures at face value.

                    That 29% of the US population would include black and Hispanic women along with black and Hispanic heterosexual men. So, if 25% of the new cases are black or Hispanic gay men. Well, you do the math. I would argue the plague is very selective indeed.
                  • tsvietok
                  • Charlotte, NC
                  Look at these stats:
                  http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6247a4.htm?s_cid=mm6247a4_w#tab1

                  Almost 2/3 of gay men have sex without condoms although they know they have Aids. Being impoverished would only increase this statistic since condoms cost money.
                    • john
                    • denver, colorado
                    The title is deceptive. Where are the profiles of Latinos?
                      • MKM
                      • New York
                      Education, Education and some more Education - the only answer. That said, each and everyone of these young men knew and understood the risks associated with unprotected sex. So the answer, more Education, more Education and more Education.
                        • abm
                        • Seattle
                        NYT Pick
                        Public health campaigns do work, if properly resourced and committed to. Children in this country no longer suffer from polio, for example. But HIV/AIDS has always been a tougher sell, in part because people can register their disapproval for homosexuality by adopting a "blame the victims" stance. When it's concentrated in the poor, that's an easy two-fer: blame the poor AND blame the gays (for their "poor life choices", as some have remarked here).

                        I do agree, however, that trying to address bigotry within minority communities is not a good job for government. Popular culture, entertainment, celebrity role models, and the clergy will likely have a greater impact over time. But what government CAN do is to encourage HIV testing, and try to get the infected on treatment. Studies have shown that those with undetectable viral loads are 96% less likely to transmit the virus, even if sex isn't protected. And yes, condoms are equally effective and way cheaper, so continued effort must be put into promoting their use, as well.

                        Thanks for a great article, NYT.
                          • Mary
                          • Atlanta, GA
                          From the CDC, the incidence of HIV has increased in the heterosexual population - it is the only growing group. Why? Primarily because people no longer see aids as a killer. So many are living long lives now with the advent of medication cocktails, that it's urgency is ignored by many.

                          The fact that the incidence is not changing for blacks and hispanic men is a non-story. It's not because they have been ignored, as this article would have us believe - they know about aids and how it's contracted. It's because a) the black and hispanic cultures do not recognize or sympathise with homosexuality. Both see it as a white problem. b) the black and hispanic communities to not like condoms - a problem healthcare providers deal with every day in black communities in the US and in Africa, as well as latin america. It's not considered manly to wear a condom.

                          Until the communities work together from within to change their culture, the prevalence of HIV within these two ethnic/race groups will not change.
                            • Dialethia
                            • Brooklyn, NY
                            NYT Pick
                            Except that the article specifically stated that a major CDC study showed that black men engaged in less risky behavior, and were actually more likely to use condoms than their white peers.

                            A major factor is access to proper health care. Many HIV positive black and Latino men and transgender women are not getting proper treatment and are thus much more likely to spread the disease than someone who is treated properly and has an undetectable viral load. Some of this has to do with stigma (e.g. people not wanting to get tested because being HIV positive is considered shameful), but a lot of it is simply about poverty.

                            Preventative measures like condoms are very important, but it is also important to recognize that there are other issues at play here. If society as a whole invested in health care for low-income communities, I'm sure we would see a drop in HIV infections.
                            • A.
                            • NY
                            I wonder how many of the young, gay, black and hispanic men "whitewashed" their sexual histories to avoid further stigmatizing. Or why would they have fewer partners and use condoms more often than the average young, gay white men?
                          • mr isaac
                          • los angeles
                          Thank you NYT for this revealing update. We spend no money to reach these kids, who we've ostracized since puberty, and wonder why we pay quintuple the amount for them when they start dying. As for black preachers, hah. They take the money when the funeral comes around. Keep fighting young people - we love you!
                            • Claire
                            • Chevy Chase MD
                            Unfortunately this behavior is not limited to poor black men. I know educated, affluent black gay men who participate in risky sexual behavior. I have 4 black gay male friends who each have master's degrees (2 working on their doctorates) and ALL engage in unprotected sex. I have confronted them about their behavior because I just can't understand it. They have NO rational excuses. These men are only out to some of their friends and to limited family members. They have more white friends than black friends and aren't even open with one another. It's so bizarre. Yet all have confided in me (I am a white female) that they have unprotected sex. I DO NOT comprehend this risky behavior.
                              • Dialethia
                              • Brooklyn, NY
                              I know affluent, educated, white and Asian people (men and women) who engage in risky sexual behavior too - unfortunately, it's very common. People off all races and income-levels do this sometimes. As the article states, some studies show that Black men actually engage in less risky sexual behavior than whites.

                              Don't make unprotected sex into a Black thing when there is no evidence that it is more common in that community.
                            • Z
                            • Toronto
                            HIV/AIDS is an illness that most dramatically affects marginalized communities. In Canada Aboriginals are about 2% of the population but are over represented in new cases. In the U.S black women are also dis-proportionally affected. Sub-Saharan Africa is one of the most impoverished regions in the world and is home to over half of the world's infected persons. REDUCE POVERTY AND REDUCE AIDS. People will be better educated, more engaged with their communities, and have the appropriate health resources to combat this disease.
                              • JCT
                              • South America
                              This is SO sad, am a bit upset, a bit speechless, ...... how can WE help? Though I'm not surprise, to know that many gay men are continuing to have unprotected sex, referring to as "Barebacking." That alone tells you, 'this is not going to be good.' I really do not understand (and if someone can enlighten me on this) WHY SOME older gay men take advantages of young gay men, mostly the ones who are poor and homeless? Aren't we supposed to care for each other, mentor, and teach our younger gay men and women who are at a disadvantage?

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