Sharpening our focus on Black MSM vital to meeting national goals
As we observed National Black HIV/AIDS Awareness Day (NBHAAD) 2014, we are reminded that African Americans face the most severe burden of HIV/AIDS in the United States. Among African Americans, gay, bisexual and other men who have sex with men (Black MSM) are especially hard hit, representing more than half of all estimated new HIV infections among African Americans each year. A particularly disconcerting estimate in 2010 showed that young Black MSM aged 13 to 24 accounted for the greatest number (4,800) of estimated new HIV infections among African Americans.
Furthermore, from an an-alysis of data about African Americans diagnosed with HIV infection from 19 jurisdictions that CDC released, we know that compared to Black women, Black men — regardless of transmission category — have lower levels of linkage to and retention in HIV care and are less likely to have achieved viral suppression (i.e., have controlled the virus at a level that helps keep them healthy and reduces their risk of transmitting the virus to others). The study also revealed that by transmission category, men with infection attributed to male-to-male sexual contact had the lowest percentage of linkage to care.
These disparities highlight that, despite important strides that have been made toward national HIV prevention, care and treatment goals, we clearly have more work to do as a nation to effectively address HIV among Black MSM, especially with regard to outcomes along the HIV care continuum.
The National HIV/AIDS Strategy highlights both the disproportionate impact of HIV among MSM in the U.S., the concentration of HIV among Black MSM within the African American community, and clearly states that “the United States cannot reduce the number of HIV infections nationally without better addressing HIV among gay and bisexual men.” The Strategy also observes that our national commitment to this population has not always been commensurate with their disproportionate burden of HIV.
So, as we mark the annual observance of NBHAAD, we all—both individually and collectively—are called to be even more thoughtful, creative, and focused about actions we can undertake to strengthen HIV prevention, testing, care and treatment for Black MSM in communities across the United States.
Among federal programs, several important activities are underway in this regard:
· Increasing the capacity, quality, and effectiveness of HIV/AIDS service providers to serve Black MSM – Applications are due later this month for a new Resource/TA Center for HIV Prevention and Care for Black MSM being supported by HRSA’s HIV/AIDS Bureau. To assist HIV service and other healthcare providers, the new center will identify, compile, and disseminate best practices and effective models for HIV clinical care and treatment across the HIV care continuum for adult and young Black MSM ages 13 to 24.
· Promoting and supporting HIV testing among Black MSM – CDC’s Testing Makes Us Stronger social marketing campaign encourages Black MSM to get tested for HIV. Through compelling campaign ads in national magazines and on targeted websites, as well as through local advertising and materials distribution in target cities, CDC emphasizes the importance of getting tested for HIV regularly to help stop the spread of the epidemic. The campaign also includes a Facebook page and a dedicated website with a suite of campaign materials available for individuals and organizations to download and distribute. Complementing this important outreach campaign, CDC makes significant investments in both health departments and community-based organizations to support high impact prevention activities, including testing.
· Supporting engagement in HIV care – The HHS Office for Civil Rights’ Information is Powerful Medicine campaign focuses specifically on Black MSM, underscoring how having access to your medical records can help you better manage your health. Access to this information empowers patients to track their progress, monitor their lab results, communicate with their treatment teams, and adhere to their important treatment plans. The campaign also provides information on e-health tools, such as the “Blue Button,” which make it easier, safer, and faster for consumers to get access to their health information.
· Strengthening state efforts for Black MSM – Under the Care and Prevention and Prevention of HIV in the U.S. (CAPUS) demonstration project, several of the eight participating states are focusing their efforts specifically on Black MSM. The three-year demonstration project is supported by the Secretary’s Minority AIDS Initiative Fund and seeks to support these states, each with disproportionately high burdens of HIV/AIDS among minority communities, to improve HIV testing, engagement, and retention in care among racial and ethnic minorities. In Illinois, for example, the state health department has launched a youth of color-specific initiative in East St. Louis to co-locate medical (including LGBT health), psychosocial, prevention and support services in a single setting by collaborating with the local health department and community-based organizations in East St. Louis, Illinois and across the river in St. Louis, Missouri.
· Supporting Implementation Research – The focus of the ongoing NIH-supported HIV Prevention Trials Network (HPTN) 073 study is determining the willingness of Black MSM to use a daily antiretroviral pill as pre-exposure prophylaxis (PrEP). Studies such as HPTN 073 are critical in bridging our understanding between biomedical advances in HIV prevention and behavioral, social and structural factors that are often in play.
“We are greatly encouraged that many of these federal activities are consistent with recommendations made during our 2012 consultation with community leaders and federal partners about HIV among Black MSM,” notes Dr. Ronald Valdiserri, Deputy Assistant Secretary for Health, Infectious Diseases. “These efforts and many more underway at the federal as well as state and local levels, are vital to reducing new HIV infections among Black MSM and to improving outcomes all along the HIV care continuum for this disproportionately impacted population.”
By Timothy Harrison, PhD, Senior Policy Advisor, Office of HIV/AIDS and Infectious Disease Policy, U.S. Department of Health and Human Services and the Regional HIV/AIDS Resource Coordinators, Office of the Assistant Secretary for Health, U.S. Department of Health and Human.