The Right to Health is a fundamental human right, & includes "access to health-related education and information, including on sexual and reproductive health."   -The World Health Organization

Recently, I read a handful of heartfelt, beautifully written posts on OS with personal remembrances of the AIDS epidemic of the 1980s and early 1990s, including Lezlie in the Southeast's Heart to Heart on the AIDS Quilt, SpiritManSF's tribute to his friend and AIDS activist, Annemarie Madison, and most recently, Tommi Avicolli Mecca's post, America's Great Shame, 30 Years Later.  Each of these posts touched my heart very deeply and brought tears to my eyes. Finally, Tommi Avicolli Mecca's post, remembering his conversation with his mom, moved me to write this post.

During the early 1990s, I was still very young, and spent most of my days working on the hospital floors of a large urban hospital.  These posts brought back the haunting memories of that time, the mostly young and middle-aged men with AIDS, and their heartbroken loved ones.  At that time, everyone (with rare exceptions) died within 10 years of becoming HIV+, and within a year of developing full-blown AIDS.  I clearly remember the first men with AIDS whom I met and talked with, each face and every story, trying to explain to me, but maybe mostly to themselves, what had happened, trying to make sense of this juggernaut, which couldn't be made sense of.  I remember the feeling that we were dealing with something large, stealthy, and powerful, as the AIDS epidemic kept casting its net wider and wider  to include more men, women, and finally babies born HIV+.  

I had two work-related needle sticks over the years, and one  long-term partner who turned out to be promiscuous and gave me a couple of STDs, and remember the huge feeling of relief each time my own HIV tests were negative.  One time I was tested at work, one time at a free urban HIV clinic (where the counsellor was excellent and gave some good advice), and once I ordered a test online.

Later on, in the mid-90s, with the advent of new drugs, being HIV+ gradually changed from being a death sentence within 10 years, to often being managed as a chronic, long-term illness.  People were beginning to be able to live with HIV.

The AIDS epidemic gradually began to drop off of my own personal radar screen, as my job changed, and the gay men that were part of my life seemed settled into long-term relationships.  One family friend mentioned that he and his partner had decided early on to always use condoms, just in the event that one or the other would stray, reflecting the new awareness following the previous decade.

Recently, though, I started to pay more attention to HIV and AIDS, maybe because my own children are teens and wading into the relationship waters.  (Wading or diving, I am not sure which.)

I realized that I don't really hear too much about HIV/AIDS anymore.  Where did it go?

The good news is that the rate of new HIV infections each year in the US has leveled off.  (CDC, HIV).  However, while the number of new cases is not climbing, it has also not declined since the early 1990s--unlike the great success in curbing HIV seen in Thailand during that same timeframe  (please see video below).   There are still 56,300 new cases of HIV each year in the US, and still 18,000 deaths of AIDS in the US each year.

 On the graph below, the number of  new cases each year is represented by the pink dotted line, while the number of people living with HIV in the United States (green line) continues to climb  steadily, now numbering more than 1 million.

I was under the very wrong impression that HIV had been decreasing among gay and bisexual men, when in fact the opposite is true.  (CDC, Men who have Sex with Men).  The incidence of HIV has been increasing in this group of men since the 1990s, and accounts for 53% of new cases each year.

(The Center for Disease Control in Atlanta (CDC) uses the term Men who have Sex with Men (MSM) rather than using self-identifying terms such as gay, bisexual, etc., so for the purposes of the rest of this post, I'll use that term as well.)

Another major group of people converting to HIV+ are African Americans, comprising 44% of new infections each year in the US.  (CDC, African Americans).  This has been relatively stable since the early 1990s.

There is some overlap between these two demographic groups, that is the group of  African American MSM.  This group of men  is especially vulnerable to getting HIV.  Among African Americans newly diagnosed with HIV, approximately 40% are MSM, 35% are women, and 25% are heterosexual men.

Why is HIV increasing among MSM?

There seem to be several reasons. 

For one thing, the risk of transmission of HIV through anal sex is higher than with vaginal sex, putting MSM at higher risk from that fact alone.  (Also, the recipients of anal sex are at greater risk for contracting HIV, as are the recipients of vaginal sex.)

Other risk factors are those most of us are familiar with:  Unprotected sex; having other concurrent STDs, which make the body more vulnerable; alcohol and drug use leading to more risky behavior; multiple partners who also have multiple partners.

The CDC goes on to say, "Internalized homophobia my impact men's ability to make healthy choices, including decisions around sex and substance use.  Stigma and homophobia may limit the willingness of MSM to access HIV prevention and care...Racism, poverty, and lack of access to health care are barriers to HIV prevention services... "

The CDC broke the statistics down further.  Among white MSM, the highest rates of new HIV infections were in the 30 to 39 age group. Among black and Hispanic/Latino MSM, the highest rate of infection was among young men age 13 to 29.

This was shocking to me.  In fact, the highest rates of new HIV cases in the United States are seen in young, black MSM, ages 13 to 29. 

Where are we going wrong?  Why isn't there more awareness among this young group of men?

A recent CDC study in 2008 found that:

-19% (1 in 5) MSM in 21 US cities were HIV+

-44% were unaware of their infection

-28% of black MSM, 18% of Latino/Hispanic MSM, and 16% of white MSM were HIV+ in this study. 

The 13- to 29-year-olds are the teens and young men of my son's generation, who I thought grew up with the ideas of safe sex, but it is just not happening.

So what can be done?

The CDC has a multifaceted approach, including:

1.  Education.

2.  Promoting HIV testing.

3.  Connecting HIV+ people with early care and treatment.

The CDC notes that people who are aware of their HIV status practice less risky behavior and try to minimize spread of infection, so HIV testing is an important step.

(Most people who are HIV+ will have a positive antibody test within 2 to 8 weeks after exposure, 97% will have a positive test within the first 3 months after exposure, and, rarely, it may take up to 6 months for the test to be positive.)

Early treatment of people who are HIV+ is also vital, both for their own health and future, as well as preventing spread of the infection to others.  "Treating people living with HIV early on reduces the risk of transmitting the virus to others by 96 percent." ( www.effectiveinterventions.org)

Another component of HIV prevention includes education to decrease risky drug- and sex-related behavior.  Some  successful programs focus on several sessions of  individual or small group teaching/counselling , with emphasis on learning assertive communication, setting goals related to drug/sex practices and how to stick to them, triggers for unsafe sex, etc., giving people the practical skills, knowledge, self-awareness, and confidence to make healthier choices.

One more recent finding is that "sexual networks involving long-term overlapping partnerships could create a kind of "superhighway" for HIV, even if everyone in the network had few partners. By contrast, HIV spread very slowly through sexual networks involving one-partner-at-a-time serial monogamy."

Increasing the availability of condoms, as well as testing for and treating other STDs, are two other ways proven to decrease the spread of HIV in the USA.  (For more ways shown to decrease the spread of HIV in our country, please see www.effectiveintervantions.org .)

Despite the tons of work being done by public and private organizations around the country, I wonder if we are missing some opportunities for widespread educational campaigns on HIV awareness and safe sex--in schools, online, and also the radio and TV stations with large young audiences?

Maybe we could learn something from Mr. Condom, Mechai Viravaidya, an amazingly honest, funny and pragmatic man, who decreased the rate of HIV infection in Thailand by 90% since the early 1990s. (Our rate here in the US decreased by 0% during the same time period.) 

Thailand was successful in large part because of a very open and honest public awareness campaign, with emphasis on access to healthcare, family planning, and condoms to everyone in the country. 

Schools, religious organizations, every person working in the media, everyone, even judges, were trained and involved in teaching about HIV.

Mechai  Viravaidya shares his ideas in this video here.   (His approach to stopping the spread of HIV begins at minute 6 of the video.  Before that, he talks about Thailand's very successful family planning program):

1.  Use condoms each and every time until you are in a very long-term, committed relationship.  Try different kinds until you find the ones most comfortable.  Many people find the ultrathin/ultrasensitive condoms comfortable. 

Some men who feel that they are average-sized find condoms very constricting, & may benefit from trying a larger size, such as the Trojans Magnums. 

If you & your partner decide on an exclusive relationship with one another, get tested before you stop using condoms, to make sure you are both HIV-negative.

2.  Value your body.  Be assertive about protecting it.  Communicate openly with your partner. 

3.  Being serially monogamous is associated with lower risk of HIV than having more than one partner, or having a partner with more than one partner. 

4.   MSM and other people at risk should be tested for HIV yearly.  HIV may not cause symptoms for years, so there is no way to know one is carrying it without testing.  Your family doctor, gyn, or  free public health clinics can test you, or tests can be ordered online.  People at higher risk should be tested more frequently than once a year (high risk includes those who have more than one long-term partner, multiple or anonymous sex partners, or use drug and alcohol during sex). 

Seek prompt medical care for any new genital rashes, unusual discharge, pain, or bleeding, because having another untreated STD increases your  susceptibility to getting HIV.   Ask your doctor any questions you may have, & be an advocate for yourself in your own health care.  If you are having trouble finding the health care you need, call infoline (211) for help, or look online at www.211.org . 

5.  The risk of HIV is reduced tremendously if you use condoms each and every time for vaginal and anal sex, and condoms or dental dams for oral sex. 

For women, anal sex is probably not a good idea, as there is significantly increased risk of infection by STDs, even when using condoms. 

6.  Both teen boys and girls should get the Gardisil vaccine to prevent the spread of HPV and cervical, anal, and throat cancer.

7.   Male circumcision, if performed safely in a medical environment, roughly halves the risk of a man becoming infected with HIV through heterosexual sex.   

One very helpful book that I found for my teens is called the Teens Survival Guide to Dating and Relating (which can be downloaded for free at this link, or available at Amazon.com under the above title, as well the title,  Can You Relate? by Annie Fox.  Used copies range from 1 cent to the cover price of $15).  It is geared more towards heterosexual relationships & addresses topics including healthy and open communication, abusive relationships, how to get along and communicate better with parents, siblings, and authority figures, sexual identity, how to know if you are ready for sex, breaking up and moving on, etc.  It is in a question and answer format, and I just left it in the bathroom for my kids to read.   I learned a lot from the book, too.  The author, Annie Fox, also has a website where teens can write in to have their questions answered:  hey, terra.

I don't know of a similar excellent book for LGBT youth, but maybe someone else could recommend a good book for teens on this topic?  The site queerattitude.com is one international online community for LGBT youth just to talk, share ideas, and get support.

Thanks, OS!  Please let's talk to all the young people we love, and equip them for the future!    :)

Some related blogs & websites:

 The Body...HIV/AIDS Blog Central  - blogs by people who are living with HIV/AIDS...The Body website has tons of info on HIV/AIDS.

 http://womenshealth.gov/hiv-aids/   Women & HIV. How to protect yourself & your children from HIV, & what to do if you find you are HIV+.  About 25% of new cases of HIV occur in women, most obtained through heterosexual sex.

www.211.org or phone 211.  This service is for anyone, & provides help locating health care, counseling, as well as food, housing, employment, and other services.

MOMSPharmacy - this online pharmacy specializes in HIV medications delivered anywhere in the US at more affordable prices

http://www.anniefox.com/teens/   and Annie Fox's Parent Forum  - Q&A website for teens and parents.

queerattitude.com international online youth community/forum for ages 13 to 25 (this moderated site is a friendly and safe place for LGBT youth to communicate with one another)

Planned Parenthood Info for Teens

Reflections of a Grady Doctor   Young, Gifted, and Black.  The story of two young doctors helping people living with HIV.  "Sometimes you just need somebody to believe you . . . .and believe in you."

www.effectiveinterventions.org    This CDC site gives an overview of our nation's strategy to combat HIV, & is a resource of interventions  shown to be effective in schools, communities, & health care settings.

What to do within 72 hours after possible exposure to HIV--  PEP (Postexposure prophylaxis) is medicine that can be obtained by going to the emergency room or HIV clinic.  Treatment should be started within 72 hours after possible exposure to HIV. 

Another HIV-prevention approach is this program for middle schoolers, which helps students envision a positive future for themselves: http://www.effectiveinterventions.org/en/HighImpactPrevention/Interventions/AIM.aspx

Some great posts from Open Salon:

Support freepap.org -- Open Salon's Oryoki Bowl talks about the importance of the Gardisil vaccine for teen boys and girls, and Pap screens for women,  to prevent cervical cancer.

Women's Sexual Empowerment -- Open Salon's Marcia Yerman posts on women & HIV, including how women can protect themselves with the new female condom, available at some Walgreen's stores, and available at Walgreen's online.

HIV in South Africa -- Open Salon's Brazen Princess, who lives in South Africa, shares her experience working in a township in this heartfelt, heartbreaking, and informative post.

"Everybody needs to be involved in trying to provide whatever it is that makes humanity a better place." 

                                                                    --Mechai Viravaidya