More than three decades after the emergence of HIV and AIDS sparked a massive campaign to curb infection, public health officials in Chicago and across the country are worried by a recent uptick in diagnoses of HIV — the precursor to AIDS — among young gay and bisexual men.
While transmission of the virus via injectable drug use and heterosexual sex has declined dramatically since the peak of the epidemic in the mid-1980s, infection of men who have sex with men is a different story.
New HIV infections in that group plummeted from a peak of about 75,000 per year to less than 18,000 per year by the early 1990s, according to the federal Centers for Disease Control and Prevention. But the drop was short-lived, and infections currently hover around 30,000 per year. Experts say it’s younger men, especially young black men, who are driving that trend.
As part of an effort to learn why, Chicago will play host to a major research project that will look at all potential drivers of transmission within a single study. The National Institutes of Health recently awarded Northwestern’s Feinberg School of Medicine an $8.7 million grant for the five-year study, which will include the Chicago Department of Public Health and community organizations like Center on Halsted as partners.
"Chicago is a great place to do this kind of research," said Brian Mustanski, who directs the LGBT health and development program at Northwestern. "It’s such a diverse city. It has so many different characteristics."
Data show that in Chicago, new HIV diagnoses of men who have sex with men and are younger than 30 jumped 76 percent from 2000 to 2011, and black men account for most of the increase. Older gay and bisexual men, meanwhile, have seen HIV diagnoses decline or stay steady.
"It makes it challenging, on one hand being encouraged by our successes in reducing HIV … but at the same time making sure that we’re all aware that there’s still this important subgroup that is beginning to carry a greater burden of the epidemic," said Nikhil Prachand, director of HIV and sexually transmitted infection epidemiology at the city’s health department.
Experts say they don’t fully understand all the factors behind the rise but that the data is a warning that new tactics are needed to stem the spread of the disease.
"It’s really hard to maintain the sense of emergency around HIV that many of us remember from the ’80s and ’90s," said John Peller, interim president and CEO at the AIDS Foundation of Chicago. "We need new ways to communicate with gay men and particularly young gay men about their … sexual health and wellness."
Segregation and socio-economics are believed to be key factors.
"African-American (men who have sex with men) tend to live in predominantly African-American communities, and many of those communities in Chicago have a higher prevalence of HIV," Prachand said. "They’re using condoms as or more often than other groups and they also have the same number of sex partners. It’s just that the context in which their behaviors occur happens to be in communities where there is more HIV."
That theory was borne out in a recent study by Mustanski’s program at Northwestern. Researchers sampled 450 young men over two years in an attempt to understand who does and doesn’t become infected with HIV and why.
"The likelihood that you’re going to get infected really depends on your partner: Does your partner have HIV or not?" Mustanski said. "And for black men, the difference was huge. For black men, 40 percent of partners were from high-prevalence neighborhoods. For white men, only 5 percent."
But that doesn’t explain why the problem is affecting younger men disproportionately.
Answering that question is the aim of the new grant-funded study out of Northwestern, which will engage an interdisciplinary team of researchers — from psychologists and physicians to virologists and statisticians — to consider all the potential drivers, including genetics of the virus, effects of medication, individual behavior, sexual partners, relationships, networks and community factors.
Mustanski, who will lead the project, said it will build on existing research but will be a first-ever look at all drivers of transmission within the same study. By the end of the study, researchers will have interviewed more than 1,300 young men who have sex with men, he said.
"What we’re trying to do is really change the trajectory of HIV in young gay men," Mustanski said.
Aaron Talley, a 22-year-old graduate student at the University of Chicago, said he agrees that isolation and a lack of resources have left black gay men at greater risk.
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