National Gay Men's HIV/AIDS Awareness Day–Letter from Drs. Fenton and Mermin

Published: September 27, 2011

 Dear Colleagues,

Today is the fourth annual National Gay Men’s HIV/AIDS Awareness Day (NGMHAAD), an observance founded by the National Association of People with AIDS to raise awareness for the HIV/AIDS epidemic among men who have sex with men (MSM). On this day we recognize the commitment, advocacy, and opportunities for HIV prevention and education among gay men.

HIV touches all segments of American society—individuals, families, and communities, across all races and ages. However, since the beginning of the epidemic in the United States, gay and bisexual men have been disproportionately affected by HIV, and HIV continues to threaten their health. According to CDC’s latest estimates of new HIV infections, MSM of all races and ethnicities remain the group most heavily affected by the HIV epidemic. While MSM represent 2% of the population, they account for 64% of all new infections (includes 3% of new infections that were diagnosed among MSM who are injection drug users).

The most recent incidence estimates also show that new infections were relatively stable among MSM overall from 2006 to 2009; however, a new generation of young gay and bisexual men is at increasing risk. New HIV infections rose among young MSM, and young black MSM were the only population with a statistically significant increase in HIV infections in recent years. While the number of deaths among gay and bisexual men with HIV has declined since the height of the epidemic, the epidemic is far from over. Despite tremendous advances in treatment, more than 7,000 MSM with AIDS died in 2008, the latest year for which data are available.

A critical step to ending the epidemic is identifying the drivers of increased incidence among affected groups, particularly in gay and bisexual men. Individual risk behaviors alone do not account for the significant HIV burden; there are complex factors that influence the chance of getting HIV. For example, a higher prevalence of HIV in certain populations or areas means that there is a higher risk of meeting a partner with HIV. In CDC’s 2008 National HIV Behavioral Surveillance System (NHBS), data showed that 19% of sexually-active MSM were infected with HIV. Additionally, young black gay and bisexual men living with HIV are least likely to be aware of their status; stigma and complacency prevent many from seeking testing and treatment.

More Frequent Testing
Knowledge of one’s status and linkage to care and treatment are of upmost importance. Although HIV testing has been recommended at least annually for persons with ongoing risks for HIV, recent data suggest that high-risk MSM should be tested more frequently. CDC guidance currently recommends more frequent testing for MSM who have multiple or anonymous partners, who have sex in conjunction with illicit drug use, or whose partners participate in these activities.

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These data confirm the need for more frequent testing. In NHBS, 45% of those with undiagnosed HIV infection had been tested within the previous 12 months, and 29% within the previous 6 months. Based on these findings, sexually-active MSM might benefit from more frequent HIV testing (e.g., every 3 to 6 months). CDC is using NGMHAAD as an opportunity to highlight this information for gay men and their health care providers.

High Impact Prevention
Reducing the impact of HIV among gay and bisexual men remains a top CDC priority and demands that we target our efforts and expand our reach. To maximize every dollar and prevent the greatest number of new infections, CDC is pursuing High Impact Prevention activities to reach the aggressive goals of the National HIV/AIDS Strategy (NHAS). Specifically, the goal is to increase the proportion of HIV-diagnosed gay and bisexual men with an undetectable viral load by 20% by 2015. To meet this goal, CDC is working with prevention partners to implement programs for gay and bisexual men, ranging from behavioral interventions, treatment and education efforts for Prevention with Positives (PWPs), testing initiatives, and social marketing campaigns.

For example, CDC is launching a new campaign, “Testing Makes Us Stronger,” for black MSM at highest risk for HIV. Previewed at the 2011 National HIV Prevention Conference, this campaign is the latest phase of CDC’s five-year, multi-faceted communication campaign, Act Against AIDS.

Expanded HIV Prevention Services
To further address the prevention needs of gay and bisexual men, today, CDC awarded $55 million over five years to 34 community-based organizations (CBOs) to expand HIV prevention services for young gay and bisexual men of color, transgender youth of color, and their partners. These awards are designed to enable CBOs with strong links to these populations to meet their specific HIV prevention needs, including providing testing to more than 90,000 young gay and bisexual men and transgender youth of color over the course of the five-year project period, with a goal of identifying more than 3,500 previously unrecognized HIV infections, and linking those who are infected to care and prevention services.

CDC has also funded several non-governmental organizations to collaborate with local education and health agencies to implement multi-component, school-based HIV prevention activities for school-aged young MSM (YMSM) as a part of CDC’s Enhanced Comprehensive HIV Prevention Planning Program. The primary goals of this school-based intervention are to educate YMSM about sexual risk behaviors and to promote testing, counseling, and treatment among this group.

Additionally, new approaches to prevention offer promising long-term strategies. For example, research studies have shown that daily oral use of the antiretroviral viral medication used to treat HIV can also help prevent sexually-acquired HIV infection when delivered as part of a comprehensive package of prevention services (e.g. condoms, behavioral counseling and treatment). Antiretroviral therapy has been proven to reduce transmission risk by 96%. This intervention, pre-exposure prophylaxis (or PrEP), may, in the future, serve as a key biomedical tool that has the potential to combat HIV.
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To stop the HIV epidemic, each of us has a part to play. We all have a personal responsibility to know our HIV status, protect our health and the health of our loved ones and our community. The gay community’s leadership once drove the nation to act against AIDS—that same energy and commitment is needed today. The HIV prevention community is in need of new champions, particularly for communities where gay and bisexual men are heavily affected.

Kevin A. Fenton, M.D., Ph.D., FFPH
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP)
Centers for Disease Control and Prevention
Jonathan H. Mermin, M.D., M.P.H.
Director, Division of HIV/AIDS Prevention
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
Centers for Disease Control and Prevention

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