Stubborn HIV rates in 35+ gays surprise advocates

Volume One, Issue 25, March 9 - 15, 2007

BY Duncan Osborne

New HIV testing data showing higher new infection rates among older New Yorkers and declines among all groups except gay and bisexual men surprised some AIDS groups.

“That really astounded me because we are focusing so much on younger gay people,” said Dennis deLeon, president of the Latino Commission on AIDS. “Something is going on there that I don’t think anyone has satisfactorily explained... We’re ignoring something with older persons.”

The city used the detuned assay, a testing procedure that identifies new infections, to evaluate 3,464 HIV-positive blood samples collected at city clinics between June 1, 2000 and December 31, 2004. A new infection was defined as one occurring less than 170 days before the blood sample was taken.

By age, the incidence rate, or the percentage who are newly infected in a year, was highest among 35- to 39-year-olds at 0.54 percent for the four-and-a-half year study. The second highest rate was among those 45 to 49 at 0.49 percent and the third highest rate was among those 40 to 44 at 0.45 percent. The rates among those 29 and younger were about half of the rates for the three highest groups.

“I was shocked,” said Terri Smith-Caronia, director of New York City public policy at Housing Works, an AIDS service organization. “I really thought that those numbers would have been reversed.”

The overall rate among men who have sex with men was 3.02 percent, by far the highest rate in the study, so where activists see higher incidence rates, such as those among the 35- to 49-year-olds, they tend to attribute them to gay and bisexual men.

At an annual rate of 3.02 percent, more than 15 percent of gay and bisexual men would become infected in a five-year period.

The overall rate among all men was 0.59, the rate among women was 0.17 percent, the rate among heterosexuals was 0.14 percent, and the rate among injecting drug users (IDU) was 1.67 percent.

In popular discourse, the assumption has been that new infections were occurring among young gay men who did not live through the early years of the AIDS epidemic and watch their friends die. The implicit view was that older gay men had somehow been inoculated by the experience of those early years and had changed their behavior.

“I think it’s astounding,” said Dan Carlson, a founder of the HIV Forum, a group that produced a series of town meetings on HIV, gay men, and drugs. “I think there’s an expected knowledge with people that age. You would think they would know how to navigate, negotiate sex.”

Jay Laudato, executive director of the Callen-Lorde Community Health Center, a gay clinic, was not surprised by the data. It showed that “the difficulty of practicing safe sex for a lifetime is a daunting, daunting challenge,” he said.

The city data showed declines in new infections among nearly all groups with the rate among men who have sex with men remaining high and stable during the study period.

Robert E. Bank, the chief operating officer at the Gay Men’s Health Crisis (GMHC), said “It’s so not shocking to me. We do not have a society that sufficiently takes notice of gay men... I think this all stems from the fact that homophobia is alive and well.”

In recent years, AIDS groups have focused their energy on addressing AIDS among women and people of color. Those groups, led by Housing Works, successfully lobbied for more city funding for prevention and care for those populations. Generally, activists said there has not been a similar effort mounted on behalf of gay men.

“Are government, community, and affected members coming together and talking? No,” Smith-Caronia said. “I think in the beginning of the epidemic there was a government, community, and affected members synergy.”

Bank disagreed saying that GMHC has asked for an additional $2 million for HIV prevention among men who have sex with men from the state and that it would be requesting an increase in prevention funds from the city as well.

“Who is making that demand?” he said. “We are constantly making that demand... We are absolutely demanding increases in all those budgets.”

The eight town meetings organized by HIV Forum in 2003, 2004, and 2005 collectively drew thousands which suggests that many gay men are concerned, but no group appears to have been able to organize those people.

“There isn’t anybody rallying the troops,” Carlson said. “Based on experience, it’s a very difficult thing to do.”