A similar trend is occurring among this same population of young men with the sexually transmitted infection, syphilis. Data released Monday showed the rates of syphilis doubled in 27 states over a three-year period among men 15 to 29.
This is not a coincidence, according to infectious disease experts. Once syphilis rates rise, increases in HIV infection are soon to follow, Dr. Kenneth H. Mayer describes Monday in his editorial in Annals of Internal Medicine.
The rates of syphilis decreased drastically after penicillin was discovered to treat the disease, and until 2000 remained that way. However, this new data shows a surprising change.
Dr. John R. Su, Medical Epidemiologist in CDC’s Division of STD Prevention agrees the two sets of startling statistics are related to the same problem. “When somebody contracts syphilis, it means they are behaving in ways that put them at risk for other [sexually transmitted infections].
Genital sores that syphilis can cause also makes contracting HIV more likely.
Some experts say that to today’s teens and young adults, because of successful treatment, HIV is no longer a death sentence, and current messages about HIV have lost their meaning.
“The old message about HIV is not working. Something else has to be done,” says Justin B. Smith, a long-time gay activist who uses his blog, Justin’s HIV Journal, to increase awareness of HIV. “We need to target and focus more on the community that’s being infected and stop using messages that would catch our eyes back in the 80s and 90s.”
While young gay and bisexual men have higher rates of HIV and syphilis across all races, the reasons why young black men are most affected are still unclear.
Dr. Donna McCree, Associate Director for Health Equity in CDC’s Division of HIV and AIDS Prevention, thinks HIV testing is a major issue for the black community.
“About 20 percent living with HIV are unaware of their infection,” she says. “If people are not aware, they are more likely to transmit it to others.”
McCree adds that although previous statistics have applauded the black community for being tested for HIV at higher rates than other ethnicities, that still leaves two out of five without testing.
The stigma involved with wanting or needing an HIV test, denial, homophobia and not being able to afford HIV testing are frequently named reasons for avoiding HIV testing.
However, a recent survey showed that physicians also are not routinely offering HIV testing, and feel hesitant because of social stigma as well. Aside from lack of time to appropriately counsel patients, 57 percent of physicians were concerned that patients would perceive the recommendation for HIV testing as accusatory or judgmental.
Several sources cite the trend of young men having sexual intercourse with older partners as a possible cause of the recent spike. Older gay and bisexual men have higher rates of HIV and sexually transmitted infections, and, in the black community, less likely to be treated. In addition, younger partners are at higher risk, because similar to heterosexual relationships, the older partner tends to decide whether to use condoms.
Lack of education about HIV has also been shown to lead to risky decisions based on incorrect perception.
A small survey from earlier this year showed that several black gay and bisexual teens perceived masculine men as healthy and HIV-negative, thus underestimating their risk. Masculine partners were also accepted as dominant in sex acts, with the decisions about condom use left to them as well.
Smith sees similar misperceptions in his advocacy work. “Some [men] feel like they are being safe and it hurts me to hear them say so, because I know first hand and in my heart that isn’t the full truth.”
CDC efforts this year are heavily focused on prevention and testing campaigns targeting this special population of young men, including partnering on a local level with community health centers.
According to McCree, outreach to these young at-risk men is not an option. “Given the age of this population, we really can’t allow the health of a new generation to be lost to HIV. It’s completely preventable.”
She adds, “We have to reach young men who have sex with men early, to help establish a lifetime of healthy behavior.”
Smith still believes there needs to be more. “I believe they are aware of the ramifications, meaning they know that HIV exist and they know they can catch it,” he says. “But, I don’t think they know how it changes their lifestyle afterwards. They don’t know how serious it is.”