Measuring what we lost

In sharp contract to previous years, the pressroom at the 2007 National HIV Prevention Conference is virtually empty.

Gone are the rows of computer terminals, the banks of phones, the stacks of press releases. The copy machine stood jammed in a corner but hardly anyone noticed. A staffer, one of four, seemed relieved to discover the inoperable machine if only to break the morning monotony.

Media representatives, often outnumbers by staff, faced no waiting for one of two furnished laptops.

In prior years, numerous expert panels briefed three-dozen or more print and broadcast media representatives about the most salient news emerging from hundreds of scientific presentations delivered at the conference. A schedule of three to five press briefings was not uncommon for the four-day gathering.

This year, however, conference organizers included just one press briefing, held quietly Monday afternoon in a severely small room that easily filled to capacity. Over a dozen reporters (all from print and online outlets) participated.

With more than 400 scientific abstracts and 3,000 attendees, officials from the Centers for Disease Control and Prevention (CDC) made curious choices about the scientific abstracts selected to represent the most compelling findings of this week’s proceedings.

Public health officials described a series of studies illuminating factors contributing to elevated rates of HIV among men who have sex with other men (MSM) in America. According to official reports, gay and bisexual men comprise nearly half of all recent HIV diagnoses and half of all those living with HIV in the U.S. HIV among African-American MSM is especially high, estimated at nearly 1 in 2. Sadly, just 20 percent of MSM’s HIV prevention needs are currently met.

In various studies, federal and community-based researchers described the MSM population as letting down its guard. Data show gay and bisexual men are increasingly engaging in high-risk sex and drug-use behaviors, leading to higher rates of syphilis and gonorrhea that in turn may be abating more HIV transmission.

While African-American MSM appear to engage in unprotected sex and drug use at lower rates than their White peers, higher concentrations of HIV among Black MSM may elevate their likelihood for sexual exposure and therefore rates of infection.

In polite terms, researchers seemed to blame HIV-positive MSM for continued transmissions. Despite ample evidence of widespread declines in protected intercourse among all MSM, researchers highlighted high rates of unprotected sex among HIV-positive MSM as well as small but significant numbers of HIV-positive MSM engaging in unprotected sex with partners of unknown or sero-negative status. At no point were these observations recast to highlight the numbers of MSM of unknown or sero-negative status engaging in unprotected intercourse with men of unknown or seropositive status.

Today’s predatory villain—and in the historical narratives of HIV there’s always at least one—is the syphilitic HIV-positive MSM who may be concurrently spreading syphilis and HIV, no doubt a potent and dangerous combination.

Unanswered questions remain: What factors underlie these numbers, what health and social challenges face men with HIV and syphilis, what interventions are suited to help men identify, treat, and prevent syphilis and better protect themselves and their partners? What motivates men—positive, negative, and unknown status—to seek unprotected intercourse? How are these issues communicated and how might such communications improve? What can be learned about men’s resiliency and motivations to help them improve their lives?

Unsurprisingly, the federal response to the HIV crisis among gay, bisexual, and men who have sex with men is consistently opaque: more testing promotion; more frequent testing as part of the STD panel; biomedical research on such unlikely interventions as circumcision; clinical counseling for HIV-positive men about prevention; more surveillance. While certainly each of these endeavors has merit, they seem to accept HIV transmission as a foregone conclusion that must be managed, counted, and deconstructed rather than actually averted.

Without strategies to engage men—and not just the HIV-positive ones—in the realities of their lives, gay and bisexual men will be left no choice but to explore such options as serosorting in order to balance the human need for meaningful relationships with the health risks present in their communities.

Mostly, men need to know that they will not just be studied, vilified, and second-guessed by health and government officials who too often appear more interested in counting each one of their infections instead of actually mounting effective responses to avert them.

Perhaps conference officials are as tired of recounting the ways we are failing in HIV prevention as reporters are at hearing it.

By David Ernesto Munar of the AIDS Foundation of Chicago
On assignment for Windy City Times