Thousands of delegates to the International AIDS Conference filled the streets of Toronto Aug. 14 to rally for AIDS treatment. (Photo courtesy AIDS 2006)
In one of the largest studies to examine the prevalence of crystal methamphetamine use among gay and bisexual men, CDC researchers announced at the conference that meth use was most often reported by white gay men between the ages of 25-34 who lived in either the western or southern regions of the U.S.
“It seems like other geographical regions are catching up with the West,” said CDC researcher Patrick Sullivan, who noted that the meth epidemic has long been thought to be concentrated on the West Coast.
The study of more than 11,300 gay and bisexual men in 15 states revealed that 14 percent of respondents admitted using crystal meth, also called “T” or “Tina,” in the last 12 months, with those who were HIV-positive more than twice as likely to report using the drug.
Another finding from the study was that HIV-positive meth users were more likely to engage in unprotected insertive anal intercourse, while HIV-negative users were more likely to engage in unprotected receptive anal intercourse.
The study “confirms some things people found in earlier studies, but it confirms it on a larger scale,” Sullivan said. “It helps us understand how common the behavior is.”
The CDC study was released a week after researchers at the University of Buffalo announced “the first evidence” that using meth causes physiological effects that make it easier to contract HIV.
The study reported that meth increases the functioning of a receptor called DC-SIGN, which allows dendritic cells to absorb more particles of HIV without the body mounting a resistance.
“This finding shows that using meth is doubly dangerous,” said Madhavan Nair, the lead researcher on the study, which will be published in the September issue of the Journal of Neuroimmune Pharmacology.
“Meth reduces inhibitions, thus increasing the likelihood of risky sexual behavior and the potential to introduce the virus into the body, and at the same time allows more virus to get into the cell,” Nair said.
The Bush administration is accustomed to criticism of its AIDS policies by those attending the biennial International AIDS Conference. But this week, two U.S. leaders in the fight against HIV — including Bush’s gay former AIDS czar — took aim at what they called the president’s “ideologically driven, abstinence-until-marriage focus that places many at risk of needlessly contracting HIV.”
In an opinion piece published Aug. 14 in the Toronto Star, timed to coincide with the city hosting the XVI annual International AIDS Conference Aug. 13-18, Scott Evertz, Bush’s former director of the Office of National AIDS Policy, wrote that current domestic policy is “creating confusion and fear among [HIV-prevention organizations] regarding the appropriate role of condoms.”
Sandra Thurman, who served as director of national AIDS policy under President Bill Clinton, co-authored the opinion piece with Evertz, who is gay and a longtime Republican activist.
The pair wrote that comprehensive HIV prevention could be a lifesaver for people around the globe, from underage sex workers in developing countries to “the young gay teen in Washington D.C., told to abstain until marriage when marriage is impossible.”
The International AIDS Conference is attended by more than 20,000 AIDS researchers and activists from across the globe. Conference speakers painted a bleak picture about HIV infection rates among men who have sex with men, both in the United States and on the international front.
“The biggest thing is less than one-in-ten homosexually active men [around the world] have access to the most basic of HIV-prevention services,” said Joseph O’Reilly, a senior policy adviser at the International AIDS Alliance, a U.K. based non-profit group.
“I think what we haven’t seen in most developing countries is a concerted strategy to addressing the concerns of [gay and bisexual] men,” O’Reilly said. “It’s going to be hard because in many countries there is a lot of silence and invisibility about gay sex.”
But with data showing the U.S. leading all industrialized countries with the highest rates of HIV — coupled with figures that indicate gay and bisexual men are the only domestic group whose HIV rate continued to rise in recent years — it’s clear that developing nations aren’t alone in their failure to reconcile the relationship between HIV and sexual orientation, said Jeff Graham, senior director of advocacy and communications at AIDS Survival Project in Atlanta.
“There is a lot of work that remains to be done,” said Graham, who is attending the conference in Toronto. “I would say there’s not been nearly enough talk or focus on men who have sex with men [at the conference].
“We cannot allow ourselves to stop looking at one group just because we’re increasing our focus on another,” said Graham, who noted that much of this year’s conference has centered on women’s issues such as the development of vaginal microbicides.
Call to action among blacks
At the conference, black gay leaders again made impassioned pleas for other African Americans to combat the spread of HIV/AIDS more aggressively, noting that blacks account for more than half of all U.S. AIDS cases.
Phill Wilson, executive director of the Black AIDS Institute in Los Angeles, rallied leaders of traditional black groups like the NAACP and National Urban League to announce a National Black Mass AIDS Mobilization aimed at dramatically reducing the number of HIV infections among blacks by 2011.
The five-year plan calls for mobilizing black political leaders, entertainers and other leading figures to help decrease the number of blacks who don’t know their HIV status, get those who are diagnosed into care earlier and end the “debilitating stigma” that currently stifles HIV-prevention efforts among blacks, said Wilson, who is gay.
“We realize this is an ambitious goal, some might say unrealistic,” Wilson said at an Aug. 14 press conference in Toronto. “We believe anything less would be immoral.”
Any effort to eliminate the threat of HIV to African Americans must also include decreasing anti-gay sentiments felt by many blacks, said NAACP Chair Julian Bond.
“Black America must reduce the evil homophobia that plagues our culture,” Bond said at the press conference. “It is perhaps the greatest single barrier to our ability to talk about AIDS.”
Some activists have criticized public health agencies for not developing or funding HIV-prevention messages that are relevant and specific to black gay and bisexual men. A study presented at the conference by a group of researchers from the Centers for Disease Control & Prevention suggested that mainstream prevention programs can be successfully adapted to reach African-American gay and bisexual men.
An adjusted version of the Popular Opinion Leader — an intervention effort that recruits well-respected individuals to speak with their peers about reducing their risk for HIV — resulted in “significant reductions” in the percentage of black gay men ages 18-34 in North Carolina who reported having unprotected anal intercourse.
“While maintaining core elements of POL, we then modified the intervention to include discussions and images, and address topics, relevant to black [men who have sex with men],” the CDC researchers wrote. “[The rate of] unprotected receptive anal intercourse decreased by 23.6 percent at four months, by 24.6 percent at eight months and by 44.5 percent at 12 months.
“We concluded that adapting evidence-based interventions is a key step in increasing the number of interventions for black [gay and bisexual men],” the study said.
HIV rates rise around
the globe for gay men
Globally, the rate of HIV among gay and bisexual men has increased in Canada, Britain, Australia and many other industrialized countries, with the U.S. leading the way, according to O’Reilly.
As many as one-quarter of gay and bisexual men in some Asian countries are HIV-positive, according to a study released at the International AIDS Conference by the Foundation for AIDS Research, also known as amfAR.
With much gay activity in Asia restricted “underground,” the report predicted the continent could “face a spiraling epidemic that could be far worse than any seen in gay communities in the West.”
“Given the difficulty of surveillance in these populations, rates of HIV infection could actually be far worse,” said Kevin Frost, vice president of global initiatives at amfAR. “This report shines a light on the extent of high-risk [gay and bisexual] behavior, and serves as a wake-up call for Asia.”
According to the 23-country study, HIV rates among gay and bisexual men in Asia varies from 3.1 percent in China, to 28.3 percent in Bangkok, Thailand. The study also revealed low levels of condom and lubricant use among many Asian gay men, as well as high numbers of sexual partners.
“There’s a huge HIV prevention services gap to close” in developing countries, said O’Reilly, who added Asian some countries are making strides in reducing HIV.
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