12/09/08

Tell us something new dept: In the US, HIV is gay and black

A little while ago, CDC estimated how many people were newly infected with HIV in the US in 2006. They told us it was a disease of gay men and black people. Now they’ve done more detailed analysis: It’s not just a disease of gay men and black people. It’s increasingly a disease of gay black men.

Nearly 40,000 men got newly-infected with this completely preventable disease in the world’s wealthiest country in 2006. Three quarters of those infections were in gay men. And while blacks make up just 14% of the US population, 35% of gay men newly infected with HIV were black. Cutting the numbers the other way, two thirds of all black men newly infected were gay and another 12% were junkies, leaving just one in five black guys infected in sex with a woman. New infections were even more rare among straight white guys — 88% of all white men newly infected in 2006 were gay, and another 6% were drug injectors; just one in 16 was infected in straight sex.

Women get infected two ways — by sharing needles when they shoot up drugs, and by having sex with infected men. Straight black men are far more likely to be infected than straight white men (not least because they are far more likely to be jailed, and, in a triumph of denial over common sense, jails in America still don’t make condoms available to prisoners). Since most Americans still have sex with people of their own race, it’s no huge surprise that black women are more likely to get HIV than white women. Nearly 15 times more likely, according to CDC. (Of the 14,000+ new infections in women in 2006, 61% were among black women, and 80% of those women got infected when they were having sex, not shooting up drugs.

Some caveats about the numbers: the national estimates are based on data from 22 states; the other states, which haven’t until very recently reported new HIV cases by name, are back-filled by applying the same ratio of new infections to AIDS cases as we see in the States for which we do have data. It’s a reasonable thing to do, for want of a better option, but it assumes that the epidemic has matured in roughly the same way in all states. Here’s the problem: two of the states with missing data are two of the worst affected and least typical, California and D.C. (ok, district, not state).

I’ve used the term “black” rather than “African-American”, advisedly. In many other countries which I follow, including the UK, Canada and Ireland, a very large proportion of heterosexual infections among black people are in fact “imported” infections. They are infections in nationals of African or Caribbean countries, and are likely to have been contracted in their home country. Of course this is far less likely to be the case in the US as a whole, but imported infections may well contribute to the high levels of infection in blacks in some of the more cosmopolitan cities in the US, including New York and Washington DC. CDC does not report infections by country of birth, but I’d be curious to see the figures.

Data quibbles aside, we’re getting an ever clearer picture of the continuing spread of HIV in the United States. Both the gay community and the black community need to demand better HIV prevention services. And those services need to be sold much more aggressively to those who aren’t currently using them, especially young black men who like to have anal sex.

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This post was published on 12/09/08 in Men, women and others.

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