The third annual National Gay Men’s HIV/AIDS Awareness Day on Sept. 27, 2010, marks an occasion to reflect on how profoundly HIV/AIDS has affected gay and bisexual men. It also is a fitting time to recognize how much this group has influenced the development and implementation of strategies to prevent and treat the virus and the disease.
The HIV/AIDS epidemic continues to exact a terrible toll on gay and bisexual men. In the United States it is estimated that since AIDS was first recognized in 1981, more than half a million gay and bisexual men have been diagnosed with the disease1 and more than 300,000 have died.2 Although men who have sex with men make up only about 4 percent of the U.S. male population ages 13 years and older, sexual transmission of HIV from one man to another accounted for more than half of all new HIV diagnoses in 37 states in 2008.3 The epidemic is particularly acute among 13- to 29-year-old black males who have sex with other males: More new HIV infections occurred in this population in 2006 than in any other age or racial group of men who have sex with men.4
Stigma and fear hamper efforts to make HIV/AIDS prevention and treatment accessible to all gay and bisexual men who would benefit from them, both in the United States and abroad. Often faced with prejudice and discrimination, these men frequently lack open and ready access to HIV prevention, treatment and care, increasing their risk for HIV/AIDS. A recent study found that the rate of new HIV diagnoses among men who have sex with men in the United States was more than 44 times as high as that of other men and more than 40 times as high as that of women in 2007.5 Between 2000 and 2006, gay and bisexual men in developing countries were an average of 19 times more likely to be infected with HIV than the general population.6
Yet many gay and bisexual men have been instrumental as AIDS activists in raising awareness about the public health impact of HIV/AIDS, shaping the HIV/AIDS research agenda and advocating that this research is well funded. In addition, gay and bisexual men catalyzed the movement to bring treatment and care to people with HIV/AIDS and to promote HIV prevention. Before the development of proven, effective therapy for HIV/AIDS, leaders in the gay and bisexual community influenced me to endorse a policy that gives people with serious illnesses access to experimental treatments, even if the individuals do not qualify for ongoing clinical trials of those treatments. This policy established by the U.S. Food and Drug Administration has become a source of hope for patients with life-threatening conditions.
Tens of thousands of gay and bisexual men have participated as volunteers in HIV/AIDS research, including clinical trials of antiretroviral drugs that now form the basis of lifesaving treatment regimens available to millions of people with HIV infection. Since 1984, nearly 7,000 gay and bisexual men have enrolled in the Multicenter AIDS Cohort Study (MACS)—the longest continuous U.S. study of people with HIV/AIDS and one of the most rigorous and productive epidemiologic HIV/AIDS studies in history. The MACS was developed and has been primarily sponsored by the National Institute of Allergy and Infectious Diseases (NIAID) and the National Cancer Institute, both part of the National Institutes of Health.
Today, nearly 3,000 gay and bisexual men are participating in NIAID’s first large trial of a promising experimental HIV prevention method called pre-exposure prophylaxis, or PrEP. PrEP studies are testing whether HIV-negative people at high risk of becoming infected with the virus could take antiretroviral medications to protect themselves from infection. We anticipate learning the results of this study in early 2011.
Meanwhile, more than 2,000 black men who have sex with men are participating in a study to determine the feasibility and acceptability of a multi-part intervention designed to reduce the spread of HIV in this population. The HIV Prevention Trials Network is conducting the study with funding from NIAID, the National Institute on Drug Abuse and the National Institute of Mental Health, also parts of NIH.
I thank gay and bisexual men for their leadership in advancing HIV/AIDS research and their participation in studies aimed at controlling and ultimately ending the pandemic. Together we will overcome the hurdles that stand between us and a world free of HIV/AIDS.
Dr. Fauci is director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health in Bethesda, Maryland.
Media inquiries can be directed to the NIAID Office of Communications at 301-402-1663, firstname.lastname@example.org
1. Centers for Disease Control and Prevention (CDC). 2010. HIV Surveillance Report, 2008. Table 2a.
2. CDC. 2010. Table 12a.
3. CDC. 2010. Table 1a.
4. CDC. 2008. Subpopulation estimates from the HIV incidence surveillance system—United States, 2006. MMWR 57(36):985-989.
5. CDC. 2010. CDC analysis provides new look at disproportionate impact of HIV and syphilis among U.S. gay and bisexual men.
6. Baral S et al. 2007 Elevated risk for HIV infection among men who have sex with men in low- and middle-income countries, 2000-2006: a systematic review. PLOS Medicine 4(12):e339.