GAY MEN'S HEALTH CRISIS Homophobia and H.I.V. among gay and bisexual men in the U.S. CHAMP Forum Sean Cahill, Ph.D. Managing Director, Public Policy, Research and Community Health January 22, 2009

Our Mission GMHC fights to end the AIDS epidemic and uplift the lives of all affected Served 15,000 clients last year in NYC Reach thousands more through prevention targeting gay/bi men/MSM, women of color Advocate for evidence-based prevention, treatment and care at local, state, national level

My presentation tonight I. Epidemiological data II. Need for CDC to fund community-level interventions to shift social norms of gay and straight people III. Need to think beyond CDC toward education, public health campaigns to promote resiliency among gay/bi men

Domestic epidemic worse than we thought Annual new infections 48,200-64,500, not the 40,000 per year estimated previously CDC retroactively estimates higher annual new infection rates back to early ’90s 56,300 new infections in US in ’06

Concentrated epidemic among gay, bi men 57% of new infections in ’06 among MSM HIV infection is on the increase among MSM nationally since early 90s, in NYC since ’01 Black MSM, then Latino, Native American MSM most affected About half of MSM new HIV infections Black, Latino (but only a quarter of MSM)

MSM only group for which new HIV diagnoses increasing

Race and age differences

Higher rates of syphilis, MRSA among MSM 65% of new syphilis diagnoses in 2007 among MSM MRSA: outbreaks a year ago concentrated among gay, bi men in SF, Boston Gay, bi men perhaps 2 to 3% of adult population Gay, bi men have odds ratio of 20 to 30 of getting HIV, syphilis

Black, Latino MSM most affected About half of new MSM infections among Black, Latino MSM Blacks 13% of pop., 45% of new infections Latinos 13% of pop., 18% of new infections Black gay and bi men are hardest hit of any group, despite no higher rates of HIV risk behavior (in some cases lower rates)

Broader context: worsening sexual health, especially for young people One in four adolescent girls years old has an STI; for Black girls, that number is close to one in two 4 million adolescents get STIs each year Adolescent pregnancy rates are up for the first time in 15 years

II. CDC and CLIs Right now CDC spends about $700m/year on HIV prevention and surveillance Under Bush-Cheney funding dropped by 20% in real dollar terms We want to see CDC funding doubled if possible, dramatically increased in any case CDC itself said it needed 2x current funding

Increase FY 2009 CDC Funding Must address the needs of the most vulnerable populations: gay and bisexual men, espec. men of color women of color (Black women 20x HIV rate as White women) young people trans women immigrants

CDC should expand support for Community Level Interventions Disproportionate HIV infection rates in vulnerable groups cannot be explained by individual behavior alone but by group-level and environmental factors for which race, sexual orientation are markers Community level interventions expand efforts beyond individual & group level – to reach a sufficient number of high risk individuals to stem the epidemic and – to help shift norms and values of communities in ways that enable individuals to lower their risk for HIV transmission CLIs include community events, social marketing, internet interventions, social/sexual networking, other mass communication efforts

Support structural interventions Structural interventions address the causes of HIV/AIDS arising from the physical, social, cultural, community, economic, legal, and policy aspects of an environment. Critical examples: – Reform prison sentencing to lower Black male incarceration rates; – Integrate economic empowerment with HIV prevention programming; – Ensure young people, especially Black women, graduate from high school

III. Look beyond CDC, promote resiliency What can public health infrastructure, DOE, churches/synagogues/mosques, other social sectors do to address root causes of disparities like those affecting gay/bi men, especially men of color? Promote resiliency: most gay men have safe sex (not true of heterosexuals), don’t get HIV; what can we learn from them?

Resiliency factors HIV and safer sex education in schools, foster care, juvi, other institutional settings LGBT-affirming school interventions (Goodenow ‘07) Strong self-esteem and mental health Not (ab)using substances Family acceptance of LGB youth (Ryan 2009) Community connectedness (GMHC, APLA ’07) The flip of these are risk factors

Youth, school interventions – Implement comprehensive sexuality education in schools, institutional settings (foster care, juvi); – Support LGBT-affirming initiatives in schools, including anti-bullying programs, GSAs; – Fight anti-gay bias as a public health threat (MA DOH subway/bus campaign)

Thank You Sean Cahill, Ph.D. Managing Director, Public Policy, Research, and Community Health (P) Gay Men’s Health Crisis 119 West 24 th Street New York, New York 10011