Sobering statistics and emotional testimony were present throughout the AIDS Foundation of Chicago's 12th Annual HIV Skills Building Conference, which took place Oct. 10-11 at DePaul University, 525 S. State.
The first night featured the forum 'Gay, Sexy, and Healthy: Strengthening Prevention for Men Like Us,' and the presenters were the Centers for Disease Control & Prevention's ( CDC's ) Gregorio Millett, MPH, and Dr. Ron Stall of the University of Pittsburgh.
Millett—whose studies concentrate on Black and Latino MSM ( men who have sex with men ) —started by unveiling some uncomfortable numbers, including that potentially one out of every two Black MSM is potentially HIV-positive. He also said that only 1 out of 129 effective HIV-related interventions applies directly to Black MSM ( with the other 128 applying to the heterosexual African-American community ) , and that none out of 157 behaviorial interventions for the Latino community applies to that demographic's MSM.
Millett also stated that, interestingly, the risk factors that affect white MSM do not necessarily apply to Black and Latino MSM, even though those minority MSM populations are more likely to be HIV-positive. Since that is the case, Millett said, behavioral scientists are examining a wide variety of social/structural/cultural and interpersonal factors. Among said factors are depression/distress, childhood sexual abuse, immunogenetics, circumcision, machismo/acculturation, poverty and discrimination. Among the recommendations Millett made were more frequent HIV/STI ( sexually transmitted infection ) screenings, appropriate care for HIV-positive MSM and new behavorial interventions. He also said that the CDC is working with Black media and churches to get the message out about HIV prevention education.
Among other things, Stall summarized the current HIV risk among MSM, reviewed the efficacy of prevention efforts and presented his case for the necessity of a 'prevention cocktail' ( multiple mechanisms of prevention efficacy ) .
Stall had his own set of disconcerting statistics for the audience. In talking about where the current HIV infection rates could go over time ( incidence ) , he analyzed incidence papers from 1995 to the present ( from North America, western Europe and Australia/New Zealand ) . Using a starting incident rate of 8 percent ( of gay men at age 20 ) and extrapolating at a background incident rate of approximately 2 percent per year, Stall found that about 25 percent of gay men would be HIV-positive at 30 and that almost half would be infected by age 50. Using a CDC study's HIV incident rate of 4 percent for Black men, 60 percent of African-American men would be affected by age 40. What is more alarming, Stall said, is that the skyrocketing rates are already occurring—and that people have known about the incident rate for two decades and have not been 'put a dent in it.'
Citing a study that revealed the importance of such factors as interpersonal skill settings ( 'How do you get a guy to put on a condom when you're bottoming?' ) , Stall said that HIV preventions can work—'if they're well-funded and well-fielded.' He added that challenges to prevention efforts among MSM involve the measurement of risk and the responsibility for safety. 'There's all kinds of information that we need but don't have access to,' he said. 'And most gay men are doing these epidemiological studies with our own lives—not a great strategy.'
An emotional question-and-answer session featured individuals asking why certain other minorities, particularly Native Americans and Asian Americans/Pacific Islanders, were not included in the studies. The response was that, among other factors, Latinos and Blacks are much more disproportionately affected and that initiatives concerning Asian-Americans/Pacific Islanders and Native Americans will appear soon.
Prevention challenges were the overriding theme during the second day. Special guest David Kern, prevention program director of the National Alliance of State and Territorial AIDS Directors ( NASTAD ) , during his 'National Overview of Prevention—'Where are We Now?'' keynote address, stressed a need to change. In his opinion, although morbidity is down, the number of people living with HIV/AIDS increases, new infections remain constant and flat federal funding continues. He said that the nation's response to the epidemic needs to shift from a focus on treatment to prevention if it ever wants to successfully combat the disease.
The bottom line, Kern stressed, is that with its current prevention response, the United States cannot keep up with the increasing numbers of people living with HIV/AIDS.
According to Kern, the nation's response is insufficient for several reasons: the 'legacy of indifference,' the public's broad but shallow support and the nation's 'piecemeal' response.
'Prevention has never been adequately funded,' Kern said regarding the nation's continued indifference. He added that the U.S. historically focuses on policy instead of real issues, and always favors treatment over prevention. The reason, he said, is because treatment is more qualitative.
'Prevention takes years to be realized; it's not as sexy,' Kern added.
Continued stigmatization and the perception that HIV/AIDS is a problem of 'others' leads to shallow public support, he said. Kern added that the nation's 'uncoordinated' and 'piecemeal' response creates unclear expectations and disregards current efforts.
Other complex problems that factor into the nation's subpar response are the lack of measures of success ( such as data on new infections ) ; the fact that opponents are using ideology and service providers and AIDS activists have 'lost control of the debate,' and the over dependence on federal resources. Kern feel service providers need to gain back some power in order to move forward, especially because the government's one-size-fits-all approach doesn't work for all areas.
Kern offered what he feels are some necessary actions that need to be taken immediately. One of those suggestions was to continue to do what is known to work, such as condoms and needle exchange programs, while continuing to educate the public and work towards eliminating disparities.
Kern was slightly critical of Chicago's failure to use all prevention tools. 'I went to some bars here in Chicago,' he said. 'I didn't see condoms in these bars.
'HIV is preventable, so use those tools.'
There is also a need, in Kern's opinion, to expand the prevention arsenal ( e.g., microbicides and vaccines ) ; make HIV testing part of a more comprehensive portfolio to identify people with HIV/AIDS and link them to treatment and care; and work towards combating discrimination such as homophobia and institutionalized racism that only worsens the spread of the disease.
Most importantly, Kern said, is a focus on prevention. He suggested intervention at a structural level, instead of focusing, for example, solely on high-risk individuals, to shift the entire curve. 'It's like getting everyone to wear seatbelts,' he said, adding that safety best efforts lowered the overall numbers of deaths among everyone, not just certain people.
But in order to do this, dollars are needed. Millions more need to be invested by the federal government for prevention efforts in a wide variety of areas, AIDS housing and more. More change and direction needs to be taken at the local level, as well, he said.
Among other conference highlights were breakout workshops and a lunchtime forum, 'Future Sex—How Technology Could Radically Alter the Prevention Landscape.'
