As National African-American HIV Awareness Day approaches on Feb. 7, Gregorio Millett is calling for funding to be directed toward the Black gay communitya community that continues to see HIV infection rates rise.
Millett is a nationally recognized epidemiologist and researcher with significant experience working at the highest levels of federal HIV policy development. He's held positions with the White House and Centers for Disease Control and Prevention. In 2014, he joined amFAR, The Foundation for AIDS Research, as its vice president and director of public policy.
Millett said despite decreases in infection rates among many different demographic groups in the United States, African-Americans as well as gay and bisexual men remain at a higher risk, and Black gay men are especially vulnerable.
"African-Americans [make up] about 46 percent of new infections each year and gay and bisexual men comprise about 66 percent of new infections each year," Millett said. "The community that is in between those communities is Black gay men. They represent about 1.4 percent in the African-American community, but they are 53 percent of new infections among African-Americans."
Millett added that Black gay men only make up about 0.2 percent of the U.S. populationhowever, they account for a quarter of the approximately 50,000 new HIV infections in the United States each year.
"The estimates are pretty shocking," he said. "We have about one in three African-American gay men who are HIV positive in major cities in the United States. These are high rates and something you don't usually see in wealthy countries."
In fact, Millett said these numbers are comparable to the infection rates of young women in sub-Saharan Africa or for transgender women in Indonesia, both of which stand at approximately one in every three women.
Most people would assume the rates of infection have to do with high-risk behaviors, but Millett said studies have proven that is not the case.
"Black gay men have fewer sex partners and don't engage in higher rates of unprotected intercourse compared to white gay men," Millett said.
The reasons for the higher rates of infection among Black gay men are in line with the reasons the African-American community in general has seen higher rates of infection overall.
"You find exactly the same issues, particularly with young African-Americans and young Black women, rates are higher in those populations compared with young whites," Millett said. "It's the same thing you see with injection drug users. Injection drug users who are more likely to be HIV positive are African-American compared to not, and they aren't engaged in higher rates of risk behavior."
One of the primary reasons for the higher infection rates has to do with a lack of access to health care.
"If someone has less access to health care they are less likely to be diagnosed with HIV and if they are not diagnosed with HIV they are more likely to transmit it to their partners," Millett explained. "If you don't have access to health care and you are HIV positive then you are less likely to be taking medications that prevent you from transmitting HIV to your partners."
People taking HIV medications are 96 percent less likely to transmit the virus to a partner.
Stigma is another key reason why the African-American community and Black gay men are more vulnerable to HIV infection.
"People are afraid to get tested or to know their results," Millett said. "They are afraid people are going to marginalize them."
Millett said the conversations that need to be happening around HIV infection are simply not occurringin any communities.
Also, stigma around HIV has not changed significantly from the 1980s, with nearly the same percentage of people in 2009 as in 1989 believing HIV could be transmitted via mosquitoes, toilet seats or sharing a glass of water.
"There is still more work we need to do to reduce stigma and misconceptions, and to make sure people can get the care they need and deserve," Millett said.
The LGBT community isn't exempt from prevailing HIV stigma, though Millett thinks things are improving.
"There is still HIV stigma that is present within the LGBT community, but you also find there are some barriers that are starting to come down, and they are starting to come down because of all the successes we've had in fighting HIV," he said.
He noted there is less stress between partners where one person is HIV positive and the other is HIV negative than in the past and younger gay men are starting to consider dating men who are HIV positive. A lot of that has to do with the medical innovations that have occurred in the last few years.
Despite the challenges, Millett is optimistic for the future thanks to the decreases in infection rates within other subgroups within the Black community.
"We are seeing infection rates decreasing among African-American women," he said. "The CDC reported they decreased by 21 percent between 2010 and 2011. New infection rates have been steadily decreasing from the mid 1990s among injection drug users in the Black community. They've also been decreasing among infants born with HIV."
Millett thinks if resources are directed smartly, the rates of HIV infections among Black gay men will also go down.
"We've had incredible leaders in Congress who really fought hard for the Minority AIDS Initiative through the Congressional Black Caucus that provided funding for dealing with HIV within the African-American community from 2000 to now," he said.
"I think some of that funding has really helped to level off the rates of HIV within the Black community and actually decrease the rates within African-American women and African-American infants born with HIV as well as African-American injection drug users. We need to see more of that focus happening with Black gay men."
Policy changes could also make an impact.
Millett said there were policies adopted at the advent of the AIDS epidemic that continue to hinder HIV/AIDS education efforts, but due to the cultural shift in acceptance of the LGBT community those might finally be changed.
"HIV-prevention efforts have been hampered to a certain degree in the United States because of policies we have on the books that make it very hard to discuss specific issues, particularly homosexuality," he said.
Millett expects 2015 to be an important year for HIV/AIDS work, because it marks the last year in President Barack Obama's HIV/AIDS strategy.
"The strategy specifically calls out African-Americans as well as gay men as priority populations for dealing with HIV in the United States," he said. "This is a good opportunity to see, within the White House policy, how well they've done in the past five years in addressing HIV in both of these populations, and what things we would like to see change as they move forward with the next iteration of this strategy."