The Ongoing Epidemic of HIV Among Gay Men

Suppose a prestigious medical journal published an issue on the negative health consequences of smoking, but rather than encouraging smokers to quit, the authors explained that health refers not only to the absence of disease, but also the possibility of a safe and pleasurable smoking experience. In addition, the journal blamed the health problems of smokers not on their inability to quit, but on social and legal discrimination against smoking.

Of course, this is absurd. In fact, in Aug. of 2012 issue of the prestigious British medical journal The Lancet an article on tobacco use concluded that “efforts to prevent initiation and promote cessation of tobacco use are needed to reduce associated morbidity and mortality.”[1] However, just three weeks earlier the same journal published a series of articles which, rather than addressing the cause of the continuing epidemic of HIV among MSM (men who have sex with men), blamed the morbidity on social discrimination.

The authors admit that the problem is serious:

Despite decades of research and community, medical, and public health efforts, high HIV prevalence and incidence burdens have been reported in MSM throughout the world.[2]

And the problem is getting worse, for even as HIV incidence in other groups is declining, it is increasing among MSM:

In the USA, HIV infections in MSM are estimated to be increasing at roughly 8% per year since 2001.[3]

The articles clearly describe the causes of increase: MSM, who socialize in networks where the infection rate is high, continue to engage in AI with multiple casual partners, often while using various illegal drugs, thus exposing themselves to infection. According to the articles, MSM’s behavior exposes them not only to HIV, but also to syphilis, gonorrhea, chlamydia, herpes simplex, human papillomavirus, viral hepatitis, enteric pathogens, and MRSA.[4]  MSM are also far more likely to be depressed, experience suicidal ideation, panic disorders, phobias, generalized anxiety disorder, and body image concerns.[5]

Nowhere in the journal do any of the authors suggest that, given the risks, MSM should refrain from AI. On the contrary, according to the authors:

Sexual health refers to not only the absence of disease, but also the possibility of safe and pleasurable sexual experiences.[6]

In other words, prevention strategies should be designed to accommodate MSM’s desire for AI with multiple casual partners. This is at best a risk “reduction” strategy not a risk “elimination” strategy, but it has not even reduced new infections.

HIV/AIDS is an easily preventable disease. A person who is HIV negative can virtually eliminate his risk of HIV infection if he restricts his intimate relations to one person at most and that person is also HIV negative and faithful, doesn’t share needles with others, and has access to high quality medical care.

However, early in the epidemic the gay AIDS activists insisted that protecting gay sexual freedom was the overriding principle that should inform every prevention strategy.[7] They rejected standard, common-sense public health strategies for controlling a sexual transmitted disease (STD). These include: mandatory testing of high risk groups (for example, those diagnosed with other STDs), contact tracing, partner notification, and closing venues where transmission was taking place. Early in the epidemic when it was clear that MSM were being infected in gay bathhouses, gay activists fought to keep these venues open.

Two gay men Randy Shilts (who died of AIDS) and Gabriel Rotello in their books And the Band Played On and Sexual Ecology[8] have laid out the history of the gay resistance to efforts to control the epidemic. The gay AIDS activists rejected these prophets from their own ranks.

Instead the gay AIDS activists insisted that all that was necessary was for everyone to use a condom every time. This strategy has failed, partly because condom failure during AI is high, but mostly because very few MSM engaging in high risk behavior with multiple partners while using drugs and alcohol use a condom every time.

New studies suggest that an infected person is more likely to infect others right after he is infected. Therefore, beginning treatment as soon as the infection is identified can dramatically reduce the risk of spreading HIV. Mandatory testing of all those infected with other STDs, tracing their sexual contacts, notifying their partners, and testing and treating them could result in a significant decrease in new infections. This would of course require identifying every carrier of HIV, providing them with HAART (highly active anti-retroviral therapy), monitoring their compliance, and contacting all their previous and current sexual partners. Gay AIDS activists have vigorously and successfully fought any form of mandatory testing, even when laws protecting privacy are strictly enforced. Without early identification and treatment, the recently infected will infect others and the HIV epidemic among MSM will continue.

Rather than admitting the current strategy’s failure and encouraging proven common-sense public health strategies, several articles in the The Lancet blame ‘homophobia,’ ‘heteronormativity,’ stigma, and discrimination[9] for the continuing epidemic among MSM, but there is no evidence to support such a claim. If discrimination were a significant factor one would expect that in high income settings where discrimination is low or non-existent and gay-sensitive medical care available, the epidemic would be under control. However, the authors admit that:

HIV prevalence rates in these men [MSM] seem to have increased in the HAART era…. in settings where MSM have full access to HAART and to a broad range of HIV services, civil liberties, and organized and visible community structures.[10]

Although according to the CDC young MSM are at very high risk of infection,[11] The Lancet articles encourage young men with SSA (same-sex attraction) to come out,[12] even as they admit that “Sexually active adolescents will need routine STI and HIV services.”[13]  There is reason to fear that this problem will only get worse since:

2011 research showed that individual sexual behavior milestones are being reached at progressively younger ages by those identifying as homosexual.[14]

There is no question that life is difficult for adolescents struggling with Gender Identity Disorder (GID) and SSA. However, for some boys, early identification and treatment of GID could prevent adolescent SSA.[15]

One sure way to eliminate the risk HIV infection is to refrain from homosexual behavior. While many MSM reject this option, some might be open to interventions designed to address their SSA, but this approach is specifically condemned by the authors who call on providers to:

Refrain from participation in health programs…that violate human rights, including so-called reparative therapy or conversion therapy.[16]

It is difficult to understand how providing therapy for someone uncomfortable with his SSA or who wishes to avoid the risks associated with homosexual behavior is a violation of “human rights.”

Given the massive resources dedicated to what has clearly proven to be a failed strategy, one would think that the AIDS establishment would consider other options.

Not only has the AIDS establishment betrayed MSM with a failed strategy, they have imposed this failed strategy on Sub-Saharan Africa. Edward Green in his book Broken Promises: How the AIDS establishment has betrayed the developing world provides a graphic description of how the inexpensive behavior change strategy, which was working in Uganda, was undermined by western funders who pushed the failed condom strategy, even though there was no evidence that it was successful either with MSM or with heterosexuals.

The articles in The Lancet demonstrate how gay AIDS activists are using the epidemic to push their political agenda. The tragedy of the HIV/AIDS epidemic among MSM is that those who claim to care about MSM have been intimidated by gay AIDS activists and refused to insist on standard public health strategies. If this continues, a preventable epidemic will grind away for decades.