On August 24th, 2009, CDC representatives at the National HIV Conference in Atlanta, Georgia reported that gay men and other MSM (men who have sex with men) are 50 times more likely to have HIV than heterosexual women or straight men. The report is not yet available at the CDC website and interestingly, only the “gay” newspapers have picked it up as a worthy news story (thus far).
This statistic is reported as confirming, in emphatic terms, the disproportionate impact of HIV/AIDS on gay and bisexual men of all races and ethnicities. It also recognizes that the highest impact is on African-American men. This announcement is crucial in a few key ways:
First, while there is no cure for HIV or AIDS (and a partially effective vaccine–soon to be another post), many in the US have had access to anti retroviral medications (ARVs) for decades. Many people therefore assume that HIV prevalence has leveled off and that there are very few NEW HIV cases in the US. This is simply not the case. We have a truly problematic epidemic here in the US, and the numbers clearly show us that certain populations are even more at risk than we knew.
This leads me to my second point: Our resources should be aligned to reflect where the risk is. It is not clear that this is happening, particularly in communities of color.
This new announcement tells us, in a convincing and unrelenting way that there is a disproportionate impact on MSM.
So, it’s clear that there’s a huge problem here. Still, I have some critical questions about this report.
1) First, is there a differential risk between gay men, bi men, and MSM who may not identify as “gay” or “bi” ? Why not report the difference in risk between gay men, bi men, and MSM?
2) Second, what is the difference between:
a) the risk among gay men, bi men, and MSM (as a category and separately, since they lumped them all together) compared to risk among heterosexual women and b) the risk among gay men, bi men, and MSM (as a category and separately) compared to risk among heterosexual men?
If there is a difference there, shouldn’t we also report that? If we don’t separate out analyses (a) and (b), don’t we unnecessarily set up a “heterosexual” and “minority sexuality” binary?
3) Further, given that (a) and (b) were not analyzed and presented and given that heterosexual women are experiencing rapid increases in risk in some populations, how can we assure that resources aren’t needlessly pulled from them due to the way the data is being presented?
I have more thoughts, but I’ll stop there for now. There are many interesting framings of data that we can offer that rely on categories of gender or sexuality. We should do both at once. I am proud of my Centers for Disease Control for coming out, so to speak, with these newest figures, and as usual, I look forward to even more figures if these are also bravely revealed. Nuance, not simplicity helps—just as we find in media sound bites.