A new Morbidity and Mortality Weekly Report (MMWR) article states that new HIV infections among MSM are up from 2001-2006.
Who writes these god awful articles in MMWR? They're entirely unreadable! It's like the purposefully make their language so painful obtuse as to prevent any American from understanding their meaning. As in this section of complicated abbreviations and statistics:
Of 214,379 HIV/AIDS diagnoses in 33 states during 2001--2006, a total of 97,577 (46%) were among MSM. Decreases in diagnoses were observed in all transmission categories except MSM (excluding MSM and IDU) (Figure 1). Among males, MSM accounted for 97,577 (63%) of cases. Men aged 25--44 years accounted for 64% of cases among MSM (Table). Among MSM, the number of diagnoses increased from 16,081 (CI = 15,784--16,377) in 2001 to 17,465 (CI = 16,938--17,992) in 2006; (EAPC = 1.5) (Figure 1).
Let me help translate that into English. You see, when the CDC reports statistics -- or for that matter when anyone reports a statistics -- there are key phrase to watch out for. "Among MSM," for instance, is telling you that the statistics they're reporting is from JUST the sample of MSM -- or "men who have sex with men" (a sanitized public health term). The rest of the data is basically thrown out. Like in the sentence, "Men aged 25--44 years accounted for 64% of cases among MSM." This is a mess of a statement, basically trying to tell you that JUST in their sample of new HIV infections among MSM, almost two-thirds of those cases are from guys who are 25 to 44 years old. Translation: CDC data indicates that young / middle-aged guys are making up the vast majority of new HIV infections among gay, bi, and queer men diagnosed between 2001 and 2006.
But it gets even more complicated, because this trend among older guys is not consistent through all the different demographic "slices" in the date. For instance:
From 2001 to 2006, a 12.4% (EAPC = 1.9) increase in the number of HIV/AIDS diagnoses among all black MSM was observed; however, an increase of 93.1% (EAPC = 14.9) was observed among black MSM aged 13--24 years (Figure 2). During 2001--2006, approximately twice as many (7,658) diagnoses occurred in black MSM aged 13--24 years as in their white counterparts (3,221).
So, let's go through this piece by piece. What we're learning here in the first sentence is that between the years 2001 and 2006 -- in their sample of JUST black MSM -- new HIV infections rose 12.4%. Translation: new HIV infections in black MSM jumped 12.4% between 2001 and 2006. But wait, there's more. When you look again at JUST young black MSM between the ages of 13 and 24 (youth), you find that in that subpopulation new infections REALLY took off, jumping 93.1%. Translation: The number of black gay / bi / queer youth testing HIV positive almost DOUBLED in FIVE years, between 2001 and 2006.
The next bit of information is even more complicated, because the writers don't actually tell you the significance of the data. "During 2001--2006, approximately twice as many (7,658) diagnoses occurred in black MSM aged 13--24 years as in their white counterparts (3,221)." That sounds pretty bad, but just how bad is it? Well, lets dig a bit deeper. The 2007 Census estimates reveal that there are about 3.3 million black men between the ages of 15 and 24, while there are about 16.9 million white men in that age group.
If new HIV infections weren't correlated with race at, then, we would expect that infections among young white MSM would outnumber young black MSM, nearly 6:1. But the reverse is happening -- young black MSM are greatly outnumbering white guys. Translation: Something REALLY fucked up is happening in America right now.
But let's throw an interesting wrench into these cogs... while the numbers are interesting, do we have the correlated numbers of HIV testing rates? IE: is the push for the black community to be tested pushing young black MSM's to be tested at a greater rate, thus indicating that the infection rate may already be there but the rate at which we are finding them is increasing???
Here in Cincinnati, there is not a single person whose job it is to reach out to young black MSM's exclusively... and only one person whose job it is to reach out to MSM's exclusively (a position I used to hold). It was not until I jumped from an ASO/community based testing model into my current position at a healthcare testing site (the main hospital's emergency room) that I ever saw more than one or two anecdotal new African-American positives.
I SUSPECT two things:
1) YES, the rates are higher and the infection rates are higher in young black MSM's (and, though the terminology includes the "down low," I suspect most of it are identified gay men).
BUT
2) The numbers we are seeing are inflated due to increases in HIV testing rates through new avenues of testing (healthcare based) and through a push in the black community to be tested.
But that's just me being contrary.
Ehhhhh.... I don't buy that, were there to be some artificial inflation, it could come close to explaining the grotesque disparity in new infections among black MSM. I also don't think the data on testing rates would support this, but I'm too tired to dig it up right now. But it's certainly always good to take a careful look at the data.
Note that I did say that it is likely the numbers are higher. I'm on my way to get *MY* HIV test right now (and have to catch the damn bus... grrr), but a quick look here from the Body (per the NHIS), black men are more than twice as likely to report being tested than white men (around 59%, actually).
http://www.thebody.com/content/whatis/art42838.html
Problems with the information:
1) Does not cover the huge disparity of rates.
2) Is for people 18+, and we know that youngers crowds tend to be less likely to be tested (I wonder if there's a "peak age" of testing... 26-34, perhaps).
3) Is from a 2006 study and is not longitudinal, nor does it cover the range of time we're talking.
But it's a good start with data.