September 27, 2022 – Today, CHIPTS joins partners across the U.S. in observing National Gay Men’s HIV/AIDS Awareness Day (NGMHAAD), a day dedicated to recognizing the disproportionate impact of the HIV epidemic on gay men and promoting HIV prevention and treatment services that allow gay men to live long, healthy lives. In honor of NGMHAAD, we are excited to feature a reflection from CHIPTS Combination Prevention Core Scientist Dr. Michael Li. Read Michael’s reflection below.
In observance of National Gay Men’s HIV/AIDS Awareness Day, it is important to highlight the significant impact of HIV/AIDS on the gay community since the epidemic began over 40 years ago. In recent years, advancements in antiretroviral therapy have allowed people with HIV to live full, healthy lives, and the availability of pre-exposure prophylaxis (PrEP) provides a critical tool for preventing infection. However, there is still much work to be done. HIV continues to disproportionately impact gay, bisexual, and other men who have sex with men (MSM), with findings from the Centers for Disease Control in 2020 showing that 56% percent of people with HIV and 71% of people with new HIV diagnoses are members of these populations.
Understanding the contextual factors driving HIV infections among gay men is necessary to ensure successful approaches to HIV prevention and care for this population. Gay men who experience stigma and discrimination are more likely to be unstably housed, use psychostimulants (e.g. methamphetamine), and develop mental health issues. All of these factors are linked to increased risk of acquiring HIV, reduced access to preventive services such as PrEP, and reduced access to HIV care and antiretroviral therapy. Furthermore, the impact of adverse social experiences on health may not only be explained by behavior, but possibly complex interactions between one’s social environment and the immune system. In research on diverse MSM, recent experiences of homophobia, violence, and housing instability have been linked to dysregulated pro-inflammatory and antiviral gene expression even when accounting for HIV viral load.
Intersectionality also plays a significant role in HIV prevention and healthcare engagement among gay men. How might race, ethnicity, age, disability, class, or other types of “membership” inform one’s preventive and care needs? How might experiences of intersectional stigma impact medical mistrust? As of 2017, it is estimated that about a third of MSM in the US have used PrEP. Although this represents an overall increase since 2014, Black/African American and Latinx gay and bisexual men were still less likely to discuss PrEP with their providers or use PrEP than their White peers. Similarly, though viral suppression has improved by an average of 9.4% per year since 2014, Black/African American MSM are still less likely to be virally suppressed than other MSM with HIV.
As we reflect on NGMHAAD, I encourage HIV researchers and service providers to adopt an intersectional lens and collaborate with the gay community as we work together to address HIV. In doing so, we will be better positioned to address the diverse, whole-person needs of gay, bisexual, and other MSM, and achieve key goals for Ending the HIV Epidemic in this community.