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Us Helping Us’ Initiation of National Dialogue on a
‘Paradigm Shift” in HIV Infection Declared a Success

Us Helping Us, People Into Living, Inc. (UHU), a community-based AIDS organization in Washington, D.C., has declared a success in its January 2011 launching of a national dialogue about a “paradigm shift” in HIV infection among black gay men.  UHU decided to initiation a dialogue when a 2010 District of Columbia behavioral surveillance study found that black gay men were reporting more condom use and less sexual risk behavior than white or Latino men yet they were disproportionately infected with HIV. The traditional theoretical model of a positive correlation between HIV risk behavior and HIV prevalence was not true for black gay men.

“Us Helping Us believed that the study showed a major shift in the dynamics of HIV infection among black gay men that could have a profound impact on effective prevention in the United States,” said Ron Simmons Ph.D., the president/CEO. “We thought it important to bring this issue to the public’s attraction because black gay men were being demonized for becoming HIV-infected through greater risk behavior when they were really engaging in less risk behavior.”

The 2010 study of 500 gay men in the District of Columbia found that 32% of the black gay men over 30 years old and 12% of the black gay men under 30 years old were HIV-infected.  In comparison, 8% of the white gay men over age 30 and none of the white gay men under age 30 were HIV-infected.  Yet, the black gay men reported using condom 50% more and having fewer sex partners than white or Latino gay men.  The same paradox was reported in a 2011 surveillance study of gay men in Chicago.  In an earlier 2005 Centers for Disease Control and Prevention (CDC) study of gay men in five-cities, an average of 46% of the black gay men tested were found to be HIV-infected, and that study also found a discrepancy between sexual risk behaviors and HIV prevalence among black gay men.

Researchers believe that the discrepancy exists because the higher prevalence of HIV in the sexual networks of black gay men results in their having a greater chance of exposure to HIV even though they may use condoms more often and have fewer sex partners than other gay men.  In addition, the higher prevalence of sexual transmitted infections among black gay men further facilitates HIV transmission in their sexual networks.

To begin the dialogue, in January 2011, UHU partnered with the Black Gay Research Group (BGRG) and sponsored a three-hour institute titled “The Paradigm Shift in HIV infection among Black MSM and Strategies for Effective Prevention” at the 2011 National African American MSM Leadership Conference on HIV/AIDS and Other Health Disparities. A presenter, Greg Millett, a senior researcher at the CDC, confirmed the discrepancy between sexual risk behavior and HIV prevalence among black gay men and through meta-analysis of surveillance studies found that such a discrepancy was evident as early as 1987.

UHU again partnered with the BGRG and presented a roundtable discussion on the “paradigm shift” at the August 2011, CDC’s national HIV prevention conference and at the November 2011 United States Conference on AIDS.  Both roundtables were attended by CDC and health department staff from several states. In January 2012, UHU and BGRG sponsored another workshop titled “The Paradigm Shift Revisited: Structural and Social Prevention Strategies” at the National African American MSM Leadership Conference on HIV/AIDS and Other Health Disparities held in New Orleans.

Dr. Simmons also spoke of the paradigm shift at meetings with CDC officials, staff from the Substance Abuse and Mental Health Services Administration, and the Director of the District of Columbia’s health department, Dr. Mohammad N. Akhter.

“The idea that the increase in HIV infection among black men is not because they engage in more sexual risk behavior but because of the sexual ecology of their sexual networks is now known and understood by many researchers and health departments,” says Ernest Walker, the Senior Manager of Programs.  “A year ago we wanted to initiate a dialogue and today the ‘paradigm shift’ is a major topic of conversation.  We achieved our goal.”

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