A former White House science advisor visiting Australia says governments need to look harder at the social factors driving recent increases in Western HIV rates, particularly ‘homo-negativity’ from religious and ethnic communities.
Dr Judith Auerbach, who is now vice president of science and public policy at the San Francisco AIDS Foundation, will address increasing infection rates among men who have sex with men at the 2009 Australasian Sexual Health and HIV conferences in Brisbane this week.
“HIV infection rates among gay men have increased steadily since the 1990s, while they’ve declined among most other population groups. The epidemic is still overwhelmingly among gay men,” Auerbach told the Sydney Star Observer.
New estimates from the US Centers for Disease Control claim men who have sex with men are 50 times more likely to have HIV than other men and women.
Higher rates of depression and alcohol and substance abuse among adult gay men have consistently been linked to HIV acquisition risk, Auerbach said.
“It’s all connected to being gay in a homo-negative culture. The background of gay men’s lives can have an ultimately very complicated pathway to acquisition and transmission of HIV.
“Everything from child sexual abuse, to being bullied in school, to other ways you could define homo-negativity, the ways dominant culture is negative to homosexuality and is played out by bullies, has a relationship to adult behaviours that lead to HIV risk.”
African American gay men have even higher HIV rates. Auerbach said that had a lot to do with their social position, driven in part by the homophobic black church culture, and also their low visibility in so-called gay refuge destinations like San Francisco’s Castro district.
“[Same-sex] marriage is not necessarily protective,” she said. “Most transfers continue to happen between main partners, not the other partnerships. All people tend to use condoms with their non-main partnerships.”
Auerbach and the SFAF are now facing the challenge of whether it is possible to tell gay men to have fewer sexual partners.
“We’re more likely to say ‘use condoms correctly and consistently’ than we are to say ‘don’t have multiple sex partners’. We don’t take an abstinence-only point of view, but we do point out there are epidemiologic arguments to be made that it would make more sense to reduce one’s sex partners.”
Gay communities are still important, Auerbach said, but gay men’s sexuality is increasingly only one part of their lives, making the traditional strength of gay communities in combating HIV more complex.