Gay Men's Health Crisis at the XIX International AIDS Conference

The following is the schedule for Gay Men’s Health Crisis (GMHC) at the

2012 International AIDS Conference.

SUNDAY, JULY 22 to FRIDAY, JULY 27

NGO Booth: "You Are Not Alone" 
GMHC will be distributing materials of social marketing, HIV prevention and testing campaigns, services for people living with HIV and AIDS, reports on public policy efforts.
Location: Global Village, Hall B, Booth #632

SUNDAY, JULY 22

Satellite Session:
“From Revolution to Reality:  How Will New Science Impact the U.S. National HIV/AIDS Strategy?”
11:15 am – 1:15 pm
Location:  Mini Room 4

Panelists:

• Keith Green , AIDS Foundation of Chicago
• David Holtgrave, PhD, John Hopkins Bloomberg School of Public Health
• Molly Morgan Jones, RAND Corporation
• Carlos del Rio, MD, Global Health Institute

Moderator:  Marjorie Hill, PhD, Chief Executive Officer, Gay Men’s Health Crisis (GMHC)

The U.S. National HIV/AIDS Strategy (NHAS) has been in place for two years.  Since its release, scientific breakthroughs and new research have transformed our thinking about the U.S. HIV epidemic.  HTPN 052 and successful PrEP and microbicide trials demonstrate that biomedical interventions hold promise that was unthinkable just two years ago.  At the same time, Gardner and his co-authors shine the spotlight on the human factors impacting the epidemic – half of people with HIV are not in medical care, and just one in four achieves treatment success.  Key researchers, including some who contributed to these breakthrough findings, will weigh in on the implications of new research on the U.S. Strategy.

Symposium:
“Gay Leaders:  Who Do You Represent Beyond Yourself?”
3:45 – 5:45 PM
Location:  Global Village – Room 2

Panelists:

• Stephen Lewis, Stephen Lewis Foundation, AIDS-Free World
• Jeanne Gapiya, Association Nationale de Soutien aux Séropositifs et aux malades du Sida (ANSS)
• Marjorie Hill, PhD, Gay Men’s Health Crisis (GMHC)
• Othoman Mellouk, MSM Global Forum

Moderator:     Yves Yomb, Alternative Cameroun

The Greater Involvement of People Living with HIV and AIDS (GIPA Principle), declared at the Paris Declaration in 1994 and formally adopted by the UNAIDS in 1999, affirms that people living with HIV/AIDS (PLWHA) should be fully involved and integrated in the development of policies related to and programs providing HIV research, care, prevention, and treatment.  The panelists will debate and analyze the evolution of the PLHIV and MSM leadership in Africa Europe and North America and in particular.

MONDAY, JULY 23

Satellite: National AIDS Leadership Circle
“Equity for YMSM of Color in the USA: Ensuring Quality Cultural, Structural and Optimal Care & Research for Gay and Bi Men of Color” – Organized by:  AIDS Action Committee of Massachusetts, AIDS Foundation of Chicago, AIDS Project Los Angeles (APLA), Gay Men’s Health Crisis (GMHC),  Legacy Community Health Services, Lifelong AIDS Alliance, San Francisco AIDS Foundation
7:00 am – 8:30 am
Location: Mini Room 6

Panelists:

• Robert Garofalo, MD, MPH, Ann & Robert H. Lurie Children’s Hospital of Chicago’s Gender, Sexuality and HIV Prevention Center
• Ron Stall, PhD, Center for LGBT Health Research, Department of Behavioral and Community Health Sciences at the Graduate School of Public Health at the University of Pittsburgh
• M. Keith Rawlings, MD, HIV Medical Affairs at Gilead Sciences, Inc.

Moderators:

• Phil Curtis, APLA
• Ace Robinson, MPH, Managing Director, Public Policy, Research & Community Health, GMHC

The satellite will engage the public on the multivariate barriers for young men who have sex with men of color (YMSM) to access and maintain competent healthcare. The discussion will focus on the cultural norms that often discourage utilization of HIV/STI prevention and intervention opportunities, policy issues surrounding structural barriers to care, and the integration of developing modalities into traditional primary care and mental health.

Satellite Session:

“The State of New Media and HIV: How new media is helping to move us closer to an AIDS-free generation” – Organized by AIDS.gov; Planning Committee:  GMHC, ISIS, Metro Teen AIDS, POZ, San Francisco AIDS Foundation

6:30 pm – 8:30 pm
Location: Mini Room 4

Panelists:

• Susannah Fox, Pew Internet & American Life Project
• Ingrid Floyd, Iris House
• Venton Jones, National Black Gay Men’s Advocacy Coalition
• Oriol Gutierrez, POZ
• Eunice Gnay Namirembe, TextToChange
• Ken Williams, Test Positive Awareness Network

Moderator: Todd Park, U.S. Chief Technology Officer, The White House
Closing remarks:  Miguel Gomez, AIDS.gov

WEDNESDAY, JULY 25

Presentation:
“At the Intersection of HIV and Cancer: Needs and Interest in Cancer-Related Programming Among AIDS Service Organizations” – John Guidry, PhD, Director, Community Health and Research
12:30 pm – 2:30 pm  

The poster presents the findings of an assessment of 60 AIDS service organizations in the tri-state area on their needs and challenges in providing cancer programming for HIV-positive persons.

Poster Display and Presentation:
“Knowledge of and Attitudes Toward PrEP in a New York City Sample of Sexually Active MSM" (WEPE277) –John Guidry, PhD, Director, Community Health & Research and Ace Robinson, MPH, Managing Director, Public Policy, Research & Community Health
12:30 – 2:30 pm
Location:  Exhibition Hall, Level 2 

The poster details the findings of a survey of gay men undertaken by Columbia University and GMHC at annual LGBT Pride events in 2011.

Oral Poster Discussion:
"International Blood Donation Guidelines for Men who have Sex with Men (MSM)" – Nathan Schaefer, MSSA, Director, Public Policy
1:00 pm – 2:00 pm

The U.S. Food & Drug Administration prohibits men who have sex with other men (MSM) from donating blood. The policy does not consider the potential donor´s HIV status, sexual activity, or relationship status. The current policy allows other populations at elevated risk of HIV to less restrictive deferrals, or no deferral at all. This type of policy reinforces incorrect information about the spread of HIV. Most countries have permanent deferrals of MSM blood donors despite chronic blood shortages. Reform of U.S. blood donation guidelines is necessary to maximize blood donations and improve blood safety protocols.

Satellite:
“HIV & Aging: The Challenge of the Epidemic’s Fourth Decade” – Organized by Community Research Initiative of America (ACRIA) in partnership with Gay Men’s Health Crisis (GMHC) and Services and Advocacy for GLBT Elders (SAGE)
6:30 pm – 8:30 pm
Location:  Session Room 7

Event Co-Chairs:

• Dr. Gottfried Hirnschall (to be confirmed), HIV Department, World Health Organization
• Naisiadet Mason, Kenyan HIV activist and older adult with HIV

Speakers:

• Kevin Fenton, MD, PhD, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention at the U.S. Centers for Disease Control and Prevention
• Joel Negin,  University of Sydney School of Public Health
• Stephen Karpiak, PhD & Mark Brennan-Ing, PhD, ACRIA Center on HIV and Aging and New York University College of Nursing
• Lisa Power, Terrence Higgins Trust

Panelists/discussants:

• Ricardo Jimenez, Ecuadorian Red Cross (Ecuador)
• Carolyn Massey, Older Women Embracing Life, Inc. (United States)
• Wojciech Tomczynski, SIEĆ PLUS Polish Network of People Living with HIV/AIDS Association (Poland)
• Ruth Waryaro, HelpAge International (Uganda)

This session aims to bring greater scientific and policy emphases to the challenges and concerns experienced by an aging HIV epidemic.  Brief presentations will cover epidemiology, prevention, and care management in the context of multi-morbidity—the occurrence of two or more chronic medical conditions, common in older adults with HIV—and caregiving challenges.  In addition, a global community panel of older adults with HIV will respond. Participants will discuss appropriate public policy responses in various national and global contexts.

THURSDAY, JULY 26

Poster Display:
"HIV Prevention and Treatment in Prisons and Affected Communities: A Global Comparison" – Robert Valdez, MSW, Policy Analyst
12:30 pm – 2:30 pm
Location:  Exhibition Hall

Numerous studies of densely populated regions have found a direct correspondence in higher rates of incarceration with higher rates of HIV infection.  Comprehensive discharge planning and reentry programs can greatly reduce these trends.  There is widespread belief that HIV transmission is common in prison settings; however, precise statistics on infection rates in prisons are not available. Although condom availability in U.S. prisons is extremely rare, distribution programs have been very successful in many other countries.  The World Health Organization, the United Nations Office on Drugs and Crime, and the Joint United Nations Program on HIV/AIDS all recommend that prisons readily provide condoms confidentially to inmates.

Poster Display and Presentation:
“It's Not Just HIV testing: Addressing the Disproportionate Rates of HIV Infection in African American MSM Through a Coordinated Prevention Approach” (THPE230) – Lynnette Ford, MSW, Director, and Kenneth Curry, Community Health Specialist, David Geffen Center for HIV Prevention and Health Education
12:30 pm – 2:30 pm
Location:  Exhibition Hall, Level 2

New York City continues to be the epicenter of HIV/AIDS infection. In 2012, the NYC Department of Health and Mental Hygiene released surveillance data that indicated 43% of all new HIV infections occur in African-American men who have sex with men (MSM).  An integral component of GMHC’s prevention activities is our innovative HIV counseling, testing, referral and partner notification program targeted to minority MSM.

Forum:
“Combination HIV Prevention” – Ace Robinson, MPH
4:30 pm – 6:30 pm
George Washington University/School of Public Health
Followed by a reception, 7:00 pm – 9:00 pm

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GMHC Lauds FDA's Approval of HIV Drug (Truvada) to Prevention New Infections

Today the U.S. Food and Drug Administration (FDA) approved the once-daily oral Truvada® in combination with safer sex practices, to reduce the risk of sexually acquired HIV-1 infection in adults at high risk. Truvada is the first drug to be approved for HIV prevention in uninfected adults, in the form of pre-exposure prophylaxis (PrEP).

"GMHC applauds the FDA decision on Truvada which will clear the way in making this new prevention tool available for adults at high risk of contracting HIV," said Janet Weinberg, Chief Operating Officer of GMHC. "PrEP drug development will be added to the vast array of HIV prevention tools including condoms, HIV testing and Post-Exposure Prophylaxis (PEP). Truvada as PrEP will clearly be one of the first iterations for Treatment as Prevention (TasP). While we do not have all the necessary information about how the public will respond and potentially utilize this medication for prevention, our clients, family members and loved ones deserve complete support to advance HIV prevention."

PrEP is a big step forward in the development of a range of prevention healthcare that each person who perceives themselves at-risk for contracting HIV may utilize in their cadre to protect his or her health.  HIV is a virus that when left untreated will ultimately kill each person it infects. GMHC adamantly supports the development of any tool that will treat the infected person or will hinder HIV-acquisition for an uninfected person. Each available tool helps stop HIV in its tracks. GMHC strongly agrees with President Obama and the National HIV/AIDS Strategy--working together, expanding testing and treatment, and building our prevention toolbox, we can achieve an AIDS-free generation.

The National HIV/AIDS Strategy at Two: The Beginnings of Reform, and a Glimpse of Success

by Chris Collins

Five years ago, hundreds of organizations signed a call to action demanding a more accountable, coordinated, and outcomes-oriented approach to tackling AIDS in America. It called for setting clear targets for progress, increasing collaboration, and focusing on hardest hit populations.

What we saw five years ago was a patchwork effort: people and organizations doing great work in countless ways, but ultimately not focused collectively on getting the job done. Today, a lot has changed for the good -- in science, policy, and in evidence of success. On the second anniversary of this country's first comprehensive National HIV/AIDS Strategy, it's worth thinking about what has gone right, and where we go next.

The strategy changed -- and in a way, restarted -- the conversation on HIV in the United States. Five years ago, the domestic epidemic seemed invisible, and President Obama should be applauded for making it a priority in policy and funding. With the strategy came a whole string of reforms -- some of them demonstrating real political courage, like greater emphasis on serving people at the center of the epidemic, including gay men and African American and Latino men and women; rechanneling money to more closely follow the epidemic; calling on states to undo senseless criminalization laws; and redirecting prevention money to have tangible impact on overall HIV infection rates.

As it was written in 2010, the strategy anticipated crucial developments of the next two years. The HPTN 052 study established conclusively that HIV treatment is also HIV prevention. The Affordable Care Act promises health coverage for millions.

Of course, it hasn't all gone as planned. There have been some advances in interagency coordination, streamlining funds and reducing reporting burdens, but there also have been numerous hold-ups in these areas. The 12 Cities Project is a worthy effort to improve the response in urban epicenters, but it has faced its own challenges with bureaucracy, paperwork, and underfunding. Evidence took a back seat to ideology when Congress prohibited federal funding for syringe exchange programs.

The original principles of the National HIV/AIDS Strategy movement remain critically important, but the context has changed significantly. Today it's less about calling for improved federal coordination, and more about challenging every level of government to build an effective response that we now know is possible. In places like San Francisco and Massachusetts we have started to glimpse success in reducing HIV incidence. A recent analysis by David Holtgrave of Johns Hopkins University shows that the strategy goals are attainable with expanded delivery of multiple evidence-based interventions.

In Massachusetts, Medicaid was expanded to cover people living with HIV in 2001, and in 2006 the state enacted health reform legislation, achieving over 98 percent health insurance coverage of its residents by 2010. HIV infection rates have fallen sharply -- by 45 percent between 2000 and 2009. The state is fortunate to have many accessible community health centers, providers who are comfortable delivering quality HIV care to people most likely to be affected, and support services like housing, nutrition, and transportation. Evidence-based harm reduction programs such as syringe exchange are in place. In many areas of the state, it's OK to be gay. All this means that people have a reason to get an HIV test; if they are positive, they know they can get care and be treated respectfully.

San Francisco has similar advantages, including broad health coverage. There, the public health department ramped up testing and earlier initiation of HIV treatment and the percentage of HIV-positive gay men who do not know their HIV status has fallen significantly. Prevention dollars were concentrated in areas where they would have the greatest impact. As more people became aware of their HIV infection and brought their HIV viral load down, HIV incidence decreased and stabilized at a lower level.

Achieving the National HIV/AIDS Strategy goals is going to require more examples like these, though of course each setting will be different. There is no substitute for local and state leadership. It is at the local level where decisions can be made to scale up HIV testing and treatment access, create comfortable health care environments, and match resources with the realities of the epidemic. State participation in expanded Medicaid is a top priority. Advocates will also need to press states to increase investment in HIV services, and insist that public health departments focus resources on interventions that can have the greatest benefit for the most acutely affected populations.

The federal government has to set the incentives to drive local success. That means increasing funding for AIDS programming and implementing health reform so that it serves people with chronic health conditions including HIV. Federal agencies also have to be clear about the markers for success. In an era in which we understand the connection between treatment and prevention, viral load should be a key measure in evaluating patient health, provider quality, and community outcomes. If the federal government clearly emphasizes a few measures such as testing rates, linkage to and retention in care, and viral load, it can focus efforts at the state and local level.

In addition, the federal government needs to partner with others to launch a full-scale media effort aimed at fighting HIV-related stigma, and using the voices of people affected by HIV to encourage HIV testing and treatment. As Jared Baeten from the University of Washington said recently, "It should be a badge of honor to know your HIV status and be on treatment if you have HIV, and on remaining HIV-free if you do not."
Five years after the movement for a National HIV/AIDS Strategy started, we can be far more specific about what is needed. And we can be confident that we can make great progress against the epidemic at home.

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Chris Collins is Vice President and Director of Public Policy at amfAR, The Foundation for AIDS Research.  His article was originally published in The Huffington Post.

Paradise Garage

by Mark Thompson

The Paradise Garage (1977-1988) was a Manhattan nightclub for Gay men and their allies. It is remembered as a mythic utopia for people whose spirituality is grounded in the performance of communal Gay male folk’s dance, an iconic space in the history of underground dance music, and the professional residency of the legendary DJ, Larry Levan.

Paradise Garage celebrants (isodisco.com/eddie-gordon- lenny-fontana-legends-of-the-dancefloor-a-piece-of-paradise-all-episodes, July 2012)

From Parking Garage to Paradise Garage
The Paradise Garage (also known as “the Garage”) was a private club that did not serve liquor. It was open Friday and Saturday, with extended hours on Saturday that could go into early afternoon on Sunday. Originally a parking garage at 84 King Street in Manhattan, the 20,000 square foot space had what some dancers considered to be the premier sound system in all of New York. The Garage opened in September 1977 with a series of “construction parties” that lasted for at least a year as the final touches were put on the club.

Street front of the Paradise Garage (jen492.aisites.com/larrylevan/paradisegarage.html, July 2012)

Owned by Michael Brody (a Gay White man), the clientele of the Garage was mostly African American and Latin. Prospective members were interviewed, and not but a few Straight people or women were accepted. Members could bring up to four guests, but only one of them could be female. The Garage catered to a Straight/Gay mix of people on Fridays, and Saturday nights were predominantly Gay.

To read more of the article, click here.

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The article was initially published by the Qualia Encyclopedia of Gay Folk Life.

GMHC Thanks City Council For Standing Up for People Living with HIV/AIDS

In the 31st year of the HIV epidemic, HIV/AIDS services faced the prospect of being drastically reduced or eliminated in the Mayor's Executive Budget. HIV/AIDS Services Administration (HASA) contracts were on the chopping block, but for the fourth year in a row the New York City Council took decisive action, stepped in and successfully negotiated to restore this critical funding.  This was no easy task considering the depth of cuts proposed to critical social services.  Supportive housing for people living with HIV/AIDS faced a $5.1 million cut, funding for Momentum's nutrition services for people living with HIV/AIDS and GMHC's Financial Management services were both slated to be eliminated.

"These restorations truly demonstrate New York City Council's unwavering commitment to people living with HIV/AIDS and ending the epidemic," said Marjorie J. Hill PhD, Chief Executive Officer of Gay Men's Health Crisis (GMHC). "On behalf of our clients who will greatly benefit from these restorations, I extend my heartfelt appreciation to Speaker Christine Quinn and all of City Council.  I want to also thank the Councilmembers Annabel Palma and Maria del Carmen Arroyo and LGBT Caucus.  Their leadership and advocacy have made an incredible difference in the lives of people living with HIV/AIDS."

GMHC remains committed to working with New York City Council, as well as all of our elected officials in the ongoing fight to end AIDS.  HIV continues to be a real and growing problem in New York City and these services remain as critical as ever.   GMHC continues to strongly advocate for greater access to HIV prevention programs while expanding access to care and treatment services.  As we work towards the National HIV/AIDS Strategy goal of an "AIDS-Free Generation," NYC must remain a steadfast leader in this struggle.

GMHC Salutes Supreme Court Decision on the Affordable Care Act

GMHC is heartened by the Supreme Court's ruling to maintain the President's passage of the Affordable Care Act (ACA).  This is promising news for people living with HIV/AIDS (PLWHA).   ACA will expand healthcare access to include people with pre-existing conditions such as HIV.

It will also provide many Americans with healthcare who have traditionally had reduced access to care. Among those who will immediately benefit from the full implementation of ACA are those most at-risk for HIV infection and poor health outcomes, such as men of color who have sex with men, women of color, transitionally-housed individuals, senior citizens and youth.  

"This is the single most important public health legislation since Medicaid/Medicare, and will impact more people living with HIV/AIDS than Ryan White legislation," said Marjorie Hill, PhD, CEO of GMHC. "We are relieved and proud of having affordable, accessible health care for more Americans."

Upholding this critically important law allows the Obama Administration to continue to advance the ongoing implementation of the National HIV/AIDS Strategy.  The available tools to realistically stop the growth of this epidemic are finally coming into place. This nation is now better poised to achieve the President's goal of this next generation being an "AIDS-Free Generation."

Of the more than 1.2 million people living with HIV in the U.S. today, an estimated one in five, or nearly one quarter of a million people, do not know they are infected. One-third of those who are HIV-positive are diagnosed so late in the course of their infection that they are evaluated with AIDS during the first year post-diagnosis. And we have learned that early diagnosis and treatment are mandatory in order to save lives and reduce the spread of HIV.

ACA also has a provision for Medicaid expansion which would benefit PLWHA who need competent and consistent healthcare. However, allowing states to opt out of Medicaid expansion could potentially result in compromised care in specific regions of the country, contributing to geographic health disparities and will likely disproportionally impact lower-income people.

GMHC will continue to engage the U.S. Congress, state and local governments and federal agencies to ensure that ACA will reach its full potential. We call on our community partners and other public health stakeholders to ensure essential health benefits and best practices are developed--and realized--to the benefit of HIV-positive and HIV-negative individuals.

Community-Based Approaches to HIV Prevention that Address Antigay Stigma

School-based interventions, social marketing on family acceptance and community connectedness

Sean Cahill, PhD
Health Policy Research, Fenway Health, Boston, Mass








Robert Valadéz, MSW
Gay Men’s Health Crisis, New York, NY

Despite 3 decades of advances in HIV testing technologies and medications, HIV continues to burden gay and bisexual men disproportionately, especially within communities of color in the United States. One key structural driver of vulnerability to HIV infection is antigay stigma. To counter the detrimental effects of pervasive antigay stigma, widespread implementation of innovative and replicable HIV prevention interventions that affirm and cultivate the healthy formation of gay identities is strongly needed. This article outlines current community-based HIV prevention approaches addressing antigay stigma being used in the field, often with little or no funding.

LGBT-affirming school-based interventions

Antigay bias is rampant in schools and in urgent need of redress. Several studies show that lesbian, gay, bisexual and transgender (LGBT) youth experience higher rates of harassment and violence from their peers because of their actual or assumed sexual orientation (Bontempo & D’Augelli, 2002; Espelage, Aragon, Birkett, & Koenig, 2008; Swearer, Turner, Givens, & Pollack, 2008; Rivers, 2004). Many LGBT students feel unsafe at school and report higher rates of social isolation, depression, suicidal ideation and unprotected sex (Russell, Ryan, Toomey, Diaz, & Sanchez, 2011).

A number of school-based, LGBT-affirming and antibullying interventions are emerging across the country. One such program is the Gay Straight Alliance (GSA). GSAs are support groups where LGBT students, those questioning their sexual orientation or gender identity, and their straight friends can gather to discuss issues associated with their sexual orientation or gender identity and foster communication with others (Ginsberg, 1999). Currently, 4,000 GSAs are registered throughout the United States. The spate of suicides that occurred in late 2010 among gay men who were victims of anti-gay harassment and bullying underscores the importance of GSAs. Research shows that these interventions are a key resiliency factor for gay youth; young gay and bisexual men in schools with pro-gay interventions report fewer risky behaviors associated with HIV transmission, including unprotected sex (Goodenow, 2007).

One study in Salt Lake City found that students’ academic performance improved, their sense of belonging to the school community was enhanced, and their school attendance increased if they were involved with the GSA (Lee, 2002). Replicating programs such as these is critical to preventing the development of risk behaviors that increase vulnerability to HIV among young gay and bisexual men and transgender women.

Social marketing campaigns promoting family acceptance of gay sons and challenging antigay stigma

Family acceptance of LGBT persons is also central to addressing HIV. Research shows that the greater the extent to which one experiences family rejection because of one’s sexuality during adolescence, the poorer the health outcomes for LGBT young adults (Ryan, Huebner, & Sanchez, 2009). In addition to exhibiting higher rates of substance use, depression, and attempted suicide, participants in the study who were rejected by their families were 3.4 times more likely to report having engaged in unprotected sexual intercourse, compared with peers who reported little to no experiences of family rejection (Ryan et al., 2009).

Gay Men’s Health Crisis (GMHC) has implemented a series of social marketing campaigns that draw on a strength-based intervention model. Strength-based campaigns are effective in changing an individual’s behavior (Detweiler, Bedell, Salovey, Pronin, & Rothman, 1999; Devos-Comby & Salovey, 2002; Rothman, Salovey, Antone, Keough, & Martin, 1993). One 2008 campaign, titled “My Son Is My Life,” models behavior in which a Black father supports his gay son. Informational palm cards and ads in print media and in bus shelters highlight reactions parents can have when they learn their son is gay and illustrate steps they can take to provide support and love. “I know he is gay, and I don’t always understand, but that doesn’t change my love for him,” the image reads.



Another campaign, titled “I Love My Boo,” depicts young Black and Latino men in loving, affectionate embraces in public settings — a portrayal of gay men of color rarely seen in mainstream media. “We’re about trust, respect and commitment,” the image reads. “We’re PROUD of who we are and how we LOVE.” The campaign ran in 1,000 subway trains and 150 subway stations in New York City in 2010 to promote positive, strength-based images of Black and Latino gay men, encourage gay men to aspire to committed, long-term relationships, and counter antigay stigma.

A 2008 campaign titled “I know my rights... Do you?” focuses on combatting the stigma transgender women experience in public accommodations by explaining a New York City nondiscrimination ordinance passed in 2002 covering gender identity. Palm cards addressed access to health care, homeless shelters and employment. Research to date on public health issues affecting men who have sex with men (MSM) has largely neglected transgender persons. There are no national data on transgender women and HIV. However, independent studies report that transgender women are among the most vulnerable to HIV infection (Clements-Nolle, Marx, Guzman, & Katz, 2001). Addressing HIV among transgender women requires better surveillance and culturally competent and effective HIV prevention campaigns.

Community connectedness

Community connectedness has also been proven to protect against HIV infection. Greater community involvement counters the negative effects of antigay bias on safer sex practices among gay men by providing social support, enhancing feelings of selfefficacy and positive self-identity, and reinforcing peer norms supporting safer sex practices (Ramirez-Valles, 2002). Greater emphasis on prevention among older adults is also necessary. The Centers for Disease Control and Prevention (CDC) reports that most new infections among White gay and bisexual men occur among those who are 30-49 years of age (CDC, 2008). In 2007, 16 percent of new HIV infections were among people 50 and older (CDC, 2007). Evidence suggests that in addition to experiencing anti-gay bias, older gay men also experience issues related to aging and self-esteem. Some older gay men experience aging differently than their heterosexual counterparts, a concept referred to as “accelerated aging” (Rosario, Schrimshaw, Hunter, & Braun, 2006). This experience of feeling older at an earlier age than one’s chronological age presents issues of social isolation for gay men over 40 who are single and equate physical attractiveness with youth. These men may put themselves at risk for HIV by meeting anonymous partners on the Internet and coupling these experiences with substance use.

Identifying the need for HIV prevention among older gay men in 2008, the Fenway Institute in Boston piloted a group intervention to reduce HIV sexual risk, depression-related withdrawal, and anxiety-related social avoidance in gay and bisexual men 40 and older. The intervention, titled “40 and Forward,” was a series of 2-hour weekly sessions that brought together groups of gay men, ranging from 49 to 71 years of age and of multiple races, to socialize and discuss topics like safer sex. Men who participated in the intervention reported a significant decrease in depressive symptoms, as well as a significant increase in condom use selfefficacy (Reisner et al., 2010). It is notable that the intervention also helped socially isolated older gay men develop social support networks, a critical resiliency factor against HIV.

International efforts

Globally, public health specialists are also recognizing the importance of combatting antigay bias to stem the spread of HIV, especially among MSM. The full scope of the global HIV pandemic among MSM is unclear, as most countries fail to gather surveillance data for MSM. However, evidence suggests that the 86 countries which criminalize homosexuality render MSM highly vulnerable to HIV infection because they are forced underground and face multiple barriers to HIV prevention and treatment (amfAR, 2008). In many African countries, the exclusively heterosexual content of HIV prevention campaigns causes gay and bisexual men to think they are not at risk for HIV. A number of studies show a disproportionate impact of HIV on MSM in sub-Saharan Africa (Beyrer, 2008; Saavedra, zazola- Licea, & Beyrer, 2008). One study reported that in middle-and lower-income countries, MSM are 19 times more likely to contract HIV than the general population (Baral, Sifakis, Cleghorn, & Beyrer, 2007).

In 2008, the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) was reauthorized and included language calling for prevention with MSM and research to understand the impact of HIV on MSM. Also in 2008, the former presidents of Zambia and Mozambique, chairing the United Nations’ Economic Commission for Africa, issued a report calling for HIV prevention with MSM and opposing legal discrimination against them. The Global Fund for HIV, Tuberculosis and Malaria is also promoting MSM concerns. In May 2011, the U.S. Office of the Global AIDS Coordinator issued field guidance on MSM (see U.S. President’s Emergency Plan for AIDS Relief, 2011). The guidance gives suggestions for providing HIV prevention to MSM in Africa, the Caribbean and elsewhere.

Conclusion

The alarming number of HIV infections among gay and bisexual men makes it imperative that U.S. and global agencies as well as state and local health departments combat antigay bias as a public health threat. School-based initiatives that affirm LGBT youth, social marketing campaigns that challenge family rejection and social isolation, and other gay-affirming interventions should be implemented on a broader scale to challenge antigay stigma and promote the health and well-being of gay and bisexual men and transgender women.

About the authors

Sean Cahill, PhD, is the director of health policy research at the Fenway Institute in Boston, Mass., where he oversees efforts to adapt Fenway’s LGBT health and HIV/AIDS research data and findings to better advocate for a progressive public health policy. He was the former managing director of public policy, research and community health at the Gay Men’s Health Crisis in New York and an adjunct assistant professor of public administration at New York University’s Robert Wagner School of Public Service. His policy priorities have included promoting a national HIV/AIDS strategy, advocating for LGBT elders and HIV-positive elders through the Older Americans Act reauthorization, repealing the HIV entry ban, and preventing HIV among gay and bisexual men in Africa and the Caribbean through the President’s Emergency Plan for AIDS Relief. He serves on the New York City Ryan White Planning Council.

Dr. Cahill directed the National Gay and Lesbian Task Force Policy Institute from 2001 to 2007, where he led research and policy analysis on demographics, poverty/homelessness, family recognition, aging, voting, the antigay movement, and other topics. He is the author of two books on LGBT family policy and the forthcoming "Lesbian, Gay, Bisexual and Transgender Youth in America’s Schools: Research, Policy, and Practice" (University of Michigan Press). His latest publication is “Black and Latino Same-Sex Couple Households and the Racial Dynamics of Anti-Gay Activism” in "Black Sexualities: Probing Powers, Passions, Practices, and Policies" (Rutgers University Press, 2010).

Robert Valadéz, MSW, is a policy analyst at the Gay Men’s Health Crisis, the world’s oldest HIV/AIDS service organization. He was a 2009 recipient of the Urvashi Vaid Fellowship of the Policy Institute of the National Gay and Lesbian Task Force. He previously held tenures at the Sexual Health and Rights Project of the Open Society Institute and the Family Services Program of the L.A. Gay & Lesbian Center. He received his master’s degree in social welfare policy from the Columbia University School of Social Work.

References

amfAR, the Foundation for AIDS Research. (2008). MSM, HIV, and the road to universal access—How far have we come? (PDF, 585KB)

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The article was originally published in April 2012 by the American Psychological Association.