Tag Archives: MSM

Alarming:  Young MSM Discontinuing PrEP

     Breaking—and alarming–news:  a third of young MSM (men who have sex with men) who take PrEP (pre-exposure prophylaxis) discontinue it within six months.  This is according to U.S. investigators in AIDS and Behavior, a peer-reviewed medical journal established in 1997 that covers aspects of HIV/AIDS research.  Common reasons for this discontinuation included being unable to get a doctor’s appointment and insurance coverage problems.

     The investigators write, “’The two most common factors for discontinuation of use…are systemic barriers, indicating that more needs to be done to increase PrEP for those who are at high HIV risk.  One potential solution may be to enable service providers, such as local health departments, to incorporate proactive services for high-risk HIV-negative individuals’.”

     What’s really disturbing?  That none of the men who discontinued PrEP reported 100% condom use, and over 40% said they never used condoms after stopping.  

     PrEP is a highly-effective method of HIV prevention.   And if taken consistently, it can reduce HIV infection risk by over 90%. 

     Since little is known about why men discontinue PrEP, investigators crafted a study analyzing rates and reasons for PrEP discontinuation and sexual behavior after stopping the drug.  The study involved young sexually active MSM PrEP users in Chicago.

     Study participants were between 16-29 years of age.  The men were asked at follow-up appointments if they’d taken or discontinued PrEP in the previous six months.  Those who reported stopping PrEP were asked why.  A subset was asked about condom use after discontinuing PrEP.

     The study occurred between 2015 and 2017.  During that timeframe, 197 participants reported using PrEP in the previous six months.  A third (65) stated that they had stopped using the drug by the time of their follow-up interviews.  Black and Hispanic men were significantly more likely to report discontinuation than white men. 

     “’These findings are particularly concerning given that Black and Hispanic MSM are also those at greatest risk of HIV’,” the researchers stated.  “’These emerging racial disparities in discontinuation may be due to structural differences between populations, for example, differences in access to healthcare facilities or access to or cost of insurance’.”

     A total of 29 persons were asked about discussions they had had with their medical practitioners concerning PrEP usage.  Most (79%) hadn’t spoken to their physician before ending treatment.

     Thirty-five men were asked about their sexual behavior after discontinuing treatment.  More than half (58%) said that they continued to engage in anal sex, with 41% reporting that they never used condoms, 35% stating that they used condoms less than 50% of the time and 24% reporting that they used condoms most of the time.  None said they always used condoms. 

     What were the common reasons for discontinuing PrEP?  These included:

  • being unable to get a doctor’s appointment (22%);
  • insurance problems (20%);
  • individuals no longer perceiving themselves as being at risk for HIV (19%);
  • side effect concerns (9%);
  • adherence (8%); and
  • stigma (6 %).

     The authors conclude, “’We observed several important factors which must be considered and addressed if PrEP usage is to continue to rise.” They then added, “’Further research must be conducted to look beyond medication adherence and develop a better understanding about which other prevention strategies are used following purposeful PrEP discontinuation’.”

Structural Inequality Fuels HIV in Black MSM

   A brand new—and perhaps controversial—study has uncovered that economic insecurity, housing instability and stigma largely shape the sexual relationships of many African-American men who have sex with men (MSM).  According to this study, these structural inequalities influence the kinds of relationships and sexual behaviors that men have.

     It’s a fact that the bulk of HIV prevention interventions and studies focus on the individual. However, according to Columbia University’s Caroline Parker in an article published in Culture, Health and Sexuality, “Our research underlines the continued need to attend to the structural drivers of HIV among Black gay, bisexual and other men who have sex with men.”

     Before we drill deeper into the study, let’s define the term structural inequality. It’s the condition where one category of individuals are ascribed an unequal status in relation to other categories of persons.  This relationship is perpetuated and reinforced by a confluence of unequal relations in roles, functions, decisions, rights and opportunities.

     Between 2013 and 2014, Parker and her colleagues conducted a qualitative, ethnographic study in New York City.  Roger Pebody states in his Aidsmap.com article, “Structural Inequalities Create Vulnerability to HIV for Black Gay Men in New York,” “In-depth interviews were conducted with 31 black MSM and participant observation was conducted in locations frequented by black MSM (such as parks, community organizations and house parties).  In addition, 17 community advocates and healthcare professionals were interviewed.

     “Amongst the men interviewed, whose average age was 29, social problems were common.  Ten had spent time in prison, 15 were unemployed, 16 had housing problems, and nine had no health insurance.  Five men told the researchers that they were living with HIV.  Whereas half identified as ‘gay,’ the others described themselves in a variety of ways, including bisexual, straight, discrete and having no sexual identity.”

      According to the study, men who struggle with housing instability and unemployment sometimes used sex to meet their material needs.  They described exchanging sex for shelter, food, clothing, the payment of phone bills and taxis, alcohol and drugs.  Some used dating app profiles to sell sex.

     And, the men’s precarious circumstances constrained their ability to negotiate condoms.  One man explained:  “’Okay.  If you are eating and you have clothing, you have shelter, you’re probably going to resist it and a very blatant resistance.  But if you are hungry, that’s a different ballgame.  I can sit here and tell you I’m a very proud person but you let my stomach rumble for more than three days, okay, you can call me’.”

     Pebody wrote, “While sex without a condom put men at risk of HIV, a lack of food or shelter might have a more immediate impact.  Men made choices which made sense to them in their current circumstances (for example, having multiple partners to access temporary housing and other resources).  Interviewees with fewer economic problems had different approaches to sexual relationships which did not reflect these pressing economic considerations.”

     The researchers took note of the way in which different places and environments formed men’s sexual relationships.  Some of the interviewees stated that they had experienced disapproval or homophobia in their family homes.  As a direct result, four of the men were made homeless. 


     As well, many men did not introduce male sexual partners to family members; consequently, sex was more likely to occur at a partner’s home or in a public space.  Recalled one interviewee: “’I couldn’t bring any company over or they couldn’t stay overnight or whatever, (but my brother) could bring girls over and there was discrimination towards me with my mom’.”

     According to Pebody, “Some men who lived independently also avoided bringing male partners home because of homophobic reactions from landlords or neighbors.  Men sometimes felt unsafe in their own homes.

     “Many respondents met partners and had sex with them in parks, streets, sports clubs, trains, supermarkets and restaurants.  This was particularly the case for men with unstable or no housing, and for men who identified as straight or discreet.  These meetings might be arranged on apps like Jack’d and Grindr. 

     “These interactions were usually rushed—men were afraid of being observed by other people, being assaulted or being arrested. The rush meant that condoms were less likely to be used.”

     Respondents of the study stated that they went to gay bars and nightclubs, particularly those frequented by Black and Latino men.  According to the respondents, they felt that these settings were safer places to socialize and meet other MSM (men who have sex with men).

     “For men who sold sex, bars provided some protection against the police,” wrote Pebody.  “Men with housing difficulties sometimes went to clubs to find ‘a generous friend’ with a place to stay. However, commercial venues did not always feel welcoming to men who did not have money for drinks or the right clothes to wear.”

     The researchers concluded:  “’Among most of the men in this sample, the pursuit of same-sex relationships took place in a social context characterized by economic insecurity, housing instability, and widespread stigma and discrimination.  We draw attention to how men’s position in a social structure configures their opportunities, restrictions and priorities in sexual relationships and how these shape their choices and behaviors in health-relevant ways’.”

Marked Increase in New HIV Infections Among  Latino MSM

Photo Courtesy of Cute Gay Couples    

Check out this alarming and truly disturbing trend:  in recent years, the HIV diagnosis rate of Latino men who have sex with men (MSM) has been on a sharp upswing—even though the overall rate of infections have dropped among Latinos.

     Poz.com has reported, “Researchers at the Centers for Disease Control and Prevention (CDC) analyzed diagnoses (as opposed to estimated new transmissions) of the virus among Latinos reported to the National HIV Surveillance System between 2008 and 2013.”   A recent NLAAD (National Latino AIDS Awareness Day) Media Summary stated, “While the rate of HIV diagnoses declined among Latinos overall during this time period (from 28.3 per 100,000 population to 24.3), the number of diagnoses increased by 16 percent among Latino MSM (from 6,141 to 7,098).

     “The increase among Latino MSM tracks with an overall increase in new infections seen among MSM in previous reports, suggesting a potential resurgence in HIV among this population.  HIV diagnoses declined among other transmission groups, and were either stable or declined among all age groups.”

     And according to the media summary, HIV disproportionately affects and impacts Latinos (likewise African-Americans); for example, in 2013, the rate of HIV infections among Latinos (18.7) was nearly three times that of non-Hispanic whites (6.6).  The analysis found that behavioral risk factors among Latinos differed, depending on place of birth—pointing to the necessity of tailored HIV prevention strategies that recognize the Latino community’s diversity.     

     The media summary added, “To combat HIV among Latinos,  the authors (of the analysis) underscore the critical need to prioritize testing; care and treatment of people living with HIV; and ensuring those as the highest risk have the knowledge and tools to protect themselves and their partners from infection, especially among Latino gay and bisexual men.”

Homophobia:  HIV’s Dependable Partner In Crime

     HIV has many allies, collaborators and accomplices, which include denial, poverty, stigma, and the “it can’t happen to me” syndrome.  And,homophobia is a member of that club—and a dominant one at that.

    According to Poz.com, the leading and renowned news site dedicated to HIV news and prevention, “Homophobic attitudes and laws in European nations keep men who have sex with men (MSM) from accessing HIV-prevention services and from discussing their sexuality with health care providers.”

     The media outlet continued, “Publishing their findings in the journal AIDS, researchers examined data from the European MSM Internet Survey,which includes HIV-related information about 174,000 gay and bisexual men in 35 European countries.  They compared this data with various countrywide laws, policies and attitudes toward homosexuality.”

     So, what did the investigators uncover?  “The researchers found that higher levels of homophobia in a nation was linked with lower HIV knowledge among gay and bi men, and that the men in these countries were also less likely to use condoms.”

     Let’s examine HIV risk.  This recent study concluded that personal responsibility actually was trumped and overshadowed by another factor—which is insidious and deeply ingrained.  John Pachankis, PhD, an associate professor of epidemiology at Yale University, stated the following: “’Our findings suggest that rather than primarily being the result of personal failure, HIV risk is largely determined by national laws, policies, and attitudes toward homosexuality.  This study shows that gay and bisexual men in homophobic countries are denied the resources, including psychological resources like open self-expression, that are necessary to stay healthy’.” 

     Sobering news, indeed. 

     Another significant finding of the study was that MSM living in nations with marked homophobia have fewer sexual partners—and therefore are less likely to have HIV.  “The investigators concluded that this was a consequence of the men being more likely to stay in the closet due to an inhospitable environment.”

     Oh, yes.  HIV can definitely depend upon homophobia for a huge assist in getting its job done.


Breaking:  HIV Is Killing Fewer Blacks

     HIV is losing a critical bout in the long and grueling boxing match called AIDS.  And this victory for persons of color certainly is a cause for celebration. 

     According to Michael Smith, writer for the health media outlet MedPage Today, the Centers for Disease Control (CDC) has reported that that the mortality rates of blacks in the U.S. fell substantially between 2009 and 2012.  During that time, the number of deaths fel1 by 18 percent. 

     However, the number of deaths remained higher among HIV-infected blacks  than among HIV-positive individuals of other racial and ethnic groups–although the gaps seem to be narrowing. 

     Consistent features of the U.S. HIV/AIDS epidemic have been ethnic and racial disparities:  each year, blacks have been making up almost half of all new diagnoses despite being only 14 percent of the population.  And cases have been soaring amongst some subgroups, including black MSM (men who have sex with men). 

    According to Smith, the CDC stated that this new data illustrate that decreases in mortality between 2009 and 2012 were seen in all groups but were “greater and more consistent among blacks than among other races/ethnicities.” 

     The CDC calculated two rates—the rate per 1,000 individuals living with HIV and the rate per 100,000 population.  In 2012, the CDC reported, “an estimated 8,165 deaths occurred among black persons living with HIV, which was 48% of the total mortality among people with HIV.  That was 1.5 times the 5,426 deaths among whites and 3.2 times the 2,586 deaths among Hispanics or Latinos. 

     “But overall, the number represented an 18% decline in the number of deaths among blacks from 2008 through 2012. 

     “The death rate per 1,000 blacks living with diagnosed HIV fell from 28.4 in 2008 to 20.5 in 2012—a 28% decline—but the rate remained 13% higher than for  whites and 47% higher than Hispanics or Latinos, the agency said. 

     “The 28% decline among blacks was greater than the 22% drop seen among all people living with HIV.” 

     Though this is encouraging and heartening news, we cannot afford “to rest on our laurels,” so to speak.  And let me put it another way:  before you “get horizontal to ‘Git Busy’,” strap on your favorite “latex raincoat!”

syphilis cells

Breaking:  Gay/Bi Guys Driving Up Syphilis Rates

     The following breaking news is disconcerting and sobering—to say the least.  According to Poz.com, the renowned health, life and HIV media outlet, the rate of primary and secondary syphilis in the U.S. is steadily climbing–with MSM (men who have sex with men) driving a 10 percent increase between 2012 and 2013.   “All told, the rates of syphilis, gonorrhea and chlamydia are all rising among men while either remaining stable or dropping among women.”  These stats are included in the Centers for Disease Control and Prevention’s (CDC) annual report entitled Sexually Transmitted Disease Surveillance. 

     Poz.com continues, “The CDC estimates that the United States sees almost 20 million cases of STDS each year, with half of them among young people ages 15 to 24.  The price tag?  Nearly $16 billion in health care costs. 

     “Since STDs are often not reported to the CDC, the figures of STDs do not paint a full portrait of the various nationwide epidemics.  They can, however, give a sense of the rate of change in new infections.” 

     In 2013, there were 17,375 reported cases of primary and secondary syphilis—a rate of 5.5 per 100,000 persons.  This translates into a 10 percent increase compared to 2012–and represents the largest jump since 1985. 

     According to Poz.com. “The increase was driven entirely by MSM, who accounted for about three quarters of the total number of cases in 2013.  An estimated half of MSM with syphilis are HIV positive.” 

     The media outlet added, “This is of particular significance considering that syphilis can increase the likelihood of both transmitting and contracting HIV.” 

    Therefore, my advice to you:  always wrap it up—and securely–before “gittin’ yo’ groove thang on.”

someone holding a banana with a condom over it demonstrating usage

Recent Study: Black MSM Experience Higher Condom Misuse, Failure Rates

     You know, I absolutely adore my assistant, Raheem!  One important reason: he uncovers topical issues impacting the LGBTQ Community for exclusive features in Wyattevans.com

     Raheem handed me an article from Poz.com about a recent observational study with this eye-opening conclusion:  Black men who engage in sex with men (MSM) report higher rates of condom breakage and slippage as well as incomplete condom usage compared with Caucasian MSM.  Researchers studied cross-sectional data of 475 MSM who participated in this Atlanta study and said they had used a condom for insertive sex (being the top) during the previous six months.

     Poz.com states, “Black MSM were twice as likely as white MSM to report both breakage of condoms and slippage when pulling out.  Nearly 40 percent of Black MSM reported using a condom incompletely, meaning they put it on after already engaging in intercourse for a time or took it off before finishing intercourse; Black MSM were significantly more likely than white   MSM to report this.”

     The source continues, “Thirty-one percent of the MSM reported using a condom correctly, with most error rates similar between the races. However, 53 percent of Black MSM reported using oil-based lubricants, which can weaken condoms, compared with 21 percent of white MSM. Also, Black MSM were more likely than white MSM to unroll a condom completely before putting it on the penis. (The correct way to apply a condom is to roll it down over an erect penis, making sure that what will become the inside of the condom is facing down before allowing the latex to touch the tip of the penis.)    MSM between the ages of 18 and 24 were 40 percent less likely to use a condom correctly compared with those 25 to 29 years of age.  When factoring out race, younger men and those with less education were more likely to use oil-based lubricants.”

     According to 54 percent of the participants, standard condoms did not have the best, the most ideal feel or fit.  And, white MSM were more likely than Black MSM to report fit or feel problems or issues with maintaining an erection while using a condom.

     “The researchers concluded that their findings suggest that oil-based lubricant use, as well as fit and feel problems, may account for a considerable percentage of condom breaks among MSM.  They called for the condom industry to design better fitting condoms to address this problem.  Better feeling and fitting condoms might not only increase the use of condoms in this population and but also decrease the likelihood of incomplete use.”

10 Things about HIV Infected men

Let’s Have Some “Poz(itive)” Talk

     Dating and/or having sex can be a daunting challenge for MSM (men who have sex with men), particularly those who are HIV-negative.  But only if you let it.  And, I’ll explain exactly what I mean about that a little later.

     But first, stats on HIV.  Recent data from the Centers for Disease Control and Prevention (CDC) show that 1 in 5 sexually active MSM in America are HIV-positive, but that 44% of them don’t know it.

     Regarding estimated new HIV infections among all MSM in the U. S. in 2010 (year of most recent stats) Blacks/Africans accounted for 10,600 (36%); Hispanics/Latinos accounted for 6,700 (22%); whites accounted for 11,200 (38%).

     Of particular note:  Overall, Blacks account for more new HIV infections, people estimated to be living with HIV, and HIV-related deaths than any other racial/ethnic group in the U.S.

     Many MSM consider dating/having sex a tricky, unnerving and perilous journey, full of potential health minefields. 

     Well, it doesn’t necessarily have to be.

     My assistant thought that a recent Queerty piece, “Ten Things HIV-Positive Guys Want Negative Guys to Know,” would make a thought-provoking article for www.wyattevans.comHe’s correct, and maybe it will help give “neg guys” a totally different perspective.

    So, without further ado, I present to you, the “Ten Things HIV-Positive Guys Want Negative Guys to Know.”

  1. All positive guys are not barebacking drug addicts.  It’s probably human nature to try and find fault in the actions of those becoming infected.  If we see them as extremists it helps the rest of us feel more secure in our own choices.  And yet, the truth is that the majority of new infections occur within “primary relationships,” such as a lover or boyfriend, and usually because one partner did not know he was infected and then transmitted HIV to his partner.  That’s why there’s such intense focus on getting tested and doing it regularly.  New infections are typically not the result of some insane night at a meth-fueled sex party or a boozy night at the baths.
  2. Living with HIV is not a toxic horror show of medications.  Yes, HIV usually requires medications and doctor visits.  So does every chronic condition.  With so many option for HIV drug therapies, side effects have been reduced drastically and ones in development will reduce them even further.  Poz guys are not weeping every morning as they chug down pills with their morning coffee.
  3. HIV infection does not automatically turn guys into dangerous liars.  One of the most unfortunate misconceptions about positive guys is that they outright lie about their status just to get laid, or worse, are on a mission to infect others.  Can we dial down the rhetoric about intentional transmission, please?  What is true is that positive men often have trouble disclosing because of the very stigma that results from sensational rumors like this one.  It is unfair to blame all positive men due to the reckless behavior of a relative few.
  4. “Drug and Disease Free, UB2” is every bit as stupid and non-productive as it sounds.  If you are using this dangerous phrase as a filter for potential sex partners, you could be doing yourself more harm than good.  We know positive guys who are undetectable are not infecting their partners, so rejecting people based on their status can be more discriminatory than practical.  “UB2” also sets you up for a false sense of security, because as one British study suggests, the risk of sex with someone who thinks they are HIV negative is higher than sex with an undetectable positive person.  This is because the viral activity in a newly positive person can be incredibly high, and he may not even know it.  Of course, either way you have to know who you’re dealing with.
  5. Our health and risk behaviors are up to us and no one else.  After decades of scientific and treatment research focused on those with HIV, new options are now available to sexually active negative men, such as Pre-exposure Prophylaxis (PrEP).  This advance puts negative guys in control of their own infection risks.  Your own health is always in your hands through the choices you make—and they have nothing to do with the status of your partner, whether known or unknown. 
  6. Guys with HIV are not promiscuous…or have a rotten sex life…or no sex life.  All of these are usually false, if you’re using the typical sex life of a single gay man as a barometer.  We all have our moments.  Sometimes our dance card is filled, sometimes there’s a drought, and sometimes the sex we have sucks, and not in a good way.  And just like the rest of us, positive guys are getting their share and having satisfying, balls-to-the-wall sex when they’re lucky.
  7. How they got it and who gave it to them is none of your business.  The details of someone else’s infection isn’t your personal soap opera or cautionary tale, no matter your good intentions.  If poz guys feel like sharing it with you sometime, they will.  Chances are they came to terms with it long ago and it’s probably not very interesting, anyway.
  8. If you need an HIV educator, go find one.  Having HIV doesn’t come with a master class in epidemiology and HIV transmission.  Every person with HIV is not an expert or a prevention specialist—or an activist.  They are simply living with the virus.  And if they do find themselves having to educate you about the simplest facts of HIV prevention, don’t be surprised if they are the ones that decline to have sex.  Nothing kills the mood like HIV 101.
  9. Positive guys aren’t going anywhere soon.  Recent studies suggest that someone being infected with HIV today in the United States has the same odds of living a normal life span as anyone else.  People with HIV see a physician more often, and other health concerns can be identified and addressed sooner.  They are also more likely to avoid drugs and alcohol, eat well and exercise regularly, the keys to health and longevity.
  10. Even more breakthroughs are coming.  There is research underway that will continue to change the landscape and make life easier and less risky for both positive and negative.  Treatments for HIV infections will become even less toxic and even more effective.

     The reality is that poz guys are out there.  And probably, there are too many MSM who believe they are neg, but actually are poz. 

     Also:  what if that poz guy is a great match for you on so many levels?  What if he’s the one you’ve been searching for?  Do you summarily dismiss him because he’s poz? 

    Meaty food for thought, eh?

Socio-Economics as a Driver of HIV in Black MSM

     Fenway Health, a Boston LGBT group, has just reported that although Black men who have sex with men (MSM) is a very small part of the population, they make up more than 20 percent of new HIV infections in the United States.

Additionally, an analysis of data from a recent six-city study of African-American gay, bisexual and MSM reveals a link between HIV and socioeconomic factors.  To read more, visit:  www.baltimoreoutloud.com/thinking-outloud/mood-swings/item/2485-socio-economics-as-a-driver-of-hiv-in-black-msm