HIV infections are rising among gay and bisexual men in the United States, but most aren't aware of current prevention and treatment options, and few have been tested for the virus recently, if at all, according to the findings of a new survey released Thursday by the Kaiser Family Foundation.
On top of that, the Centers for Disease Control and Prevention has found that only half of gay and bisexual men who have been diagnosed with HIV are receiving the proper treatment to suppress the virus. That's crucial, because proper treatment drastically reduces the likelihood of transmitting HIV to others.
Together, the survey and the study illustrate substantial gaps in education and awareness around HIV prevention and treatment options as well as obstacles keeping many gay and bisexual men from accessing the medical care they need — even though these men are disproportionately impacted by the virus.
The Kaiser Family Foundation survey of 431 gay and bisexual men found most of the men don't know about current methods of prevention and treatment and only a third are aware that new infections are on the rise in their demographic.
"I think what the survey really points to is that there needs to be more awareness about current developments in HIV prevention and treatment," said Liz Hamel, an author of the survey and director of the KFF's Public Opinion and Survey Research team. "This shows there's a huge opportunity to educate and raise awareness across the country and among that whole population."
Specifically, the survey found only 3 in 10 said they have been tested for the virus in the last year, and gay and bisexual men under 35 were twice as likely to have never been tested for HIV at all than those who are older. As a whole, a majority — or 56% — of the men said they are not personally concerned about becoming infected.
But with that, little over half of the men said their doctor has suggested they be tested for HIV, and 61% said they don't discuss the virus with their doctor. Michael Kaplan, president & CEO of AIDS United, said this could be because many people's primary doctors simply don't talk to patients about their sexual activity.
"There needs to be systematic changes in the medical system," Kaplan said when reached by phone. "We don't have doctors even talking about sexual activity and the possibility of getting tested."
As for prevention and treatment, only about a quarter of the men surveyed said they know about pre-exposure prophylaxis (PrEP), or a daily pill that's shown to reduce the risk of transmission, and less than half of them said they knew about current guidelines calling for treatment with antiretroviral drugs as soon someone is diagnosed. Antiretroviral treatment to suppress the virus has been shown to reduce passing on the virus to others by up to 96%.
Along with the lack of awareness of antiretroviral treatment indicated by the Kaiser survey, the CDC's new findings, released Thursday, revealed that just over 50% of gay and bisexual men diagnosed with HIV actually received such treatment in 2010. Young men who have sex with men and black men who have sex with men were the least likely to receive the proper medical care and treatment, according to the study.
"Treatment is one of our most powerful tools and it's only reaching a fraction of gay men who need it, and that's really a problem," Dr. David Purcell, deputy director for behavioral and social science in CDC's Division of HIV/AIDS Prevention, told BuzzFeed News. "The gaps in care and treatment may be playing a role in the severe and ongoing toll among gay and bisexual men. To stop this epidemic, we know that we have to stop these disparities."
Out of the gay and bisexual men diagnosed with HIV in 2010, just over 77% were linked to medical care in the three months after the diagnosis, but only about half remained in care, and slightly fewer than half were actually prescribed antiretroviral drugs to combat the virus. Only 42% of the men achieved viral suppression, which, along with greatly reducing the risk of transmitting the virus to others, helps those with HIV live healthy lives, according to the study.
"Viral suppression is the hallmark of where we want people to be to reduce further infections," Purcell said. "If someone is HIV positive, we want them to do everything they can to stay in care, because treatment matters. Viral suppression is great for their immune system and greatly reduces chances of transmission."
Purcell said the disparities in treatment and access to medical care could be due to a number of factors, such as societal stigma around HIV, as some men might not want to go into a clinic labeled for HIV services. Generally poor access to health care, too, could be a major factor separating HIV-positive gay and bisexual men from treatment. Purcell cited the possibility of a lack of transportation to health providers for those in rural areas as another factor.
About 26% of those ages 18 to 24 achieved viral suppression, the study shows. As for black men who have sex with men, 37% achieved viral suppression, versus 44% and 42% of white and Hispanic men who have sex with men, respectively, according to the study.
"Homophobia is potentially impeding access to treatment, especially for young and African-American gay and bisexual men," Purcell said. "For youth, one of the factors is a lack of experience navigating the health care system and a lack of support from parents doing that. It's a developmental transition for youth."
Not only were young and black gay and bisexual men less likely to receive appropriate care for HIV and are disproportionately affected by it, the Kaiser survey shows these men also had different attitudes toward HIV and how it affects their lives.
More gay and bisexual men of color and ethnic minorities said they were personally concerned about becoming infected with HIV than their white peers, according to the Kaiser survey. Generally, the survey findings suggest gay and bisexual men or racial minorities saw HIV as more of a significant issue.
Age, again, figured into how some of the men viewed HIV as part of their lives. Gay and bisexual men over 35 were more likely to have a personal connection to HIV than those who are younger, with 47% of those over 35 saying they've lost someone close to them to HIV/AIDS, while only 8% of those under 35 saying they had.
Notably, about 50% of the men said they discussed HIV with casual sexual partners and 60% with long-term partners. In general, over two-thirds said they don't talk about the topic with their friends in those in their personal circles, the survey found.
Kaplan said the Kaiser survey results reveal the disconnect in how gay and bisexual men understand the current state of the HIV epidemic.
"What I think the survey shows is that despite the current epidemic, where we see so many men living with HIV, myself included, we have yet to really help gay and bisexual man understand the changed reality of HIV today," he said. "We're still scared be next to someone or date someone who is positive and still don't understand how prevalent HIV is in our own community."
Kaplan said the glaring holes in treatment and prevention won't go away until the community — and Americans as a whole — bring the same energy in educating people about HIV and fighting against it as seen in the 1980s and '90s. The health care system and the portrayal of HIV in the media, too, must change to better respond to the epidemic.
"One of the things I often talk about is if we still had the urgency and energy as we did back in the '80s and '90s, plus all of the solutions we have today, we could be in such a great place," Kaplan said. "Unfortunately, the energy peaked before the solutions hit."