The Centers for Disease Control and Prevention have released one of the most detailed studies to date documenting the spread of HIV in the US population. To this point, most agencies, contrary to the advice of many advocates and common sense, have developed intervention efforts which were meant to be applied broadly to the population. Understandably, this strategy was probably intended to attract the most funds in the beginning when only the unpopular groups of gay men and intravenous drug users were believed to be affected. The strategy continues, perhaps unwisely, in this era of massive HIV/AIDS funding and increasing widespread acceptance or indifference to sexual orientation.
The fact remains that this epidemic disproportionately affects gay men in the United States. In that sense, this report tells us nothing new. However, it does give a clearer picture as to the scope of the current infection profile. Some are beginning to suggest that this study should be used to re-focus intervention efforts towards the populations that remain most at risk.
The New York Times reports the following highlights from the study:
- Most gay and bisexual white men are infected in their 30s and 40s while blacks tend to be infected at younger ages;
- Blacks make up nearly 50% of new infections with black women carrying the brunt of that burden.
- Overall, women accounted for about 27% of new infections;
- 81% of newly infected white males were gay or bisexual where as 63% of newly infected black men were gay or bisexual;
- 80% of gay or bisexual men in 15 cities had not been reached by intensive HIV prevention efforts.
It isn't yet clearly understood why blacks are so disproportionately affected by HIV though Dr. Richard Wolitski, acting director of the Centers' division for HIV and AIDS prevention, struggled with the reasons. According to Dr. Wolitski, African Americans appear not to be any more likely to have been infected via IV drug use. However, it was noted that young black men are incarcerated at higher rates and ex-prisoners tend to have a much higher incidence of HIV infection -- although the observation begs the question rather than answers it.
A possibility not mentioned, which has recently been discovered by researchers in Africa, is an apparent genetic predisposition of Africans, and therefore possibly African Americans. The "Duffy-negative" variant is only found in those of African decent; and, in Africa, 90% of those who carry this gene variant appear to be at 40% greater risk of acquiring HIV through comparable exposure as compared to those who don't carry this gene.
“It is an Africa-specific variant, which is why it’s so interesting in the context of AIDS research,” recently commented Robin Weiss, Professor of Infection and Immunity at University College London, a member of the study team which studied the Duffy-negative gene. The Duffy-negative gene variant increases protection of Africans against Malaria and therefore was an evolutionary advantage which now appears to serve as a handicap in the face of HIV.
Returning to the new CDC study, several conclusions have been drawn:
- Clearly there is a need to improve efforts in the gay communities. They make up nearly 81% and 63% of the newly infected white and black men respectively. This probably means that the gay community represents about 75% of new infections overall. The question is what should those efforts entail;
- There proabably needs to be increasing investigation in to the "Duffy-gene" varient in the African-American community. It will be important to know whether this is putting African Americans at greater risk;
- Considering that the bulk of new infections in those groups are in the over 25 crowd, when we consider all races, it might be inferred that the need for protection must be constantly re-enforced. It could be possible that as men get older they tend to take increasing risks;
- With the vast majority of new infections among gay men over 25, routine infant circumcision cannot be rationally justified. That decision can be be deferred until appropriate informed consent is possible if the individual finds themselves in a high risk group and believes they could possibly benefit from it.
That last point bears repeating. If we take seriously informed consent and the freedom to choose appropriate medical interventions by those on the receiving end of said interventions, there is simply no viable argument for neonatal circumcision in the HIV/AIDS battle in the United States.
