Since the end of the last century few diseases have evoked so much fear and concern as AIDS. While the prime reason for this continues to be the fact that a definite and complete cure has continued to elude scientists, another equally strong cause remains the confusion and misconception over how AIDS is transmitted and who is at highest risk of the infection.
First of all it is necessary to get a clear picture about AIDS the disease. AIDS or Acquired Immunodefiency Syndrome is a disease that weakens the human immune system to the point when it can no longer fight off infections and results in death unless treatment is started. AIDS is caused by the HIV or human immunodeficiency virus which belongs to a group of viruses known as retrovirus. While it is necessary for an AIDS patient to be infected with HIV, one can have HIV in the system without exhibiting the symptoms of AIDS. AIDS actually refers to an advanced, more specifically Stage-3, stage of HIV infection when infection-fighting CD-4 cells in the body fall to a critical level and/or the immune system is no longer able to ward off certain types of infections and cancers.
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According to the Center for Disease Control of the US Department of Health and Human Services1 the most common ways for the transmission of HIV infection are through exchange of specific body fluids like blood, semen, vaginal fluid and breast milk from the HIV-infected to the non-infected person. In United States, the most common ways of transmission of HIV are:
- Unprotected sexual activity including anal and vaginal sex
- Sharing needles with an infected person
A fact sheet on the CDC website reveals that Gay and bisexual men — referred to in CDC surveillance systems as men who have sex with men or MSM — of all races continue to be the risk group most severely affected by HIV, according to most recent data show that of between 2006 and 20092. The fact sheet states that in the US the percentage of MSM infected by HIV is 49%, or an estimated 580,000 total persons. This accounts for nearly half of the approximately 1.2 million people living with HIV in the country. Not only this, MSM account for more than half of all new HIV infections in the United States each year. So 61%, of the new HIV infections each year are those of gays or bisexual men - in terms of numbers this amounts to an estimated 29,300 new infections each year among them. While CDC estimates that only 4 percent of men in the United States are MSM, what is especially worrying is that the rate of new HIV diagnoses among MSM in the United States is more than 44 times that of other men. In terms of numbers, the rate of new infection is 522 – 989 per 100,000 among MSM as opposed to 12 new infections per 100,000 among other men.
In yet another study of 21 major U.S. cities in 2008, which the CDC factsheet quotes, gays and bisexual men were found to have high levels of HIV infection, and what’s worse many of those infected with HIV did not know it. The results of the study found out that overall, one in five MSM was infected which amounted to 19 percent of the MSM participating in the study. While MSM of all races and ethnicities were severely affected, MSM from the African-American community seemed to bear the greatest brunt of the HIV infections. What is especially a matter of concern is that among those who were infected, nearly half or 44 percent were unaware of their HIV status. All these statistics become pertinent in the light of the final fact that since the beginning of the epidemic, more than 286,000 MSM with AIDS have died.
A complicated nexus of social, sexual and economic factors seem to increase the risk of gays and bisexual men of contracting HIV infection.
- The foremost reason seems to be the high rate of prevalence of HIV infection in the gay and bisexual community. Since a large percentage of this MSM are already infected, all men who have newer sexual encounters with them stand to contract the infection unless properly protected. Thus each new sexual encounter raises the number of gays and blacks who are being exposed to the virus and this increases the risk factor for the community as a whole.
- Gays and bisexual men from underprivileged economic section or the black community are often unaware of the methods of transmission of HIV virus and how they can protect themselves. Among younger men, this lack of awareness may be worsened by a sense of complacency since they did not personally experience the severity of the early AIDS epidemic of the 1980s and 1990s. Because of these reasons many gay and bisexual men of younger age groups underestimate personal risk and suffer the illusion that because of treatment advances, HIV is no longer a serious health threat.
- Sexual promiscuity is yet another factor which appears to raise the risk of HIV infection among gays and bisexual men. The inability to remain in monogamous relationships not only increases exposure to infection but also makes it difficult to consistently maintain a safe sexual behavior over long periods of time. This is not to imply that straight couples are less promiscuous than gays; but the difficulty in maintaining long term, monogamous and safe sexual relationships among gays has a worse impact on their sexual health as compared to couples of other sexual orientation.
- Wherever there is a higher incidence of drug abuse among gays, this translates into higher risk for HIV infection as well. Substance use can increase the risk for HIV transmission through risky sexual behaviors while under the influence and through sharing needles or other injection equipment.
- Finally there are some cultural and religious groups which continue to promote homophobia; the fear of stigma and lack of access to healthcare for MSM in these communities may in turn heighten risky behaviors or be a barrier to receiving HIV prevention services.