A new report by the Chicago Department of Public Health shows a significant increase in HIV testing, awareness of HIV status and access to medical treatment among Chicago MSM, or men who have sex with men.
The most significant and encouraging numbers were reported among young black men, the city’s only subpopulation currently experiencing annual increases in HIV diagnoses.
The report, released Friday, compared findings from CDC-funded National HIV Behavioral Surveillance System surveys conducted in 2008 and 2011.
Public Health Commissioner Bechara Choucair said the report shows community mobilization, expanded HIV testing and programs designed to bring newly diagnosed individuals into medical care have had a positive impact on the epidemic in Chicago.
“Everyone’s efforts are moving us along the journey to an AIDS-free generation. We are moving in the right direction,” Choucair said. “We still have a lot of challenges, but we know MSM in Chicago are testing more often, are aware of their HIV status a lot more, and are taking medication for HIV.”
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Nearly all MSM in Chicago have been tested for HIV at some point in their lifetime and 57 percent are meeting the CDC guidelines of at least annual testing. Young black MSM youth reported the highest number of annual testing with 71 percent.
Testing has led to a dramatic decrease across races in the number of people who are unaware of their HIV infection. Only 22 percent were unaware of their HIV infection in 2011 compared to 52 percent in 2008.
Nikhil Prachand, senior epidemiologist at the Chicago Department of Public Health, said that rates among black MSM are the most significant. Two thirds of black MSM were not aware of their infection in 2008. Now just one third are unaware.
“This is really a strong, hopeful sign that shows people are willing to talk about HIV and go get tested,” Prachand said. “Perhaps stigma may be decreasing.”
And for those that do test positive, they are far more likely to be on medication. The percentage of HIV-positive black MSM who reported being on HIV medications almost doubled from 2008 to 2011. Now 84 percent report being on medication, up from 44 percent. The proportion of white and Hispanic MSM on anti-retrovirals also rose.
Not all numbers trended in the right direction. The 2011 numbers show that the percentage of men who have sex with men that are HIV-positive increased slightly since 2008, although this is likely to continue as people with HIV continue to live longer, healthier lives.
Twenty-one percent of survey respondents tested positive for HIV in 2011, up from 18 percent in 2008. Racial disparities have continued in the most recent survey.
Prachand said since 2005 we have seen a gap in new diagnoses, particularly between black and white men who have sex with men.
In 2011, 35 percent of black MSM survey participants tested positive for HIV, compared with 17 percent of white and 13 percent of Hispanic participants.
Some high risk behaviors have also grown more prevalent. The percentage of survey participants reporting unprotected anal sex, more than one male sex partner and using illicit drugs all increased. In the 2011 report, 59 percent of survey respondents reported unprotected anal sex.
Amanda Smith, an epidemiologist with the Division of HIV/AIDS Prevention at the CDC, works as a technical monitor with the Chicago data-collection team. She said it’s great to see the Chicago Department of Public Health using the data locally because it will help community groups know where to focus.
“In surveillance, we’re seeing what’s going on and sending that message to the community leaders,” Smith said. “They’re the ones that can make the difference.”
The report was presented to community members taking part in the 2012 Chicago LGBTQ Health and Wellness Conference Friday at the Center on Halsted. After an overview of the findings, community leaders from Howard Brown and the Chicago Black Gay Men’s Caucus discussed their initial reactions.
Representatives from both groups were concerned with some of the high risk behaviors like unprotected sex. But, the conversation focused on another part of the survey, social determinants of HIV infection like homelessness, incarceration, unemployment and low educational attainment.
These adversely affect young black youth at much higher levels than other subpopulations. Among black MSM aged 18 to 29 surveyed, 18 percent reported being homeless at some point in the prior 12 months, 30 percent were living in poverty and one third reported being held in prison or jail for at least one day.
Craig Johnson, secretary of the Chicago Black Gay Men’s Caucus, said the survey gives the community a starting point to begin addressing some of these issues.
“If you’re unemployed, if you are not making any money, if you have a lower education level and you’re looking at all these other barriers, from a real human standpoint what does that mean to you as someone under 30? What does that mean to us as a community? How do we address that person? These will all be barriers to adherence and staying in care,” Johnson said.
Choucair said the CDPH has identified these areas as a focus. The department released the LGBT Community Action Plan in March to outline specific methods to address disparities and healthcare access in the community.
“We know that by improving on the social determinants of health, by getting people better jobs, better education, getting people out of poverty, that’s how we can really help to move the population forward,” Choucair said.
The Chicago Area HIV Integrated Services Council, CAHISC, will use data from the report released Friday to help draft funding recommendations they will give to the city for programs 2014.
CAHISC Chair Joe Hollendoner, also senior vice president of programs at the AIDS Foundation of Chicago, said this report shows the need to look for demonstration projects that address social determinants of risk like homelessness and unemployment.
“Traditionally, we have looked at things like prevention for positives and the need for the distribution of condoms, but this underscores that social and system level interventions are just as important.”