GAY PEOPLE'S CHRONICLE July 15, 2011

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Fund gay prevention right, AIDS groups say

Gay and bi men are 2/3 of new cases, but less than 1/3 of state money

On June 24, the AIDS Resource Center Ohio, which serves more than two-thirds of Ohio's 88 counties, called upon state and local governments to "ensure that HIV prevention efforts for gay and bisexual men receive an equitable share of public resourcesone that corresponds to the continuing impact of HIV on gay and bisexual men."

Nearly every major AIDS service organization in the state has endorsed this statement, as well as LGBT equal rights groups.

The request for equitable funding allocations is one of a series of recommendations made in a policy brief entitled "Two Steps Forward, One Step Back: Gay/Bisexual Men and HIV/Sexual Health Education in Ohio." The brief was released to coincide with LGBT Pride Month.

"Gay and bisexual men still represent approximately 2/3 of all new HIV cases in Ohio," noted Bill Hardy, CEO of AIDS Resource Center Ohio, "but less than a third of state HIV prevention dollars are allocated to HIV prevention programs specifically designed to reduce HIV among gay and bisexual men. The data confirm what are clearly skewed priorities-misplaced priorities that could have tragic consequences for gay and bisexual men in our state."

In an effort to disseminate this information to an audience broader than legislators and policymakers, the Gay People's Chronicle is running the paper in its entirety.

Two Steps Forward, One Step Back

Gay and bisexual men have been, from the very beginning, disproportionately affected by HIV/AIDS in the United States, and here in Ohio. But lesbian, gay, bisexual and transgender communities didn't just stand idly by: they took action by creating education campaigns, supporting research, and volunteering to care for sick friends.

Much has been accomplished, but much remains to be done. Gay and bisexual men are still 44 times more likely to live with HIV infection than other men. There is growing concern, in Ohio and across the U.S., that HIV prevention efforts focused on gay and bisexual men are not receiving the public resources they need. We must adopt the right perspective in HIV prevention programs for gay and bisexual men, use the right tools and programs, commit the right resources, and ensure that resource allocations equitably match the true impact of HIV on MSM (men who have sex with men) in Ohio.

Background

From the outset, gay and bisexual men have been disproportionately affected by the HIV/AIDS epidemic in the U.S. At first there was little in the way of treatment, so those who were diagnosed with AIDS often got sick, and died, quickly. Many gay and bisexual men who did not acquire HIV in-

fection nevertheless watched many of their friends suffer illness, discrimination, and death. The medical and emotional toll on U.S. LGBT communities was devastating.

Because MSM were so deeply affected by AIDS, they pioneered prevention programs, and advocated for risk reduction among peers. Those efforts were effective in reducing HIV rates in many major U.S. cities. And by the mid-1990s, it was clear that new treatments for HIV held out the promise of enhanced length and quality of life for many. Across the board, LGBT community advocates and public health authorities believed that progress was being made.

Still, in 2011, gay and bisexual men remain disproportionately affected. A 2010 study by the Centers for Disease Control and Prevention estimated that 19% of sexually active gay men in the United States are HIV-positive, and nearly half are unaware of their infection. In addition, recent trends have shown an increase in new infections among younger gay and bisexual men, in part because success in medical treatment of the disease has reduced the perceived urgency for HIV risk reduction among all young persons. Of equal concern is the reality that HIV does not affect all MSM equally: While all MSM are at dramatically increased risk, African American and Latino MSM are currently more likely to have acquired the virus than their white counterparts.

In 2009 (the last year for which data are available), the Ohio Department of Health concluded that male-male sexual contact remains the leading transmission category for HIV infection in the state. For that year, the department estimated that 84% of new Ohio HIV/AIDS cases among all male cases were among MSM, and two-thirds of all new 2009 cases were men who have sex with men. In Ohio, then, as in the rest of the U.S., men who have sex with men remain disproportionately affected by HIV/AIDS.

What it will take

What will it take to achieve greater reductions in HIV infection among MSM? Here are a few critical recommendations:

The right perspective. The evidence is clear: if HIV prevention programs are to be effective for gay and bisexual men, they must be based on an affirming view of LGBT sexuality and identity, and must recognize the importance of equal rights for LGBT persons. Judgmental, biased perspectives simply do not work.

Entities carrying out HIV prevention programs for MSM must be grounded on a confirmation of the rights of gay or bisexual men to equal treatment, the responsibilities that MSM have to themselves and each other, and a positive attitude about human sexuality.

The right programs. Decades of experience developing and implementing HIV prevention programs for MSM have yielded an array of successful program models, generally referred to as "Effective Behavioral Interventions" by the CDC. They include

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community-based programs such as Mpowerment, small group programs such as Many Men, Many Voices, and one-onone interventions. HIV testing and outreach is an essential part of all effective behavioral interventions.

These programs have been tested and validated, and a number of them are now being implemented in Ohio. It is clear that behavioral science has developed a range of effective strategies, and that only those strategies that have proven validity—programs that are "evidence-based"-should be carried out.

The right tools. It is also clear that if MSM are to reduce their HIV risk, they need ready access to the right tools. HIV prevention will mean adopting one of three strategies:

• 100% abstinence from all sexual risk behaviors;

• Mutual, faithful sexual monogamy with an HIV-negative partner; or

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Consistent, correct condom use. Condom availability is essential for HIV prevention programs, including programs for MSM.

The right resources. We also need the resources to support these critical programs. In recent years HIV prevention funding has not kept pace with the growth of HIV/AIDS. A number of cities in Ohio are "making do" with substantially fewer HIV prevention resources than in the past, even as HIV grows by nearly 56,000 new cases year in the U.S. Clearly HIV prevention resource investments now will pay off both in the shortterm, and the long run.

The right allocation of resources. Many public health analysts have noted the stark disparity between the percentage of HIV infections accounted for by gay/bisexual men, and the percentage of funding distributed to prevention efforts focused on gay/ bisexual men. In Ohio, for example, less than 30% of Ohio Department of Health HIV prevention funding goes to programs reaching MSM, even though, as noted earlier, 67% of new cases of HIV infection in 2009 were among MSM. While ODH has worked to reduce this disparity, there is still a long way to go before prevention equity has been achieved.

Recommendations: taking action

We urge advocates, public health officials, service and prevention agencies, and funders to take the following steps:

• Work with public entities and private funders to ensure that HIV prevention efforts overall are adequately funded.

• Work with local health departments and funders to ensure that HIV prevention efforts for gay and bisexual men receive an equitable share of public resources—one that corresponds to the continuing impact of HIV on gay and bisexual men.

• Encourage "Evidence-Based Interventions" in HIV prevention for MSM, to ensure the most effective use of scarce re-

sources.

• Ensure that HIV prevention agencies and programs overall are sensitive to, and inclusive of, the needs and experiences of gay and bisexual men or MSM.

The policy education activities of Healthy Gay Men Ohio, a program of the AIDS Resource Center Ohio, are funded in part by the George Gund Foundation and Elton John AIDS Foundation.

"Two Steps Forward, One Step Back" was written by AIDS Resource Center Ohio/ Columbus AIDS Task Force, and is endorsed by the AIDS Taskforce of Greater Cleveland, the Community AIDS Network of Akron, Caracole (Cincinnati), the Ohio AIDS Coalition (statewide) and Equality Ohio (statewide).

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