The Current State of HIV Among LGBTs

The perception of AIDS as a "gay plague" dates to the early 1980s, when neighborhoods populated by gay men began experiencing a sudden and unprecedented wave of deaths. Due to this outbreak, one of the first proposed names for AIDS was GRID, or "gay-related immune deficiency." However, it soon became apparent that AIDS is not exclusive to gay men -- it is a human plague that affects men, women, and children, regardless of sexual orientation, race, or class.

The same is true for the different segments of the LGBT population. HIV not only afflicts gay men; it affects the lives and health of lesbian, transgender, and bisexual individuals with equal pain, though in varying numbers. In many respects, this virus has become inextricably linked with LGBT history and community, uniting its members in a common cause. In his 1988 watershed speech "Why We Fight," gay activist Vito Russo -- himself dying of AIDS-related complications -- equated the fight for treatment and a cure with the battle for civil rights. He contended that the disease's prevalence in minority communities was indicative of systemic problems and prejudices on the part of the government and society.

"AIDS is really a test of us, as a people," he said. "When future generations ask what we did in this crisis, we're going to have to tell them that we were out here today. And we have to leave the legacy to those generations of people who will come after us.

"Someday, the AIDS crisis will be over. Remember that. And when that day comes -- when that day has come and gone, there'll be people alive on this earth, gay people and straight people, men and women, black and white, who will hear the story that once there was a terrible disease in this country and all over the world and that a brave group of people stood up and fought and in some cases gave their lives so that other people might live and be free."

Russo delivered this speech more than two decades ago, yet the fight to end the worldwide HIV and AIDS crisis is as vital and challenging as ever. According to a report released Thursday by the Centers for Disease Control and Prevention, about 26% of new HIV infections each year occurred in people age 13-24, and the majority of those newly infected young people identified as gay or bisexual. Moreover, the CDC estimates that 60% of HIV-positive young people are unaware of their status, leading them to unknowingly pass the virus on to others.

In light of this challenge, The Advocate has compiled a State of HIV for each segment of the LGBT community.

HIV in Gay and Bisexual Men
Although men who have sex with men (MSM) represent a very small fraction of the general U.S. population, this group accounted for 61% of new HIV infections in 2009.

The rate of transmission is higher in urban areas. The CDC reports that in 2010 gay and bisexual men accounted for 62% of new infections in major cities such as New York, Chicago, and Los Angeles. Rates were lower in less populous metropolitan areas, but still significant: This demographic accounts for 56% of new infections in smaller cities and 54% in nonurban regions.

Jonathan Mermin, director of the CDC's Division of HIV/AIDS Prevention, estimated in a U.S. News and World Reportarticle that "gay and bisexual men are over 40 times more likely to have HIV than heterosexuals." He also pointed out disparities in racial and ethnic groups, saying, "We see marked racial disparities, 60% of youth with HIV infections were African American, 20% were Latino and 20% were white. ... And black gay and bisexual men made up 54% of new HIV infections."

The CDC lists three major factors that contribute to these statistics. The first is sexual risk behavior -- more than any other sexual behavior, unprotected receptive anal sex carries the greatest risk of HIV infection. The second factor is alcohol and drug use, which lowers inhibitions and can increase this risky sexual behavior. The third factor is social stigma and discrimination, which can lead to depression and thus encourage the use of these substances.

In 2009 the CDC funded an HIV testing program for 2.6 million people. Of the 4,100 people who identified as transgender, 2.6% tested newly positive. By contrast, 0.9% of nontransgender men and 0.3% of nontransgender women received newly positive results. But the problem could be even more severe. One finding, compiled by aggregating four studies showed numbers as high as 27% in transgender women.

Research also indicates that black and Hispanic transgender people have disproportionately high rates of HIV. In a separate study conducted in New York City (2005 to 2009), nearly 90% of transgender individuals newly diagnosed with HIV were members of these minority groups.

There are many challenges unique to transgender people. Although every LGBT person is subject to the psychological consequences of social stigma and discrimination, studies show the suicide rate of transgender people to be nearly 25 times the rate of the general population. According to a 2011 report compiled by the National Center for Transgender Equality and the National Gay and Lesbian Task Force, 41% of transgender people have attempted suicide.

Depression feeds into substance abuse, which in turn leads to high-risk sexual behavior. According to the survey in New York City, 50% of transgender women had a history of substance abuse, homelessness, sexual abuse, and prostitution. Moreover, the CDC points to the insensitivity of health care providers as a major obstacle to treatment and prevention.

HIV in Bisexual Women and Lesbians
According to the CDC, there are no confirmed cases of HIV transmission resulting from women having sex with women (though we know of some, anecdotally). However, there are other risk factors, including drug use and risky sex with men, that cause HIV infections in women. Major population studies, including one in American Psychologist, observed higher rates of anxiety, depression, and substance abuse in lesbians, which manifest from social stigma and contribute to these behaviors.

By December 2004 the CDC reported a total of 246,461 HIV-positive women. In this group, 7,381 claimed to have sex exclusively with women. The CDC does not negate the possibility of sexual transmission between women, pointing to glaring holes in the review process, in which there is simply no cause of infection listed for 60% of these women. The organization also warns about means of exposure for women having sex with women, including torn tissues, menstrual blood, and vaginal secretions.