Getting the story wrong on HIV
September 8th, 2010
When I was a kid, we would sometimes play a game called “telephone” that went like this:
…the first player whispers a phrase or sentence to the next player. Each player successively whispers what that player believes he or she heard to the next. The last player announces the statement to the entire group. Errors typically accumulate in the retellings, so the statement announced by the last player differs significantly, and often amusingly, from the one uttered by the first.
Well it seems to me that there is a game of telephone going on in the mainstream (and other) media in which each retelling of the story gets further and further from the truth. The headlines are the most glaringly obvious:
- The Guardian – September 6: Young gay men fuelling HIV epidemic, study warns
- Daily News & Analysis – September 7: White homosexual men ‘still taking too many HIV risks’
- Pink News – September 7: ‘Young, white gay men’ are ‘contributing’ to spread of HIV infections in Europe says report
- UPI – September 8: White gay men take greater HIV risk
The UPI article, the most recent, tells us about a study at Ghent University
A significant number of new HIV infections occur through high-risk behavior between young white homosexual men, researchers in Belgium say.
It follows the rather breathless report from Pink News:
According to new research published today, reckless sexual behaviour among a subset of young gay men is fuelling the HIV epidemic in Europe and the UK.
According to open access journal BioMed Central (BMC) Infectious Diseases, a considerable number of new HIV infections in Belgium, where the study was conducted, were occurring as a result of high-risk sexual contact between young, white gay men.
Well there is a story that comes out of the Ghent University study, and it does discuss gay white youth. But the story coming from the study is hardly what you’d think reading the later reports. Here’s what happened:
Researchers at Ghent University in Belgium looked at regional HIV infection to see if they could identify trends. They looked at 506 patients who seroconverted in Belgium between January 2001 and March 2009 and analyzed them by race, sex, transmission cause, and HIV strain.
Sixty percent of those who seroconverted had HIV-1 subtype B and were mostly young gay Belgian men. In addition, this group also had statistically high levels of other STIs, including syphilis and chlamydia.
The other forty percent had other strains of HIV (18 variations identified) and were 60% African and 33% Caucasian. These transmissions were predominantly through heterosexual sex or intravenous drug use.
They also looked at the specific genetic attributes of various infections and found “clusters”, individuals with virtually the same virus. Among gay men (subtype B), clusters were small (3 to 10), but one cluster of 57 patients was found. Fewer clusters were found among non-B strains.
The conclusions from this study were that there are two distinct methods of HIV transmission in Belgium and that these two populations have little overcross. Young gay men who become infected get the virus from other local young gay men while Africans and other non-gay patients came to be infected through travel or migrated to Belgium with the virus.
- * What this study did not find was that “white gay men take greater HIV risk”. The study told us almost nothing whatsoever about whether “white gay men” or “gay men of color” take greater risk, because the study had few gay men of color. Belgium is not known for its racial diversity (racism in Belgium is defined in terms of Dutch v. French speaking people). Nearly all of Belgium is white, so nearly all gay Belgians who seroconvert were also white.
- Nor did it find a rampant disregard for safer sex among gay Belgians. A rough calculation suggests that only about 4% of gay Belgian men are living with HIV, a rate a third that of the US. In fact, it would appear that a small subset of young gay Belgians were behaving irresponsibly (perhaps specific social circles) and were consequently infected with a number of sexually transmitted diseases, including HIV.
- Nor does the research of transmission rates and methods in Belgium tell us much about rates and methods in the rest of Europe and especially the rest of the West. This was a local study involving one Belgian city, not “Europe and the UK” or anywhere else for that matter.
Accurate reporting on such issues is important. Headlines declaring that “white gay men” are fueling an HIV epidemic only serves to further stereotypes about gay men in general. But more importantly, they distract from populations that could believe themselves to be outside that demographic and can impact the allocation of resources where they are most needed.
In Belgium, high-risk taking MSM (specific young white gay men) constitute the most important source of local onward HIV transmission in their region, and this is where prevention efforts should be focused. This study even argues for “a debate on the appropriateness of systematic treatment of MSM meeting some of the characteristics associated with a higher chance of being a transmitter.”
But in the United States, the subpopulation most highly impacted by local onward HIV transmission are African Americans – mostly gay but also heterosexual. There are various reasons why blacks are disproportionately impacted; but one big contributor was the flawed focus of early prevention efforts. By narrowing resources and prevention messages to white gay men and virtually ignoring minority populations, there was a false impression created that HIV/AIDS were a white gay mans disease.
We must be diligent to both provide the resources necessary for care and targeted prevention messages in the black community (and all communities impacted) and to derail any confusing and contradictory messages – like this one – that could be counter-productive.