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The Prevalence of HIV in the Gay Community

Timothy Kincaid

July 31st, 2008

It is difficult to state with any certainty how prevalent HIV/AID is among gay men. In the 1980′s, HIV and AIDS were the introduction to many people of the existence of a gay community. And media reports, along with activism and compassionate care efforts, united Homosexuality and AIDS in the minds of many.

In more recent years America has come to know its gay children and neighbors outside the parameters of a disease. Stories in entertainment as well as more visibility and openness have allowed gay people to be seen in a fuller light, as people not dissimilar to their heterosexual friends.

But anti-gay activists try to stir up and continue the stereotype of gay persons as “sick”. They like to equate orientation and seroimmunity status so as to bolster anti-gay arguments by appealing to fear and disease.

Some recent examples of anti-gays conflating gay persons with persons living with HIV/AIDS include:

But is this fair linkage? It is true that most of the persons in the United State who are living with HIV/AIDS contracted the virus through same-sex activity, but is the inverse true? Are most, many, or only a few gay Americans infected?

What Percentage of Americans are Gay?
To answer that question, we need to make an estimate as to the gay population. This, of course, is not easily done accurately. Various estimates have been made over the years ranging from 10% to 1%, with the percentage selected usually dependent on the agenda of the ones making the claims.

To know how many gay people there are, one has to explain what one means by “gay person”. And there are several ways to approach this.

Just a few decades ago, self identification would be a useless parameter. Two men could have lived together for decades and been known to friends and family as a devoted couple without either being willing to be publicly identified as “gay” or “homosexual”. Even today, epidemiologists are careful to use terms such as “men who have sex with men (MSM)” so as to include for health purposes those who do not use LGBT identifications.

But sexual behavior is also not a good indicator. Some gay or bisexual persons may identify publicly as gay and yet for personal reasons choose not to be sexually active. A self-identified gay Christian, for example, may elect celibacy or may defer sexual activity until united in the bonds of a committed relationship but they are no less “gay” than the man with a life partner or the woman living for her next sexual conquest.

Perhaps the best definition would be those who are exclusively or primarily attracted to the same sex. But this definition might also include ex-gays and others who would object to being so identified. And for purposes of discussions of “gay community”, it’s hardly fair to include those who have no communion with other gay persons.

Others, thinking in terms of community, might include as “queer” all persons who do not identify at heterosexual. But to my way of thinking this is far too broad for our purposes, including asexual persons, anti-sexual persons, and those who choose to avoid labels, regardless of sexual attractions.

Although it is tentative and difficult to interpret, I think a conservative estimate can be reached by reviewing the findings of a CDC Report (pdf) released in 2005 and based on 2002 research. This report is valuable in that it had a large sample base, sought for a representative sample, and allowed for anonymous answers. Also, as the CDC was seeking information on sexual health, they had low incentive to build bias into the study which could over- or under-estimate populations.

Also, the CDC asked questions that allow us to extract information based on identity, attraction and sexual behavior. By looking at all three, I think a good estimate can be found.

For MEN, the answers reveal

Identity:

    90.2% – Heterosexual
    2.3% – Homosexual
    1.8% – Bisexual
    3.9% – Something else
    1.8% – Did not report

Attraction:

    92.2% – Only female
    3.9% – Mostly female
    1.0% – Both
    0.7% – Mostly male
    1.5% – Only male
    0.7% – Not sure

Behavior:

    4.5% of 15-19 y.o.; 2.4% in the last year
    5.5% of 20-24 y.o.; 3.0% in the last year
    6.5% of 24-44 y.o.; 3.0% in the last year

(the first figure is oral or anal sex with another man in their life, the second is within the past year)

As with all such results, the answers are probably not as straightforward as first glance might show. How does one treat those who reported “something else”? Are some of them same-sex attracted persons who dislike the homosexual label? And what are we to deduce from those who froze and did not make any selection?

Also, many observers of sexual identity might note that some gay men who have no discernable attractions to women will identify at least for a while as “bisexual”, believing it to be more socially acceptable.

    Based on the above, I think it fair to state that at least 2.3% of men are gay and at least 4.1% are “gay or bisexual”.

For WOMEN, the answers reveal

Identity:

    90.3% – Heterosexual
    1.3% – Homosexual
    2.8% – Bisexual
    3.8% – Something else
    1.8% – Did not report

Attraction:

    85.7% – Only males
    10.2% – Mostly males
    1.9% – Both
    0.8% – Mostly females
    0.7% – Only females
    0.8% – Not sure

Behavior:

While the definitions of “sex” between women are not as clear, 11.2% of women have had same-sex contact and 4.4% had same-sex contact in the past year.

    Based on the above, I think it fair to state that at least 1.4% of women are gay and at least 4.1% are “gay or bisexual”.

How Many Gay Americans Are There
An estimation of the total number of gay people is also difficult, even if one were able to have definitive percentages. Do we count as “gay” the teenager in GLSEN? Or what about her classmate on the baseball team who has same-sex attractions but is afraid of what would happen if he self-identified?

A few decades back one might hesitate to include minors in any definition of orientation. However, the CDC Report indicates that boys report sexual activity at a much younger age and that 38% of 15 year old boys had engaged in either oral or vaginal sex with a female. It seems, then, an unduly puritan definition that excludes this age group.

For our purposes, I will apply the estimates of rates as determined above to populations of those males and females over the age of 15.

The most recent demographic information from the Census Bureau is for 2005. Assuming that sex disparity is consistent through each age group, we find that there were about 111.6 million males and 116.2 million females over the age of 15 in 2005. The Census Bureau also estimates that the current population is about 16% larger than the 2005 demographics report.

    Although this is based on assumptions, by applying the above percentages it is reasonable to state that there are at least 5.3 million gay or bisexual men and at least 5.5 million gay or bisexual women above the age of 15 living in the United States, for a total GLB Community of at least 10.8 million people.

How Many Gay American Men are Living with HIV/AIDS?
Like the questions above, this is difficult to state with certainty. A number of states, including some with large HIV populations, do not do name-tracing on HIV-positive residents and multiple testing might result in double counting. Alternately, a large number of HIV positive individuals may be unaware of their status due to failure to test.

At the end of 2003, the CDC estimates that the total number of people living in the USA with HIV/AIDS was between 1,039,000 and 1,185,000. About 50% of those were infected by male-to-male sexual contact (either with or without injection drugs).

Additionally there have been between 55,000 and 58,500 new infections each year since. Of these, about 57% involved men who have sex with men. Since 2003 there have also been about 72,500 deaths among persons with AIDS.

    Based on the above, it is fair to estimate that there are roughly 635,000 gay or bisexual men living with HIV/AIDS. This is about 12.0% of the gay male population.

How Many Gay American Women are Living with HIV/AIDS?
According to the CDC, through December 2004, a total of 7,381 women who were reported to have had sex with women were HIV infected. Of these, 534 were reported to have sex only with women (but had other risk factors).

To date, there are no confirmed cases of female-to-female sexual transmission of HIV in the United States database.

    Based on the above, it is fair to state that for making projections about the HIV status of gay or bisexual women, virtually none are living with HIV/AIDS. In total, we can say that perhaps 5.9% of gay people (men and women) are living with HIV/AIDS.

Some Cautions
These numbers are estimates. And while I think they are relatively close and can be used for the purpose of argument and to refute those who would propagate lies, there are limitations built in due to inadequate information.

Also, HIV/AIDS does not impact the gay community uniformly. For example, African American men who have sex with men are ten times as likely to be HIV positive than white MSM. While black Americans are only about 12% of the population, they make up nearly half of all new infections, and about 60% of all female transmissions.

HIV/AIDS appears to be more prevalent in communities in which there is a greater reluctance to identify as gay or bisexual. Because our estimations of the total gay and bisexual population relied to an extent on self-identification, there may be a significant number of transmissions by means of MSM that are in individuals not included in the gay/bisexual population. Therefore our estimations about the total percentage of gay and bisexual men living with HIV/AIDS may be overstated.

I did not find information that would readily assist in determining the number of transgender persons living in the United States. These persons may, to some extent, be included in the estimated number of gay and bisexual persons calculated above, but due to limitations in self-identification options it is difficult to be certain.

Health care workers believe that transgender persons have a higher rate of HIV/AIDS than other segments of the LGBT Community. Because such transmissions are likely to be included in our estimate of persons living with HIV/AIDS who contracted the virus by means of MSM, and because transgender persons might not be included in the total population estimate for gay and bisexual men and women, the percentage calculated above may be overestimated.

The estimates provided above address the US population only. According to the HIV Vaccine Trials Network,

Worldwide, 85% of new HIV infections are acquired heterosexually, with the greatest number in sub-Saharan Africa. In the United States, 31% of new infections are passed through heterosexual contact.

And while 12% may seem low when compared to wild claims of 70%, and while many people live full rich lives while infected with HIV, this does not suggest that precautions can be discarded. This virus does impact the immune system of its victim, usually requires a lifetime of careful medication and limitations, and people still die regularly from HIV and AIDS.

Updated 8/21/08

Comments

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Pepe Johnson
August 6th, 2008 | LINK

RE: People dying younger, Insureme.com

My mother is an amateur genealogist. I learned in school that people in the “olden days” always died so much younger than we do today. While it is generally true, I was always struck by my mother’s research showing how we had ancestors in the 1700s and 1800s that lived well into their 70s and even 80s – just as long as we live today. What I was learning in school didn’t seem to fit with what I learned helping my mother.

Later I learned about “averages” and how averaging people’s ages would make it seem like everyone died very young. In reality the cause was a high infant mortality rate, so someone dying with less than one year would totally skew the results when combined with those living into their 70s. So if you made it passed childhood, you stood a decent chance of making it to a ripe old age.

I think the same is true of HIV/AIDS. I know in the early days of the disease, many men had never come out until they were diagnosed. When the passed at a young age, their deaths skewed the reality of LGBT mortality rates. Today we are coming out more and more and I imagine that the public will eventually see a more realistic picture that isn’t clouded by disease.

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