A report by the state Department of Public Health (DPH) finds efforts at HIV prevention in Massachusetts have made little headway among gay and bisexual men in the last several years.
While nearly every other mode of transmission, including through injection drug use and heterosexual sex, has seen a drop in new infections per year since 2001, the rate among men who have sex with men (MSM) has remained stable over that same period, averaging about 336 new cases per year. The report provided the first ever estimates for rates of HIV prevalence among MSM in Massachusetts. Drawing on seven years' worth of data collection efforts, DPH estimated that between 2.9 and 6.4 percent of MSM in Massachusetts are HIV-positive. Kevin Cranston, director of DPH's HIV/AIDS Bureau, said that DPH is working to understand why the infection rates among MSM have remained steady.
"We have to learn a lot more to understand this. The simple answer is there's already a lot of HIV in the population ... and certain sexual behaviors, particularly receptive anal intercourse, are efficient at transmitting the virus," said Cranston. But he added that HIV prevention is complex, and there are a lot of other factors that may account for continued HIV infections, including stigma and discrimination, trauma, substance abuse and mental health issues.
The report also found that prevention programs aimed at gay and bi men receive a disproportionately small share of funding from DPH; while 39 percent of recently reported HIV infections were among MSM, only 33 percent of the current prevention funding targets the gay and bi male community. Cranston said that translates into about half a million dollars that should be going towards MSM-targeted prevention efforts if the funding was distributed proportionally. He said DPH has no immediate plans to change how it allocates prevention funding, but he hopes the report will jumpstart conversations between the department and members of the community about how to better target prevention funding.
"These decisions have not been made. We're issuing this report in part to elicit feedback from providers, the larger community, about how to respond," said Cranston. He said the Centers for Disease Control and Prevention (CDC) have recently offered funding to states to assess the need and plan services for HIV prevention aimed at the gay and bi male community, and Massachusetts is applying for that funding.
Cranston said one urgent need he hopes the report highlights is the dearth of CDC-approved HIV preventions interventions targeted toward the gay and bi male community. Of the CDC's 42 approved programs, only seven target MSM, and Cranston said he has heard complaints from some providers that some of those programs are not as effective for some subsets of the MSM community, such as African Americans or refugees. Even those programs that do target the gay and bi male community seem to be making little headway, with only between 10 and 18 percent of MSM in Greater Boston reporting that they have been involved in an individual or group-level HIV prevention intervention. Cranston said that points to the need to find ways to do HIV prevention that do not depend on men setting aside time to attend a regular counseling session or other intervention.
"I think we need to bring HIV interventions closer to gay men's lives. ... Prevention needs to come back to them in the social environments where men meet each other and, frankly, in the environments where men are engaging in sex with one another," said Cranston.
DPH has already taken some steps in that direction, doing outreach on hook-up sites like Manhunt and doing STD screening at bars, clubs, and even private events.
Cranston said the scarcity of CDC-approved interventions for MSM reflects a lack of investment at the federal level in focusing on fighting the epidemic in the gay and bi male community, and he believes that stems in part from the political climate in Washington.
"It speaks a little to the field overall on the national level, about where the relative investment has been placed. ... It is somewhat striking that so few science-based interventions have been developed specifically around the needs of men who have sex with men," said Cranston. "You can imagine there has been something of a political overlay in the development process at the national level."