THE NEW YORK TIMES
January 2, 2008
New H.I.V. Cases Drop, but Rise in Young Gay Men
By SARAH KERSHAW
For years he had numbed his pain and fear with drugs, alcohol and anonymous
sex. But in a flash of clarity one day, when the crystal meth was wearing off,
Javier Arriola dragged himself to a clinic to get an H.I.V. test, years after
he stopped using condoms.
He knew the answer before he received the results, but it was far worse than he
thought: At age 29, he had full-blown AIDS.
He had planned to have a party for his 30th birthday. Instead he was thinking
of hanging himself in his apartment in Hells Kitchen.
There were feelings of terror, like when you were a little kid and theres
that thing that terrifies you, he said. This was it. The worst nightmare, and
I brought this onto myself.
The number of new H.I.V. infections in men under 30 who have sex with men has
increased sharply in New York City in the last five years, particularly among
blacks and Hispanics, even as AIDS deaths and overall H.I.V. infection rates in
the city have steadily declined.
New figures from the citys Department of Health and Mental Hygiene show that
the annual number of new infections among black and Hispanic men who have sex
with men rose 34 percent between 2001 and 2006, and rose for all men under 30
who have sex with men by 32 percent.
At a time when the number of new cases among older gay men is dropping by 22
percent in New York City during the same period AIDS experts are bearing down
on what they say is a worrisome and perplexing growth of H.I.V. infection among
young men like Mr. Arriola.
So far, they say, the significant factors feeding the trend appear to be higher
rates of drug use among younger men, which can fuel dangerous sex practices,
optimism among them that AIDS can be readily treated, and a growing stigma
about H.I.V. among gays that keeps some men from revealing that they are
infected. There has also been a substantial increase in the number of new
infection cases among young white men who have sex with men, but still that
group had fewer new cases in 2006: 100, compared with 228 among blacks and 165
among Hispanics.
The rising rates for young men in New York City come as federal health
officials acknowledge that infection rates nationwide, while flat, may be
substantially higher than previously thought because of underreporting.
The highest rates of H.I.V. infection nationally are among gays, blacks and
Hispanics, with a recent trend toward a younger infected population mirroring
New York Citys experience, according to AIDS researchers, who say they are
concerned that the countrys infection rates over all have not declined in the
past 10 years.
Its really unconscionable that we havent had a decrease in new infections in
the past decade in the United States, said Wafaa El-Sadr, chief of infectious
diseases at Harlem Hospital Center and a professor of public health at Columbia
University. Its not anymore in the headlines; many people think its gone
away, and it hasnt gone away.
AIDS activists and medical providers say the rates among young men could signal
a new wave of the disease.
Unless you start pulling it apart, unless you start looking at really
addressing this and talking honestly, unless you start talking about it in a
real way, said Soraya Elcock, deputy director for policy at Harlem United
Community Aids Center, in a neighborhood that has one of the highest infection
rates in the city, well be here in another 20 years having the same
conversation.
As a young, black gay man, Lynonell Edmonds says it seems like a miracle that
he has not contracted the AIDS virus. Before he turned 20, he had a haunting
realization: in his group of 20 close gay friends, he was the only one without
H.I.V.
Mr. Edmonds, now 25, does outreach work for the Harlem AIDS center, trolling
Craigslist and other online meeting spots as a sexpert, encouraging men to be
tested. He and a crew of outreach workers also go to gay nightclubs late at
night, with a van carrying H.I.V. tests that can be conducted on the spot. The
crew parks the van, which has no obvious signs of its mission, on the street.
When they go into the clubs, they make conversation and delicately inquire
whether a clubgoer would like to take the test.
Mr. Edmonds said that for many gay black men there is a sense that getting the
virus is almost inevitable.
A lot of guys say, Im going to get it anyway, Mr. Edmonds said.
Mr. Edmonds and other gay men say the stigma of being infected with H.I.V. is
growing, and may be greater now than it was in the 1990s, when the AIDS
epidemic became a unifying cause, a shared tragedy for gay men.
I call it, Dont ask, dont tell, Mr. Edmonds said. People are not asking
its like its an offensive question.
Kyle, who found out that he had the virus two years ago, at the age of 23, said
he had grown weary of what he called pity dates, men who agreed to go out
with him after he revealed he was infected, but had no intention of pursuing a
relationship. He said that out of about 10 men he had dated in the last two
years, only one who was, at 40, the oldest was willing to go beyond pity
dates.
They blame you and want nothing to do with you; they put you at the end of the
line, said Kyle, who spoke on the condition that his last name not be used
because he said he believed his condition would hurt him professionally. The
older generation sees AIDS as a tragedy, the younger generation sees it as
self-destructive behavior.
He said he was infected by someone who did not reveal that he had the virus
until after they had unprotected sex.
For Mr. Arriola, who struggled with being molested as a child, the H.I.V.
diagnosis put him at rock bottom, he said.
He continued to use drugs for several more months, but then, as his suicide
plan was becoming an obsession, he called a friend who was a recovering addict.
He got clean and sober, joined a 12-step group, started going to therapy and
has slowly pieced his life back together.
For me today, Ive done a lot of work to accept myself. I dont drink and
drug, I meditate, theres a lot of visualization of the person I want to be,
he said. A lot of it is acceptance. Im 32, Im Latin, Im gay and I have
H.I.V. And I dont feel bad about it. Its very, very important for me to not
feel shame about this.
As the face of the epidemic grows younger, city health officials acknowledge
that their efforts including a widespread condom distribution program, new
investments in education programs at places including churches, and more
availability of H.I.V. testing are falling short.
It leaves us a little bit scratching our heads: What is it that is going on?
said Christine C. Quinn, the City Council speaker. Something clearly is not
working, and its literally about life or death.
The city, which has the highest number of AIDS cases in the nation, about
100,000, and one of the highest H.I.V. infection rates, according to the health
department, has made great strides in bringing down H.I.V. rates among
intravenous drug users and pregnant women. The department, which is giving out
three million condoms a month in a program begun last year, has also recently
announced several efforts to expand rapid testing, which provides results
within a day.
The citys health commissioner, Thomas R. Frieden, said in an interview that
the increasing rates among younger men was being driven by stubbornly high
rates of substance abuse, involving drugs like crystal methamphetamine and
cocaine, which not only reduce inhibitions but can also lead to
hypersexuality: extended periods of sexual activity, potentially with
multiple partners.
Dr. Frieden also said that another likely explanation was treatment optimism,
and the many messages gay men receive through AIDS drug advertisements that
people like Mr. Arriola can live long and normal lives.
People who grew up watching their friends die of AIDS are a lot more careful
than those who didnt, said Dr. Frieden, who said he cared for large numbers
of AIDS patients in his earlier medical practice.
He said the department was planning to begin a new H.I.V. prevention campaign
aimed at younger men, and a new marketing strategy for their condom campaign
later this year. Whens the last time we saw someone with lesions walking
through Chelsea and Hells Kitchen? said Victoria Sharp, director of the
Center for Comprehensive Care, which is currently providing medical care and
other services to 3,000 H.I.V. patients at Roosevelt Hospital and in Harlem.
You dont see it, and we havent seen it since the mid-1990s, so there is a
whole generation or two who have grown up without seeing the physical
manifestations.
Health officials said they were also concerned about the growing number of
patients receiving concurrent diagnoses of both H.I.V. and AIDS, after waiting
too long to be tested. And while some policymakers say more aggressive testing
could partly explain the higher infection rates, experts say one in four people
with H.I.V. do not know they are infected, so the actual rates could be much
higher.
Since receiving the AIDS diagnosis, Mr. Arriola, now 32, has developed a large
group of sober friends, become a licensed real estate broker, repainted his
apartment all things that seemed impossible to imagine in the darkness of his
drug use and when he learned he had the disease.
Then, he said he would look in the mirror and see the worthless person he
believed he was. I wont make it to 35, he would say.
But these days, with the antiviral drugs he takes, about five pills a day, his
health is good, he said. Around his apartment, he has posted upbeat messages to
himself, like the one on his mirror, where he has written thank you.
On the refrigerator he has a list of goals: Write a book, own New York City
property, spread love, own a business (20 million), get a college degree, run a
triathlon, have a family (partner, car with driver and kids) and 190 pounds
(muscle).
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