Devastating HIV forecast seen as call to action

Javontae Williams, a 31-year-old gay black man, has seen plenty of statistics during his years in nursing school in Florida, as an undergraduate in sociology at Temple University, and in his graduate program in public health at West Chester University.

Yet nothing has struck him like the news that at current rates, half of all black men who have sex with other men will be found to have HIV at some point.

"The mind-set of it is, one in two, you are just waiting your turn," said the West Philadelphia resident, who is working full-time as a nurse on a geriatric unit and most definitely is not just waiting his turn.

The statistic, a projection by the U.S. Centers for Disease Control and Prevention based on infection rates between 2009 and 2013, infuriates him for how it illustrates the yawning gaps in vulnerability. The estimated lifetime risk of HIV was one in four for gay and bisexual Latino men, one in 11 for gay and bisexual white men, one in 49 for heterosexual black women, one in 2,514 for heterosexual white men.

At the Boston conference where the CDC study was presented, HIV doctors and researchers had similar, if less personal, reactions. They described the study as a call to action for the public health community at a time when there are relatively new - and underused - tools to prevent transmission.

"It is projecting out what would happen if we don't change," said Patrick S. Sullivan, a professor of epidemiology at Emory University and principal scientist of AIDSVu.org, which maps HIV data in major American cities. "The hope is that when we see statistics like this, we get mad as hell and say we are going to do things better."

Nearly 19,500 Philadelphia residents are living with HIV/AIDS, including 624 whose conditions were newly diagnosed during 2014, the most recent year for which statistics are available. About one-third of the new cases were among gay and bisexual black men.

Sullivan and others worried that some people in high-risk groups would read the headlines and conclude that their future is sealed.

"It doesn't have to be," said Kathleen A. Brady, medical director for the Philadelphia Department of Public Health's HIV programs. "I think we have to empower people to get tested; if they are positive, to get on treatment; and if they are negative, to get on PrEP."

Pre-Exposure Prophylaxis is the most significant new preventive measure in years. Truvada, a drug that treats HIV infection, in this case is used to prevent infection in people who are at high risk. The once-a-day pill, which was approved as a treatment in 2004 and as a preventive measure in 2012, is highly effective and has few side effects.

"I'm a mom. If my child was a young gay man or a trans woman, I would want my child to be on PrEP," Brady said.

In Philadelphia, she said, supply exceeds demand. Medicaid covers PrEP, and the city has requested coverage of the uninsured through the state's AIDS Drug Assistance Program. Williams, the graduate student, is HIV-negative and has been on PrEP for a little over a year; he pays a $45 monthly co-pay through his employer-provided health insurance.

Williams also is "doing the kinds of things I need to do to protect myself: using condoms, knowing the [HIV] status of my partner, getting tested regularly."

He said he had brought at least five people to Mazzoni Center Family and Community Medicine, the LGBT-oriented health clinic where he gets his care, to get them started on PrEP.

For HIV, protection is both an individual and a community issue. People who take measures to avoid infection won't pass it on. With frequent testing, they'll know if they have become a risk to others. Those who are already infected cannot transmit it if their "viral load" is suppressed by medication; they are basically living with a chronic non-communicable disease.

But the message has not reached enough people, especially African American gay and bisexual men, to stop the virus' continued spread.

For most of the more than three decades since AIDS appeared, prevention messages have been aimed mainly at gay white males, said R. Eric Thomas, 34, program director at the William Way LGBT Community Center. Add the stigma of HIV, and that the epidemic mostly affects poor minorities, and "this community is basically penned in. So it is no surprise that rates of infection would go up."

To D. D'Ontace Keyes, the latest statistic means that if he thinks of six friends, "three of us will contract HIV/AIDS. . . . It says our existence is a defect and that this poison is going to replicate and continue for years."

As chief creative officer of Philadelphia Black Pride, Keyes designs "untraditional ways of engaging our people."

Instead of setting up HIV testing tables, which can be stigmatizing, he draws people into conversations that lead them to information. "You only have like four seconds to engage, especially for men under 25," said Keyes, a 25-year-old M.B.A. student.

A few months ago, he ran a campaign that placed small cards at a social event. Each showed the well-chiseled bare back of a black man and the word PrEPARED with a large question mark, along with "Text: prepared to 313131." A return text linked to information about PrEP.

The campaign also distributed blue fortune cookies - Truvada is a blue pill - containing messages about PrEP.

While the CDC's new statistic is "disheartening," Keyes said, it also "demonstrated a level of opportunity" for black men who have sex with men "to be at the forefront of reporting our own health and well-being."

dsapatkin@phillynews.com

215-854-2617 @DonSapatkin