1. Gay Men & HIV: Challenges In The Third Decade Jeff Bailey, MPH Director Health Education & Prevention L.A. Gay & Lesbian Center

2. Gay Men & HIV: Challenges In The Third Decade 1.Overview of epidemiological profile in the County of Los Angeles 2.Syphilis outbreak among gay men 3.Historical perspective of HIV & gay men. 4.Social impact of HIV 5.Emerging issues 6.Where do we go from here?

3. Source: Data Analysis Unit, HIV Epidemiology Program

4. 2002 Male AIDS Cases by Race/Ethnicity Rates per 100,000 Population – LAC and USA

5. Cases of AIDS in Los Angeles County, by Mode of Exposure--Cumulative for Year 2002 Source: HIV Epidemiology Program Advanced HIV Disease (AIDS) Quarterly Surveillance Summary, LAC/DHS, data as of 12/02.

6. Proportion of Persons Living with HIV and AIDS by BRG - LAC, 2003 55% 3% 4% 8% 12% 6% 3%

7. Estimated Number of Persons Living with HIV (including AIDS) by BRG 28,400 6,400 4,200 3,100 1,700 # BRG with AIDS 1,700

9. Annual Syphilis Cases: Percent Co-morbidity with HIV by Gender, Sexual Orientation and Year-LAC, 2002-2003

10. Early Syphilis Surveillance 2005200420032002 #%#%#%#% Total85100%847100%828100%720100% Male7285%75389%74890%65791% Female1315%9111%536%639% MSM4351%52462%52864%47866% WSM911%658%617%568% Age <1500%2 1 1 15-1900%212%202%203% 20-2489%9411%759%7510% 25-2967%11313%8510%8512% 30-341214%12815%13416%13419% 35-392428%18422%15719%15722% 40-441518%17220%12115%12117% 45-491012%688%708%7010% 50-5434%354%374%375% 55-5911%14717%121%122% 6067%132%81%8

11. Historical Perspective of HIV HIV has primarily impacted gay men in North America.HIV has primarily impacted gay men in North America. HIV emerged as historical arguments against homosexuality were collapsing.HIV emerged as historical arguments against homosexuality were collapsing. In some countries the gay rights movement gained momentum with the emergence of HIV.In some countries the gay rights movement gained momentum with the emergence of HIV. HIV linked to sexual behavior – resulted in the reporting of cases based on lifestyle.HIV linked to sexual behavior – resulted in the reporting of cases based on lifestyle. GRIDGRID Gay related cancerGay related cancer “Being gay is a health hazard” (1982).“Being gay is a health hazard” (1982).

12. Social Impact of HIV 1.Men initially reduced the number of partners. 2.Created AIDS Organizations to respond to the epidemic. 3.Emergence of gay families 4.“Safer Sex” becomes a norm in sexual speech.  Erotizing safer sex (1980’s) 5.The condom code 6.HIV Negative Men 7.Circuit parties

13. Challenges “Post AIDS”“Post AIDS” –AIDS fatigue –HIV & the media ABC’s of HIV PreventionABC’s of HIV Prevention –Abstinence –Be Faithful –Use Condoms InternetInternet Substance UseSubstance Use Gay men of colorGay men of color Circuit partiesCircuit parties  21% of HIV+ & 9% of HIV-negative attendees reported UAI during a distant circuit party.

14. Where do we go from here? Office of Men’s healthOffice of Men’s health Integration of HIV/STD effortsIntegration of HIV/STD efforts Integration of substance use and sexual health strategiesIntegration of substance use and sexual health strategies Improve the life for gay men in low prevalence areas:Improve the life for gay men in low prevalence areas: Addressing violenceAddressing violence Sexual Health modelSexual Health model Community building activitiesCommunity building activities Do smarter preventionDo smarter prevention Not all gay men are at risk for HIVNot all gay men are at risk for HIV Historical context of individual level interventionsHistorical context of individual level interventions Alternative events for gay men to socialize with one anotherAlternative events for gay men to socialize with one another