The AIDS generation

Seven Things You Need to Know about HIV But Probably Don’t — From An Expert

2Q==Despite vast improvements in the treatment and prevention of HIV in America, ignorance still abounds, both in urban gay male communities and well outside.

We asked our friend Perry N. Halkitis, author of The AIDS Generation and an expert on gay men’s health, to round up some critical truths everyone should know about HIV and AIDS in America.

Here are seven things you should know about HIV…

1. 50% of Americans living with HIV are 50 and up

3o years ago as a young man coming of age in New York City and watching so many young people die (many my friends), I dreamed that one day people could grow old living with HIV. And now they can.

2. Some 14 percent of HIV+ Americans do not know they are HIV+

Here’s the thing. Most poz folks are seeking care and on treatment. So the real danger in transmitting HIV is from people who don’t know their status or are “the mythologically negative”—those that have not kept up with routine testing despite active sex lives. That is why so many agencies including the New York State AIDS Institute embrace the concept of Target, Test, and Treat.

3. Being HIV positive can increase the likelihood of anal cancer

For any HIV-positive gay man, exposure to certain strains of HPV (the virus that also causes anal warts) can lead to anal cancer if untreated. But there are actions to you can to cut down the risk. First, regular anal checkups and testing for HPV is a sure fire way to catch irregular cells before they turn into cancer. Second, there is some evidence that even if you are exposed to HPV, vaccination may be helpful. Talk to your doc.

PS: This is true for HIV-negative guys, too.  And all young gay men should be vaccinated for HPV before they start having sex. (This one’s for you Dr. Goldstone!)

4. Gay men represent 2-4 percent of the U.S population but over 60 percent of HIV infections

I know HIV can affect anyone, but as I state in my book, The AIDS Generation, “Despite the prevalence of HIV/AIDS in all segments of the population, the epidemic in the United States has always been and still is, and likely will continue to be, primarily a gay disease.”

5. A 20-year-old who tests HIV positive before the virus compromises the immune system and who accesses care and adheres to treatment is likely to have a normal life expectancy.

Lesson: Find out your status, get into treatment, and take your meds as prescribed.

6. There are at least two known cases of people on PrEP who have developed resistance

PrEP is great tool in our fight against HIV. In fact some recent studies have shown that PrEP can reduce the risk of HIV by 86 percent. But like all tools, PrEP has its limitations. In a recent study in Africa, two HIV-negative patients on PrEP developed resistance to the drug and acquired HIV. To date only one medication is approved for use as PrEP-Truvada. The good news: Resistance is a rare occurrence, and other meds are being tested to use as PrEP including long-lasting injectables that wont require remembering to take a pill every day.

7. Meth use does not precede HIV seroconversion. Lack of safer sex practices do.

We want simple answers to why HIV continues to affect gay men over 33 years. The use of the drug Meth is one simple answer but too simple an answer. Yes, meth use creates risk. Men who have sex on Meth are less likely to use protection or to know the status of their partners. No one denies that; and it likely increases the chances of acquiring HIV because of the sexual risks you might take while high. But so does any drug, including alcohol, which is enjoyed by far more gay men. Just because someone uses meth doesn’t mean they will become HIV-positive automatically. In fact, some men who use meth practice safe sex or are on PrEP. The truth is many poz men turn to meth as a way of dealing with HIV after they become infected.

Perry N Halkitis is an internationally recognized expert on the intersection between the HIV epidemic, drug abuse, and mental health burden in gay and bisexual men. He is the author of The AIDS Generation: Stories of Survival and Resilience

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