In the United States, men account for more than 76 percent of all adults and adolescents living with HIV infection, and 67 percent of those are gay, bisexual, and other men who have sex with men (MSM).
Those numbers hit home in Nashville, which – along with Memphis – houses the highest percentage of HIV cases in Tennessee. According to the Centers for Disease Control and Prevention, there were an estimated 44,000 new HIV infections in 2014, and 67 percent were among MSM. Within the subpopulation of 28,000 MSM, 11,200 were black, 9,000 were white, and 7,550 were Hispanics/Latinos.
Race as a Risk Factor
What role does race play in the spread of HIV? Donald J. Alcendor, PhD, associate professor in Microbiology and Immunology in the Center for AIDS Health Disparities Research at Meharry Medical College, said white males still make up the largest group of men infected with HIV. However, other races are disproportionately impacted.
A 2014 CDC study found 44 percent of estimated new HIV diagnoses in the United States were among African Americans, who comprise only 12 percent of the U.S. population. Similarly, Latinos made up 17 percent of the U.S. population but had 23 percent of all new HIV diagnoses. “When you look at gay African American men, they tend to have smaller and more exclusive sexual networks with a high infection rate so the likelihood of interacting with someone in a small group makes the incidence of infection higher,” he explained. “This is why it’s become the health disparity that we know.”
Heterosexuals & HIV
Individuals infected through heterosexual sex made up 24 percent of all new HIV diagnoses in 2014. Four years earlier, the CDC found that heterosexual males were 44 times less likely to contract HIV than homosexual men.
While HIV conversations typically revolve around men, Alcendor said it’s tough to discuss HIV in men without talking about women, who typically contract the virus from men. To that end, much of Alcendor’s work focuses on recreating the sexual microenvironment, i.e. “sex in a petri dish.” By studying a common condition called bacterial vaginosis (BV), he hopes to determine the link between HIV inhibitory factors in normal vaginal fluid vs. those in an inflammatory microenvironment. BV predisposes women to HIV transmission, and Alcendor believes increased levels of BV in African American women have contributed to HIV infection rates 20 times higher than that of white women.
Risky Business
The consistent rise in HIV cases begs the question, why aren’t individuals doing more to protect themselves? Alcendor, who speaks about HIV prevention in high schools, universities and faith-based communities nationwide, said there’s still a great deal of misinformation about HIV, even among the “educated.”
“Teenagers have an interesting way of thinking about HIV,” said Alcendor, who recently polled students from some of the top high schools in Nashville. “There’s so much confusion from students heading off to college, and many just don’t have the information required to protect themselves adequately from HIV.”
He’s seen a similar lack of education among college students and caregivers of HIV patients. Young gay and bisexual men accounted for 92 percent of all new HIV diagnoses in people aged 13-24 in 2014; and young, African American gay and bisexual men are even more severely affected.
Unfortunately, it’s not just America’s youth who need guidance. HIV education has also missed the mark on adults 50 and over, as most HIV prevention campaigns target teens and young adults. However, 25 percent of HIV patients are over the age of 50, and that number is expected to climb as advances in treatment can allow early-diagnosed patients who adhere to treatment a near normal life expectancy.
PrEP & nPEP
While HIV cure research is still underway, long-acting HIV meds can help a patient manage 98 percent of the virus in his peripheral circulation. The remaining two percent is stored in the body’s HIV reservoir, which allows HIV to rebound when a patient stops his medication. Other breakthroughs include Biomedical intervention PrEP (Pre exposure prophylaxis), prescribed to HIV negative individuals at risk for HIV infection to keep them negative. Another tool is Non-occupational Post Exposure Prophylaxis (nPEP), a 28-day course that can be started within 72-hours of potential exposure to HIV.
AMP Study
Now in clinical trials, recurrent infusions of antibodies to viral protein to protect cells from infection. In April, Vanderbilt University became the first U.S. site to enroll an HIV negative MSM in the Antibody Mediated Prevention (AMP) Program.
In traditional vaccine studies, people are given vaccines and wait to see if their bodies will make antibodies against HIV in response. In this study, participants are given a broadly neutralizing HIV antibody, VRC01, directly through IV infusion. The antibody is believed to stop HIV from binding to human T-cells by attaching to the virus and preventing it from infecting the T-cell.
Locally, 89 participants will be enrolled through Vanderbilt. “This has been a very exciting breakthrough study,” said Susan Conway, community educator and recruiter at the Vanderbilt HIV Vaccine Program. MSM participants undergo blood work every four weeks and receive IV infusions every eight weeks for 22 months.
“All volunteers are HIV negative and continue to utilize anything and everything in their tool box, from abstinence and condoms to PrEP, to make sure they don’t get HIV,” Conway said.
Overcoming Stigma
One of the greatest challenges in addressing HIV is the stigma, strong enough to keep a dying person from reaching out for help. “People don’t understand the power of stigma,” Alcendor said. “It’s tremendous.”
Cultural competency is often forgotten, as well. “Everybody has value and should be treated with respect and dignity regardless of circumstance,” he said. That includes social support groups, HIV ministries at places of worship, support for those living in poverty, and those underserved and incarcerated.
“For some people, drug addiction is a way of dealing with the pain that comes with living a life they’re not proud of, and sometimes it simply means survival for those left behind,” said Alcendor.
He believes the only way to truly manage the HIV epidemic comes from a group effort that includes policy makers, community stakeholders, medical providers, and innovative research. To reduce the number of new infections he strongly supports targeted testing for HIV. “You need community liaisons with boots on the ground to encourage people at high risk for HIV to get tested,” he said.
RELATED LINKS:
Meharry Center for AIDS Health Disparities Research
