Minorities’ AIDS Toll Exceeds Whites’

For the first time since the AIDS epidemic began nearly two decades ago, the number of cases among minority gay men has climbed higher than that among white gay men, federal health officials announced Thursday.

Data also indicate that African American and Latino gay men are being infected at younger ages than white men, suggesting the need for earlier preventive interventions, said the federal Centers for Disease Control and Prevention in Atlanta.

“We believe this will surprise many in the nation,” said Dr. Helene Gayle, who heads the CDC’s center for sexually transmitted diseases, tuberculosis and AIDS.

“While gay men consistently have accounted for the largest single category of AIDS cases, we still think of the gay epidemic as being a white one,” she said. “The epidemic is by no means over in white gay men, but we are clearly seeing a reversal in the trends.”

Moreover, “our calculations are probably an underestimate because we don’t really know the extent of minority gay and bisexual men,” Gayle said.

Los Angeles has emerged as a dramatic example of the trends. It had the largest number of cases among Latino gay and bisexual men, followed by New York and Miami. And Los Angeles had the largest total of cases among gay Asians, Pacific Islanders, Native Americans and Alaska Natives, even though these groups represent fewer than 2% of overall cases among gay and bisexual men, CDC said. In this category, Phoenix was second.

Among African American gay and bisexual men, New York had the largest number of cases, followed by Washington and Atlanta.

Researchers said that the cultural stigma against homosexuality in communities of color has a significant influence on the trends because those suffering from the disease are often reluctant to seek prevention services and treatment. Other factors include poverty, unemployment and lack of access to health care.

“This report demonstrates the unacceptable costs of homophobia in black America and the stigma still attached to AIDS,” said Julian Bond, chairman of the National Assn. for the Advancement of Colored People.

Dr. Rafael Campo, of the Harvard University Medical School, said, “Latinos are overwhelmingly Catholic and find it very difficult to counter the teachings of the church on homosexuality and the use of condoms.”

And Dr. Jane L. Delgado, president of the National Coalition of Hispanic Health & Human Services Organizations, said that prevention approaches have to tailor AIDS programs to community sensibilities.

“What is successful with gay white male communities cannot be just translated into Spanish but must be adapted to reach our men and their beliefs about themselves,” Delgado said.

Minorities have borne a disproportionate burden of the total of AIDS cases in the United States--despite being only 28% of the population, they account for 69% of AIDS cases--but until recently whites held the largest share of cases among gay and bisexual men.

However, from 1989 to 1998--the decade singled out by CDC for scrutiny--cases among minority gays rose from 31% to 52% of all gay and bisexual cases, while those among white gay men dropped from 69% to 48%, the agency said.

The year 1998 is the most recent one available with full reporting of AIDS cases.

Since powerful drug treatments became available in 1996, annual numbers of AIDS cases and deaths have declined among all gay men, but the drops have not been as steep among gay men of color as they have been among whites, the agency said.

The majority of AIDS cases among gays and bisexuals of color, 85%, was concentrated in cities with populations greater than 500,000, leading with New York (12%), Los Angeles (9%), Miami (5%), Washington (4%) and Chicago (3%), the agency said.

The stigma is exacerbated by the fact that many men of color who have sex with other men regard themselves at heterosexual, which contributes to their perception that they are not at risk.

The CDC surveyed 8,780 HIV-positive men who have had sex with other men. The results, also released Thursday, showed that 24% of the African Americans and 15% of the Latinos identified themselves as heterosexual, compared with 6% of the whites.

“Many men from Spanish-speaking countries may have sex with other men but do not use terms like ‘gay’ or ‘bisexual,’ ” said Dennis de Leon, executive director of the Latino Commission on AIDS. “This . . . can make it very difficult to reach those at risk with HIV prevention messages.”

CDC also released data on infection rates gathered from 1996 through 1998 from 25 states.

Among gay and bisexual men, 16% of African Americans and 13% of Latinos were in the youngest age group, 13 to 24, compared with 9% of whites of those ages, suggesting that minority gays are in greater danger of becoming infected at a younger age.

CDC provides prevention funds to the states. Every year the agency awards $300 million to $400 million to states to support HIV education and prevention programs. States determine how they will use the money.

In fiscal 1999, Congress provided CDC with an additional $7 million specifically for programs targeted to minority gay and bisexual men. Of this, California received nearly $1.7 million, with $418,218 going to programs in Los Angeles.

Finally, CDC said that minority gays appear to be benefiting less than whites from the potent new drug cocktails that include protease inhibitor drugs.

In 1996-98, AIDS deaths dropped 53% among African American gays and 60% among Latinos, compared with 65% among whites, likely indicating differences in access to care, CDC said.

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Breakdown of AIDS Cases

Proportion of AIDS cases among gay and bisexual men by race/ethnicity.

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*Estimated number of AIDS diagnoses adjusted for delays in reporting of AIDS cases and anticipated redistribution of cases initially reported with no identified risk; data reported to Centers for Disease Control and Prevention through June 1999.