African-American men who have sex with other men typically are more conservative in sexual behavior than gay men in general. So why are they far more likely to contract HIV/AIDS?
"Generally, they take far fewer risks than white guys. They are much more conservative than gay men in general. But it's a 30-year-long epidemiological puzzle," said Ron Stall, in the department of behavioral and community health sciences at the University of Pittsburgh Graduate School of Public Health. "Where's all the virus coming from? If you can't answer that question, you can't do HIV prevention."
The graduate school and the Center for Black Equity in Washington, D.C., now hope to answer that question.
They've landed a $3.2 million grant through the National Institute of Nursing Research at the National Institutes of Health to answer the question and help put the brakes on the national epidemic of human immunodeficiency virus and the deadly disease that HIV causes -- acquired immune deficiency syndrome, known as AIDS.
The research team plans to survey nearly 6,000 African-American men who attend annual Black Gay Pride events in Atlanta, Chicago, Los Angeles, Philadelphia and Washington, D.C., which draw about 300,000 participants annually.
"We will bring the community, and Pitt will bring the science," said Earl Fowlkes, president and CEO of CBE. "We hope to get answers to help both institutions and all of society. This is the most important thing we've done in the history of our organization."
The study will create the largest sample of HIV-related data ever collected from African-American MSM, "and that will yield important data about the health and well-being of our community," Mr. Fowlkes said.
In minority communities, MSM is preferable to the term gay.
During the five-year study, gay African-American men will complete surveys anonymously to identify what prevents or encourages them to receive HIV testing and care, including the impact of family, community and religion on their decision-making, he said.
The study also will investigate other factors important to the overall health of African-American MSM, including depression, substance use, violence, victimization and other health problems. Their answers will determine what factors to target in convincing them to follow safe practices and to seek testing and treatment. Reducing HIV infections among African-Americans is expected to help stem the national epidemic.
Mr. Stall, a doctor of behavioral epidemiology, said recent studies suggest it's not individual risk-taking in their sexual behavior that's driving the epidemic among African-American men. Instead, "less access to medical care makes it less likely for them to know if they are infected.
"When you are positive and not in treatment, you are a very efficient transmitter of the virus, and so it's not the risk-taking. It's the background level of the community viral load -- the proportion that is positive and out of treatment."
About one-third "of all new HIV infections in the United States occur among African-American men who have sex with men," Mr. Stall said. "It's a huge proportion of the epidemic."
In cases where men involved in the survey test positive for HIV, community-based health services working in partnerships with the research team will help them find counseling and health care. "Getting guys into care, lowering the infection rate in the population and lowering the epidemic -- that's the idea," Mr. Stall said.
State Rep. Jake Wheatley, D-Hill District, said the grant "is absolutely important for us to continue to educate, involve, and advance a message and strategy that allows us to break all barriers to access to appropriate care for all citizens and all communities."
In a recent news release, Mr. Wheatley reported that African-Americans in 2011 were 8.6 times more likely to be diagnosed with HIV infection, as compared to the Caucasian population. "That disparity should concern everyone," he said.
The Pennsylvania Department of Health's most recent profile of HIV/AIDS in Pennsylvania, African-Americans comprise 11.4 percent of southwestern Pennsylvania's total population but represent 44 to 46 percent of the region's residents living with HIV/AIDS.
The Pittsburgh AIDS Task Force continues canvassing neighborhoods in the city to spread awareness of the health disparities facing the black community, including their impact on the HIV/AIDS epidemic. It continues offering HIV testing at area public housing communities through Friday.