How Do We Get More Bi and Gay Latino Men To Test for HIV?

When Plus interviewed the original Queer Eye cast member Jai Rodriguez in 2017, the star of stage and screen was shocked to learn of the Centers for Disease Control and Prevention’s prediction that one in every four gay or bi Latino men will become positive in their lifetime, if 2016 rates continued unabated.

“That shook me to my core,” Rodriguez said at the time. The HIV-negative Latino actor has long been involved in HIV causes, mainly through his Broadway connections, and said he “thought I really knew my stuff.” But, like many gay and bi Latinos, he wasn’t initially aware that transmission rates were reaching such pervasive levels in his own community.

Black gay and bi men currently bear an even higher burden in HIV transmission rates, with the CDC predicting in 2016 that one out of every two gay or bi Black men would become HIV-positive in their lifetime. But two new studies suggest Latinos may be catching up to Black men in new HIV diagnoses.

In 2013, the U.S. National HIV Surveillance System began routinely sequencing the DNA of HIV found in newly diagnosed people. This type of analysis can help identify clusters — groups of two or more people whose viruses are so genetically similar that they suggest a common origin.

Clusters have historically been analyzed to trace the growth of a localized epidemic, to analyze the viral load in transmission pairs, or to see when different HIV strains first arrived in a population, their transmission network, and how long they persist. The NHHS now collects so much data (HIV DNA sequences from 280,000 poz people) that it can determine the current rate of new contractions in particular clusters. It can also identify clusters that are unusually active, which can lead to HIV “hot spots.” Since late 2015, the CDC has been using that data to identify these clusters and calculate contraction rates.

In results reported at last year’s Conference on Retroviruses and Opportunistic Infections, the CDC identified 60 priority clusters with especially high rates of HIV transmissions. On average, one in 25 people with HIV in the U.S. transmits their HIV to another person in the course of a year, which statisticians represent as four transmissions per 100 person-years. In these 60 clusters, the average transmission rate was 44 per 100 person-years — or 11 times the national average. In the highest cluster, there were 132 transmissions per 100 person-years.

Members of these priority clusters were more likely to share certain characteristics: for example, they were more likely to be men who have sex with men (83 percent versus 59 percent in non-priority clusters) and younger (70 percent under 30 vs. 42 percent over 30).

Unexpectedly, Hispanics were over-represented in the priority clusters and Blacks were under-represented: 38 percent of priority cluster individuals were Hispanics versus 27 percent of non-priority clusters, and Blacks accounted for 31 percent of priority vs 41 percent of non-priority cluster members. Researchers suggest these findings could be early indications of a dramatic shift taking place in the racial makeup of Americans at highest risk of becoming HIV-positive.

“These findings suggest rapid transmission in networks involving young MSM, especially young Hispanic MSM,” said the CDC’s Anne Marie France at CROI. “We will be using these data to guide future prevention interventions…. Prioritizing these clusters for public health intervention may have increased potential to reduce future infections.”

Aside from this study, additional stats from the CDC reinforce the suggestion that gay and bi Latinos are increasingly at-risk in terms of both new HIV diagnoses — and medical outcomes. From 2011 to 2015, the estimated annual HIV transmission rate increased by 13 percent among gay, bisexual, and other MSM Latinos, and all ages (aside from those between 35-44 and over 65) saw rates increase. In contrast, during that same period, while Black MSM 25-34 saw dramatic increases (30 percent), all other age groups saw significant decreases (e.g. 45-54 down 25 percent) or stayed the same.

If the new studies are indeed representation of broader demographic shifts it may be because — after the alarming one out of every two prediction was announced — activists, service providers, and pharma companies sprang into action. Since then, gay and bi Black men have been heavily targeted through numerous HIV prevention campaigns and it’s starting to make a difference. There are encouraging signs that culturally-competent outreach and increasing PrEP access are beginning to have real impacts in reducing HIV transmission rates among Black men. While that’s great news, the latest stats suggest Latinos are being left behind.