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How did HIV spread quietly in the United States? What is the story behind it?
Since the 1970s and 1980s, the HIV/AIDS epidemic in the United States has gradually spread, especially issues related to men who have sex with men (MSM). The initial signs of an epidemic came in 1981 when clusters of diseases such as Kaposi sarcoma and Pneumocystis pneumonia were discovered among homosexual men in Los Angeles and New York City. The first official report from the Centers for Disease Control and Prevention (CDC) came on June 5, 1981, detailing the cases of five young homosexual patients, bringing attention to the virus.
"In 1982, the medical community called this disease 'gay-related immune deficiency' (GRID), but in fact, HIV/AIDS is no longer exclusive to a certain group of people."
As knowledge about HIV increases, scientists are realizing that the virus does not just affect MSM, but can infect anyone, regardless of gender or sexual orientation. However, according to global data, MSM remains a high-risk group. Although MSM accounts for a relatively small proportion of the total population in the United States, they are the group most affected by the HIV/AIDS epidemic.
Behavioral characteristics of MSM
MSM are defined as men who have sex with men, regardless of their self-identification. The term includes not only people who identify as gay or bisexual, but also men who have never had sex with men. Because it is difficult to count the number of men who have sex with men, many studies use MSM as a more behavioral term.
MSM Population in the United States
According to the Centers for Disease Control and Prevention, MSM accounts for approximately 2% of the U.S. population. However, other studies have shown that about 6% of men between the ages of 15 and 44 have had oral or anal sex with other men.
"Approximately 57% of men who have sex with men identify as heterosexual or bisexual, which presents them with unique challenges in epidemic prevention measures."
The “lower class culture” of black MSM
In the African American community, a culture called "Down-low" has gradually emerged, representing a contradiction between identity and behavior. Many men in this subculture, while identifying as heterosexual, actually have sexual contact with other men, often without being public. Against this backdrop, African American men who have sex with men have higher rates of HIV infection, and many are unaware of their infection status.
Risk Factors and Preventive Measures
According to various studies, the risk of HIV infection among MSM is 22 times higher than that of other adult men. Multiple studies have shown that unprotected anal intercourse and substance abuse (such as amphetamines or heavy drinking) significantly increase the risk of infection. As society's awareness of HIV decreases, many people's concerns about infection have also decreased, especially among young people, who have a clear lack of awareness of the risk of infection.
“Prevention measures include promoting safe sex, making testing more accessible and improving public knowledge about HIV.”
Future Directions
Although the transmission rate of HIV has declined over the past few decades, it has not fundamentally changed its epidemic trend. Providing better education, promoting self-testing, and eliminating the stigma associated with HIV are the most urgent tasks today. Studies have shown that even among those who have been tested for HIV, the proportion of those who go back to get the test results is low, which means that many infected people are unable to receive treatment in a timely manner.
As the HIV/AIDS epidemic continues in the United States, how to effectively carry out prevention work for high-risk groups in the future has become a major challenge facing global public health?
