Thomas C. Mills

Association of Co-Occurring Psychosocial Health Problems and Increased Vulnerability to HIV/AIDS Among Urban Men Who Have Sex With Men

OBJECTIVES We measured the extent to which a set of psychosocial health problems have an additive effect on increasing HIV risk among men who have sex with men (MSM). METHODS We conducted a cross-sectional household probability telephone sample of MSM in Chicago, Los Angeles, New York, and San Francisco. RESULTS Psychosocial health problems are highly intercorrelated among urban MSM. Greater numbers of health problems are significantly and positively associated with high-risk sexual behavior and HIV infection. CONCLUSIONS AIDS prevention among MSM has overwhelmingly focused on sexual risk alone. Other health problems among MSM not only are important in their own right, but also may interact to increase HIV risk. HIV prevention might become more effective by addressing the broader health concerns of MSM while also focusing on sexual risks.

Suicide Attempts Among Gay and Bisexual Men: Lifetime Prevalence and Antecedents

OBJECTIVES We examined lifetime prevalence of suicide attempts and psychosocial correlates in a large population-based sample of men who have sex with men (MSM). METHODS A telephone probability sample of US urban MSM (n = 2881) were interviewed between November 1996 and February 1998. RESULTS Twenty-one percent had made a suicide plan; 12% had attempted suicide (almost half of those 12% were multiple attempters). Most who attempted suicide made their first attempt before age 25. Although prevalence of parasuicide (i.e., attempted suicide) has remained constant across birth cohorts, mean age at initial attempts has declined. CONCLUSIONS MSM are at elevated risk for suicide attempts, with such risk clustered earlier in life. Some risk factors were specific to being gay or bisexual in a hostile environment.

Running in Place: Implications of HIV Incidence Estimates among Urban Men Who Have Sex with Men in the United States and Other Industrialized Countries

Attempts to document changing HIV incidence rates among MSM are compromised by issues of generalizability and statistical power. To address these issues, this paper reports annualized mean HIV incidence rates from the entire published incidence literature on MSM from Europe, North America and Australia for the period 1995–2005. Publications that met the entry criteria were coded for region of the world, sampling method and year of study. From these reports, we calculated a mean incidence rate with confidence intervals for these variables. Although no differences in mean incidence rates were found for MSM from 1995 to 2005, HIV incidence rates are lower in Australia than either North America or Europe. We calculated a mean incidence rate of 2.39% for MSM in the United States, which if sustained within a cohort of MSM, would yield HIV prevalence rate of approximately 40% at age 40. These extrapolations overlap published HIV prevalence rates for MSM younger than age 40 in the United States. HIV incidence rates in the 2–3% range will adversely affect the health of gay male communities for decades to come. This analysis suggests that greater attention should be devoted to the question of how best to design prevention interventions that will lower HIV incidence rates among gay men.

A Quarter Century of AIDS

This summer marks the 25th anniversary of the first scientific description of the AIDS epidemic.1 Since the publication of the initial report describing 5 cases of an unknown disease, the epidemic has grown at an exponential rate. An estimated 40300000 people are living with HIV infection around the globe, of whom 4900000 were infected during the year 2005 alone.2 The explosive trends in the global epidemic have also occurred in the United States; an estimated 925000 to 1025000 HIV-seropositive persons resided within the United States in 2003.3 Unless we find ways to field effective AIDS prevention and treatment programs on a global basis, we will continue to stand witness as a dangerous epidemic spins out of control, with tragic repercussions for the rest of this new century. Here, we identify the most prominent attributes of AIDS—already evident at the quarter century milepost—that challenge the effective functioning of prevention and treatment efforts and identify some initial successes that may provide guidance for future advances in managing the epidemic.