More than a quarter of gay and bisexual men in some cities and states in the South are living with H.I.V., according to a new study a far higher rate than in the country as a whole.
The study shows how much more common H.I.V., the virus that causes AIDS, is among gay black men, especially in the South, as well as how little is being done to prevent its spread in a group whose members face discrimination and are less likely to have medical insurance.
Gay men with insurance are more likely to be in treatment if they are infected or to be using pre-exposure prophylaxis if they are not, both of which significantly cut the chances that an infection will be passed on.
There are just not enough services, said Dr. Ronald O. Valdiserri, an AIDS expert at the Bloomberg School of Public Health of Johns Hopkins University, who wrote an editorial accompanying the study.
Its not just medical care its housing, employment, vocational rehabilitation and transportation, Dr. Valdiserri said. These individuals are fairly vulnerable, and there arent enough assets to cope with their illness.
The study, by epidemiologists at Emory University in Atlanta, was published online Tuesday in a relatively obscure outlet, The Journal of Medical Internet Research: Public Health and Surveillance. But it was accompanied by a second editorial by top AIDS specialists at the Centers for Disease Control and Prevention.
In South Carolina and Mississippi, the study estimated, 28 percent of gay and bisexual men are infected with H.I.V. In Louisiana, the estimated infection rate is 26 percent, and in Georgia, 25 percent. In Washington, D.C., which resembles a city more than a state in its demographics, it was even higher, 32 percent.
The lowest estimated infection rate was in South Dakota, where less than 4 percent of gay and bisexual men are infected. Among states that have particularly large gay populations, Californias estimated infection rate is 17 percent, Floridas 18 percent and New Yorks 20 percent.
The trend was even more pronounced in cities. Researchers counted only men who had received an H.I.V. diagnosis (the statewide figures relied on estimates), and consulted previous data on how much of each citys population was gay and sexually active. Then the researchers calculated which 25 cities had the highest infection rates among those men.
In Jackson, Miss., that figure was 39 percent; in Columbia, S.C., 30 percent; in El Paso, almost 29 percent; and in Augusta, Ga., 27 percent. Twenty-one of the top 25 cities were in the South.
The lowest rate, just under 13 percent, was found in the Los Angeles-Long Beach-Anaheim metropolitan area.
Nationwide, the report said, about 11 percent of gay and bisexual men have an H.I.V. diagnosis.
We hope these data empower local public health officials, community-based organizations and everyone fighting H.I.V. to bring resources to the gay and bisexual men who need them the most, said Dr. Jonathan Mermin, director of the C.D.C.s National Center for H.I.V./AIDS, Viral Hepatitis, S.T.D. and TB Prevention.
