By Dawn Wolfe Gutterman
LANSING – According to a press release issued by the Michigan Department of Community Health on the eve of the 25th anniversary of the discovery of HIV/AIDS, the face of AIDS in the state is changing.
It's getting younger.
While most new cases are found in 30-44-year-olds and African-Americans and men who have sex with men (MSM) continue to be infected, the state has found "significant increases among young people aged 13 to 24."
According to the release, "During the last five years, the number of cases diagnosed each year remained stable at about 890 diagnoses per year. However, during this time, statistically significant increases were observed in the proportion of new HIV/AIDS diagnoses among men who have sex with men and among persons aged 13-24 years. Of the 185 thirteen-twenty four year olds living with HIV/AIDS in 2004, most (77 percent) were 20-24 years old." Most of the increase was seen in African-American youth.
In addition, the release says, "African-American, white and Hispanic MSM continue to lead the epidemic in Michigan and we have seen significant increases in HIV among these men."
Leaders of Michigan's AIDS service providers blamed lack of funding and lack of education for the increase in HIV among youth.
"We need to expand prevention programs that work and have proven to work like … targeted prevention programs for at-risk groups like youth, comprehensive HIV education that runs the gamut from abstinence, to sexual responsibility to proper condom usage, to safer sex practices, to how to have a talk with your partner(s) about their past risky behavior," said Hank Millbourne, associate executive director of AIDS Partnership Michigan.
"Funding for AIDS organizations to work in the schools disappeared years ago, and the schools will not recognize issues of young people's sexuality, particularly the gay youth. Young people develop their sexual practices in their mid to late teens, and schools are unwilling or unable to face that issue," said Craig Covey, executive director of the Midwest AIDS Prevention Project.
Jake Distel, executive director of the Lansing Area AIDS Network, agreed.
"One of the issues that we are facing in the fight against HIV is the focus in classrooms on an abstinence-based message that is not effective and frankly not real," Distel said. "Youth are not abstaining from having sex. Nearly 70 percent of young people report that they have had sex by age 18. Over 46 percent reported having had sexual intercourse before graduating from high school. A full 22 percent report having had sexual intercourse with four or more partners prior to the end of their senior year."
According to Distel, young people aren't getting infected because of apathy, but because of a lack of knowledge about HIV/AIDS.
"LAAN recently started the Street Smart program in collaboration with the Ingham County Youth Center," he said. "The program is specifically designed for at-risk youth and deals with issues relative to young people and HIV, specifically risk reduction and safer sex options. The young people that participated were engaged and eager. It was obvious that the majority of the young people had not been exposed previously to similar information."
"I think that we have accessible services available to youth, but not the right types or intensity of education and awareness campaigns that are needed to show the importance of HIV prevention and testing," said Jimena Loveluck, executive director of the HIV/AIDS Resource Center in Ypsilanti. "In addition, after 25 years of AIDS, youth learn about HIV but view it as a chronic disease that can be managed (look at Magic Johnson). It doesn't have the same urgency as it did 20 years ago."
Addressing the level of infection in the African-American community, Millbourne said, "Stigma and discrimination continue to play a large role in fueling the epidemic among black Americans and particularly for black MSM. We need to acknowledge and affirm the sexual diversity that exists within the community and move on and stop demonizing and marginalizing groups. All of the institutions [that] interface with the lives of people must also come to realize that this is their problem, too, and play a role in stopping the epidemic. The 'we' must be expanded to include churches, school, community organizations, businesses, block clubs, social organizations, etc."
"Our prevention interventions must be relevant to the target groups where we see increases and they must be based on the realities of people lives," he added.
"Among MSM and African-American communities, the importance of targeted and culturally competent HIV services cannot be stressed enough. These statistics will not change unless we continue to involve members of the MSM community in developing, implementing and evaluating HIV services," said Loveluck.
In addition to citing the changes in infection trends, the press release cited "complacency" as a challenge in the continuing fight against AIDS.
"We cannot afford to become complacent with HIV and AIDS in Michigan," said Janet Olszewski, director of the Michigan Department of Community Health. "Because of the availability of medicines to treat this illness, many individuals believe AIDS is a thing of the past, but it is still a public health threat that we need to redouble our efforts to eliminate."
"I agree with Ms. Olszewski that there is definitely some complacency out there. I do feel that there is a certain segment of the population that may believe that AIDS is something of the past, that it has become for all intents and purposes a chronic controllable disease. This is not the case," said Distel.
Distel said that, although there are now drugs available to help people living with AIDS, those drugs are costly – both in terms of money and side effects.
"It is true that new medications are leading to much longer lifetimes, that people are surviving with HIV for extended periods of time. I know of people who have been diagnosed over 20 years who are doing relatively well. Note 'relatively,'" he said. "The reality is that there are many side effects to many of the drugs used in medical protocols. Many of these side effects are severe and include chronic diarrhea and neuropathy [damage to the nervous system]. So, although people are surviving longer it is not an easy road to travel. The long-term impacts and the long-term viability of certain medications also remain uncertain. The costs of care and treatment are huge."
"I think that complacency about HIV is widespread. With AIDS death rates dropping dramatically in the U.S. and a wider array of increasingly successful treatment options, HIV has lost its importance in our country's landscape. Furthermore, with the decimation that HIV is causing in developing countries who rightly need great amounts of funding and assistance, it is even harder to bring the message home about HIV/AIDS in our own communities," said Loveluck.
Covey placed some blame for the continuing spread of HIV/AIDS on the gay community, citing "refusal of the bath houses and public officials to deal with the highest risk behaviors that occur there."
"Many men who have sex with men refuse to discuss the issue prior to sex," Covey said. "Sex from the Internet chat rooms often doesn't even involve knowing the person's name, much less their health status."
Ultimately, Covey said, a lack of political will is hampering his agency's struggle to contain the disease. "When our political leaders talk to gay groups, they often forget to mention AIDS," he said. "The mayor of Detroit and the governor of Michigan could do lots more to help. Political leaders are more afraid of the Christian fundamentalist right, than they are of AIDS."
Speak OUT
According to some Michigan leaders in the fight against AIDS, incomplete sex education that stresses abstinence until marriage at the expense of accurate information about STDs is at the root of the increase in infections among young people. Contact your state Representative and Senator and the Michigan Department of Education and urge that our state's sex education policies be re-written to include comprehensive sex education, including medically accurate information on preventing sexually transmitted diseases.
For contact information for your state Representative call the Michigan State House Clerk's office at 517-373-0135 or visit http://house.michigan.gov/find_a_rep.asp
For contact information for your state Senator visit http://senate.michigan.gov or call the Secretary of the Senate at 517-373-2400.
Contact the Michigan Department of Education via postal mail at 608 W. Allegan Street, P.O. Box 30008, Lansing, MI, 48909, via phone at 517-373-3324, or via email at [email protected].
