HIV/AIDS In The Lives Of Gay And Bisexual Men In The United States

From the earliest days of the HIV epidemic, gay and bisexual men have been among the hardest-hit groups in the United States. While gay men make up just 2 percent of the U.S. population, they account for two thirds (66 percent) of new HIV infections, a majority (56 percent) of people living with HIV, and more than half (55 percent) of all AIDS deaths since the epidemic’s beginning.¹ It is estimated that 12-13 percent of gay and bisexual men in the U.S. are HIV-positive², including one in five in many major U.S. cities³. Gay men are the only group in the country among whom new infections are on the rise; between 2008-2010, new infections rose 12 percent overall among gay men, and 22 percent among younger gay men ages 13-24.⁴ Recent research shows that antiretroviral therapy, which already has helped to dramatically increase the quality and length of life for people with HIV, has the potential to play a powerful role in the prevention of HIV. People living with HIV can reduce the risk of transmitting the infection to others by up to 96 percent if they are taking consistent ARV treatment⁵, and for those who are HIV negative, new pre-exposure prophylaxis (PrEP) offers a daily pill that can help them to stay negative.⁶

What do gay and bisexual men know and think about HIV, and about these new treatments? What are the obstacles to this population taking greater advantage of them? To help answer these questions, the Kaiser Family Foundation conducted a survey of gay and bisexual men in the U.S. focusing on attitudes, knowledge, and experiences with HIV/AIDS and new HIV therapies. The survey was conducted July 17-August 3, 2014 with a sample of 431 men who self-identified as either gay or bisexual using a nationally representative, probability-based Internet panel (more details available in the Survey Methodology section of this report). Some highlights of the survey are presented here, and a more comprehensive examination of the survey findings follows.

Highlights Of Survey Findings

• The survey allows us to provide some basic demographic information about gay and bisexual men, and finds that just over half (53 percent) report being in a committed relationship, including one in five (20 percent) who say they are married. Twelve percent live in a household with at least one child under the age of 18.
• About half of gay and bisexual men say HIV/AIDS is a “very” or “somewhat” significant issue for them personally (49 percent), while the other half say it is “not too significant” or “not a significant issue” in their lives (51 percent). However, just about a third (35 percent) say they are personally concerned about becoming infected, while more than half (56 percent) say they are not personally concerned.
• Just a third of gay and bisexual men realize that new infections are on the rise among gay men. About one in five (22 percent) think rates are decreasing and the rest either think the situation is staying the same or acknowledge that they don’t know.
• Most gay and bisexual men are not aware of current treatment recommendations for those who are HIV-positive, or of the latest developments in reducing new infections. Only about a quarter (26 percent) know about PrEP, a recently approved medication that people who are HIV-negative can take to lower their risk of becoming infected. Just one in ten know someone, including themselves, who has taken PrEP, and eight in ten say they have heard only a little or nothing at all about the new medication.
• Fewer than half (46 percent) of gay and bisexual men are aware that people with HIV should start antiretroviral (ARV) treatment as soon as they are diagnosed, and only a quarter (25 percent) know about treatment as prevention, or TasP; that is, that taking consistent ARV treatment significantly reduces the risk of passing HIV on to one’s sexual partners.
• Majorities say that too many gay men not knowing their status (75 percent), complacency about HIV in the gay community (62 percent), and HIV-related stigma (56 percent) are major reasons it’s been hard to control the spread of HIV among gay men.
• Few gay and bisexual men report talking much at all about HIV with friends or even with sexual partners. Three-quarters (68 percent) say they “rarely” or “never” discuss HIV with their friends, and large shares report not talking much about it with casual sexual partners (50 percent) or with long-term partners (60 percent).⁷
• Relatively few gay and bisexual men report getting tested for HIV as regularly as is often advised. While seven in ten say they have been tested at some point in their lives, just three in ten (30 percent) say they were tested in the last year, including 19 percent who say their most recent test was within the past 6 months. Fully three in ten (30 percent) say they have never been tested for HIV.⁸
• More than half (56 percent) of gay and bisexual men say that a doctor has never recommended they get tested for HIV, and six in ten (61 percent) say they rarely or never discuss HIV when they visit their doctor. Lack of communication with doctors may be a barrier to more men getting tested: almost half say they’ve never discussed their sexual orientation with a doctor, and three in ten say they don’t feel comfortable discussing sexual behaviors with health professionals. Three in ten gay and bisexual men report that they don’t have a regular physician, and these men (who tend to be younger, lower-income, and more racially diverse) are even less likely to report discussing HIV with doctors and to say they have been tested for HIV.

Highlights Of Differences Between Groups

The relatively modest sample size of the survey (431 men total) limits our ability to provide results among all subgroups of interest within the overall population of gay and bisexual men. However, we note some areas where responses differ significantly for some broad categories, including white men compared to members of racial and ethnic minority groups, and younger men (ages 18-34) compared with those ages 35 and older.

Differences by race/ethnicity

• Gay and bisexual men of color are more likely than those who identify as white to say HIV/AIDS is a significant issue for them personally (64 percent versus 42 percent) and that they are personally concerned about becoming infected (53 percent versus 28 percent).
• Nearly half (46 percent) of gay and bisexual men overall say they use condoms all or most of the time, although about a quarter (24 percent) say they never use condoms. Men of color are more likely than white men to report consistent condom use (61 percent versus 39 percent).⁹
• While most gay and bisexual men believe they have all the information they need about an array of issues related to the transmission and prevention of HIV, men of color are more likely than white men to say they want more information on most topics.

Differences by age

• There is a large generational divide in the share saying someone close to them has died from HIV/AIDS. Nearly half (47 percent) of gay and bisexual men ages 35 and older say they have lost someone close to them to the disease, while just 8 percent of those ages 18-34 say the same. Older men are also somewhat more likely than younger men to say they know someone currently living with HIV (54 percent versus 39 percent).
• Younger gay and bisexual men are twice as likely as older men to say they have never been tested for HIV (44 percent of those under age 35 versus 21 percent of those ages 35 and over). ¹⁰
• Men under the age of 35 are more likely than those ages 35 and older to say they would be uncomfortable having both sexual and non-sexual relationships with someone who is HIV-positive.
• Men ages 35 and older are more likely to support widespread use of PrEP (64 percent say it should be used widely and 35 percent think it should be used on a more limited basis), while those under age 35 lean in the other direction (56 percent say it should be used on a more limited basis and 43 percent think it should be used as widely as possible).