Black Men in Focus in U.S. HIV Drug Trial
by Matthew Bigg
Much of the early AIDS research in the United States focused on gay white men because they were the first group affected and subsequently developed an effective lobbying voice. Now a clinical trial by the AIDS Research Consortium of Atlanta is focusing on gay black men, who are not as well organized but who have a higher incidence of the disease. The trial aims to determine whether an AIDS drug is safe for people who are negative for HIV, the virus that causes AIDS. It has stirred debate among participants and researchers about gay sexuality within the black community and its attitude to safe sex. "The black gay community has become complacent about HIV and STDs (sexually transmitted diseases) as a whole," said Duncan Teague, recruitment coordinator for the project. "A lot of people in the black gay community are looking for love so they have sex because they think that means that that person loves them," Teague said. Blacks make up around 12.8 percent of the U.S. population but comprised 50 percent of new diagnoses of HIV in 2003, according to data from the Centers for Disease Control and Prevention and the U.S. Census Bureau.
In Georgia, 78 percent of people diagnosed with AIDS and 81 percent of people diagnosed with HIV infection in 2005 were black, as were almost all of the women who were newly diagnosed, said Melanie Thompson, the trial's lead investigator.
"African-American men are disproportionately affected by HIV and underrepresented in clinical trials. We are testing in order to know whether a drug is safe for the people who will ultimately use the drug," she said.
"While the study is open to men of any race, we are working hard to enroll as many men of color as possible," she said.
The trial involves giving daily doses of the drug tenofovir, an antiretroviral drug made by Gilead Sciences Inc. and marketed as Viread.
Participants, who could also be given a placebo, complete a computerized questionnaire about their sex lives and get risk-reduction counseling and condoms at every visit.
Half the group won't receive the drug for the first nine months to see if taking a pill that might potentially make them less likely to contract HIV might encourage men to take more risks with sexual health.
It's part of a long-term project that includes similar studies in Botswana, Thailand and elsewhere to determine if a drug that suppresses the AIDS virus could one day be used to prevent people from contracting it.
Researchers said one reason for the reluctance of blacks to participate in the study is the legacy of the notorious 40-year-long Tuskegee experiment, which was exposed in 1972 and led to an apology by President Bill Clinton on behalf of the government to the victims.
In that experiment, the U.S. Public Health Service starting in 1932 told 400 blacks with syphilis in Alabama they had "bad blood," leaving the syphilis untreated to study its long-term effects on the body.
Some 43 percent of men enrolled in the AIDS drug study are black, but many others were reluctant to take part because of misunderstandings about what the study entails and fear within the black community about clinical trials, Thompson said.
"My first question was 'Wait, are you going to inject me with the HIV virus?,'" said Dorrington Poitier, who is now taking part.
Atlanta is considered by some the gay capital of black America and gays organize an annual gay black pride festival on the Labor Day weekend.
Despite the large numbers of at-risk men, researchers said lack of organization within the gay black community had made it harder to promote awareness and mobilize against AIDS, which has also killed some community leaders.
"AIDS has sucked so much energy out of the community. The leaders started dropping dead, started getting sick. And we have been trying to replace them but against the odds," Teague said.
Another underlying reason for the prevalence of HIV infection is the stigma still attached to homosexuality within some parts of the black community, which leaves some gay men vulnerable to social isolation that makes poor choices about sex easier.
"People within the black community say: 'It's fine to be gay but...don't wear it on your sleeve. They see black as something you can't really hide but they don't want you to be gay in public," said Anthony McWilliams, a project organizer.