HIV and College Campuses

1
HIV and College Campuses

• Peter A. Leone, MD
• Associate Professor of Medicine
• University of North Carolina
• Medical Director
• HIV/STD Prevention and Care Branch NCDHHS

2
Acknowledgement

• Lisa Hightow
• Justin Smith
• Andy Kaplan

3
African Americans as Percent of People Living
with AIDS Top 10 States, 2003
10 of top 10 in the South (U.S. percent 42.4)

• District of Columbia 81.5
• Maryland 79.7
• South Carolina 73.4
• Mississippi 71.9
• Georgia 69.7
• North Carolina 67.8
• Delaware 67.5
• Alabama 62.9
• Louisiana 62.4
• Virginia 58.7

Sources Centers for Disease Control and
Prevention, Division of HIV/AIDS
Prevention-Surveillance and Epidemiology, Special
Data Request, October 2004. Available at
www.StateHealthFacts.org
4
African Americans as Percent of Estimated AIDS
Prevalence, Incidence and Population by Region
AIDS Incidence
AIDS Prevalence
61
Population
55
48
49
48
45
43
44
19
19
17
12
11
10
5
United States
South
Northeast
Midwest
West
Notes U.S. total does not include dependencies,
possessions and associated nations AIDS
prevalence and incidence are 2003 estimates
population data are from 2000 and include only
people classified as Black or African American
alone. Sources U. S. Census Bureau, The Black
Population 2000, Centers for Disease Control and
Prevention, HIV/AIDS Surveillance Report, Vol.
15, 2004.
5
NC Persons Living with HIV as of December 31,
2005 - genderN18,900
6
New females reported with HIV disease in 2005 -
race/ethnicity N498
7
New females reported with HIV disease in 2005 -
mode of transmission N498
8
New males reported with HIV disease in 2005 -
race/ethnicity N1,308
9
New males reported with HIV disease in 2005 -
mode of transmission N1,308
10
Detection of Outbreak

• November 2002 NCs Screening Tracing Active
  Transmission (STAT) Program
• HIV RNA screening to all public VCT for detection
  of Ab-negative, acute HIV Infections
• Robotic Pooling
• Rapid notification/confirmatory testing
• Rapid tracing/prospective screening of partners
• Of 5 acute infections detected in lt3 months, 2
  were male students attending college in the same
  city.

Hightow et al, JAIDS, 2005
11
Study Design

• Retrospective review of state HIV surveillance
  records
• Men age 18-30
• January 1,2000-April 30, 2005
• All 100 NC counties
• Includes
• Counseling and testing site data
• DIS interview records

Hightow et al, JAIDS, 2005
12
Increasing Percentage of College Cases by Year of
Diagnosis
13
Network Diagram College Cases (n140)
14
Network Diagram Colleges
15
157 College Students
133 African American (84.7)
44 Male and female sex partners (33.1)
6 Female sex partners (4.5)
79 Male sex partners (59.4)
Hightow et al, JAIDS, 2005
16
Factors Associated with College

• College students more likely
• OR 95CI
• African American 3.19 1.99-5.15
• Diagnosed with recent infection 3.17 1.84-5.44
• Both male and female sex partners 3.03 2.01-4.57
• Report anonymous sex 1.52 1.06-2.19
• Meet sex partners in
• Gay bars/clubs 2.01 1.37-2.96
• Internet 5.76 3.81-8.70
• College campus 16.79 7.39-38.90

Hightow et al, JAIDS, 2005
17
Comparison of CTS data with DIS interviews

• 83/142 (58) college students with both CTS and
  DIS information
• 50 discrepant
• 20 not reporting MSM activity at time of
  testing

18
6 Separate Networks 17 schools 58 students 2
contacts
Hightow et al, STD, 2006
19
1 Connected Network 26 schools 95 students 8
contacts
Hightow et al, STD, 2006
20
(Strength Through Youth Livin
Empowered)Justin Smith
21
Project STYLE Team

• UNC Chapel Hill
• Lisa Hightow, MD, MPH Co-PI, clinic physician
• Peter Leone, MD Co-PI
• Justin Smith Project Coordinator
• Andre Brown Research Assistant
• Marcie Fisher-Borne, MSW, MPH Research Assistant
• Michael Scott Research Assistant

• North Carolina Central University
• David Jolly, DrPH co-investigator
• Jeffrey Love Outreach Worker
• Alliance of AIDS Services- Carolina
• Sebastian Battle Outreach Worker

22
Sexual activity affirms masculinity

• Historically I think that black men have felt
  emasculated by society, and being sexual and
  sexually active is a way of re-affirming your own
  masculinity and sometimes it moves into being
  promiscuous

23
Meaning of the word gay

• White dudes embracing in a public place.
  (31)
• Gay to me is a lifestyle. I guess gay is
  being free, you know careless meaning not
  caring how you act or the way you present
  yourself.(29)
• Flamboyancy. Theyre walking around with
  tight jeans on, switchin, head movin all around,
  nails painted, toes all done up. Actually, hes
  white. (23)
• Gay is not a positive word to me. It just
  doesnt ring positive when I hear Im gay. It
  just doesnt. (27)

24
Rejecting Gay Im just me

• I just live, ya know what I mean? I dont
  broadcast who I am - Even on the form I dont put
  down that I was gay, straight, bisexual. Im
  just me. Im just a person. There are so many
  other qualities about who I am that, thats just
  so incidental, you know what I mean? (39)

25
On Being a Black Man

• I would basically tell him that nowadays they
  look at us Black males as failures, just people
  out here gang-banging, drug dealers, robbers,
  killers and rapist and all that. So basically
  Id tell him its just proving people who think
  negative of you wrong, letting them know just
  because Im Black I aint gotta be like the
  others. I can make something of myself and help
  you and the others. (22)

26
Conflict between black and gay

• I think coming from the black community, youre
  supposed to have that strength, and that boldness
  about you, and I think they the black community
  think that being gay is a wimpy thing or being
  less than a man. I think thats why a lot of
  black men are in the closet, because the black
  community associates gay with being inferior.
  (34)

27
Conclusions

• HIV is an increasingly Black epidemic
• Many questions remain concerning Black MSM sexual
  identity
• The HIV epidemic has moved into our college
  population raising concerns about bridging
• Black women acquire HIV heterosexually with many
  contextual factors contributing to risk
• Homophobia, racism, poverty and the stigma of HIV
  all are contributing factors to the ongoing
  epidemic