I continue to hear rumors that newly diagnosed cases of HIV among young men are not abating in 2010, and I continue to not see much of a response from the government regarding this increase. I don’t think anyone has answers about how to solve this problem, and that’s ok. It’s the lack of effort to try to find solutions that really bothers me. Anyway, here’s what ran in the strib:

As Pride weekend arrives once again, we remember the shocking news that came out of last year: The Hennepin County Public Health Clinic identified six new HIV-positive people, five of whom were under 30. This was a number that hadn’t been seen in years.

A few months later, the Minnesota Department of Health (MDH) issued a startling letter to service providers identifying a large increase in newly diagnosed HIV cases, with a bulk of them in the metro area. MDH then released preliminary 2009 data to much media fanfare.

HIV in men under 25 increased 83 percent in the last year and 300 percent since 2001, to a level not seen since 1986.

The story came and went.

Locally, Hennepin County’s Ryan White Program answered this startling news by organizing just a few sparsely attended youth events.

Its use of this dated and financially wasteful tactic was against the strong and early advice from those of us who work within these affected communities. MDH points to the Internet as a cause of the increase in HIV, yet none of this funding was spent online.

Now we’re back to the same HIV-prevention activities from the past decade; politically safe and of apparent decreasing effectiveness. Yet, with few exceptions, HIV-prevention activities have yet to truly utilize the Internet.

So what’s the impact? In the last five years, 222 young men have been infected with HIV in Minnesota. This is 132 young men beyond our endemic 2001 levels. It translates to $137 million dollars in lifetime medical costs, much of which will be paid for by state and federal programs.

For every $1 spent on HIV prevention, $7 are saved in future medical costs. It is imperative from both a fiscal and humanitarian standpoint that we take immediate action.

Increased funding alone is not going to solve this problem. Rather, we need to support new and innovative ideas, critically reevaluate our current prevention activities, support culturally competent partner services staff and meet youths where they are. That’s something that the governmental leadership in the HIV community has refused to do.

It’s time to talk prevention in the 21st century. It’s time to stop playing politics on the backs of our youth. And it’s time for new leadership.

CURT PRINS AND JOHN SCHROM

Prins is executive director of District 202, a Minneapolis-based organization for gay, lesbian, bisexual and transgender youths. Schrom is a member of the Minnesota HIV Services Planning Council.

Someone at the summit made a comment to the effect of, “if we only knew sooner, we could have done more.” This got me thinking… how could we have not known?

I went to the Minnesota AIDS Project’s (MAP) annual reports. It seems that we’ve known about this for quite a while, but weren’t able to effectively address it. Pointing fingers doesn’t do any good (i.e., it’s not just a MAP or MDH failure) … but this is, nonetheless, disappointing and deeply concerning.

2004:
“Over two-thirds of the new [syphilis] cases were among gay and bisexual men, with nearly one-half of these cases involving co-infection with HIV. These patterns raise concerns about a potential surge in new HIV infections among gay and bisexual men.”

2005:
“Also, over the past three years, there has been a gradual increase in the rate of infections among young people age 13 to 24, with 17 percent of new infections in 2005 reported in this group.”

2006:
“[...] an alarming growth in infections among minority women and young people, MAP’s challenges in prevention, education, and services have expanded exponentially.”

2007:
“Disturbing increase in young gay and bisexual men.
There has been a steady increase in new cases occurring within the population of young gay and bisexual men (under the age of 24) since 2001. Of newly reported cases of HIV in 2007, 15 percent occurred in young men ages 13–24. In 2005–2007, virtually all of these cases (98 percent) are estimated to have male-to-male sex as their risk.”

2008:
“RAPID INCREASE IN YOUNG GAY & BISEXUAL MEN
Since 2001, there has been a steady increase in new cases occurring within the population of young gay and bisexual men (under the age of 24). In 2008, there was approximately double the number of newly reported cases in this demographic as compared to 2001 reports. For the 117 young men who tested HIV-positive during the three year period of 2006—2008, all of the young men, who reported risk, indicated same sex contact.”

I think one of the major adaptations is going to be moving towards user generated prevention. This is beneficial for three reasons: the population is most adept at communicating with each other (i.e., 16 year olds speak “teenager” better than most 40 year olds), there’s an innate prevention activity in developing the message, and these types of media campaigns can be dirt cheap.

There are a couple of agencies that are already doing this. The Minnesota Organization on Adolescent Pregnancy, Prevention & Parenting is having a video contest (PDF) regarding general adolescent health. MTV and funny or die recently had a crazy sex advice contest called Say What. The Minnesota AIDS Project/Pride Alive is collecting 10,000 messages, and trying to distribute them to 1,000,000 people. And, of course, Hennepin County and MDH are moving forward on a video contest (it technically ended, but stay tuned for a few announcements).

I think this is the right way to move. We’ve been living in a Web 2.0 world for half a decade, and we’re all getting used to sharing everything we’re thinking and telling other people what we think about what they’re thinking (this would be a good time to encourage you to follow me on twitter…). So, it seems logical that young adults should want to have input into what messages they think are appropriate, and what HIV prevention strategies they think are reasonable.

So, since these contests seem to be a good idea, I want to ensure we’re doing this appropriately… it sometimes feels like these contests are being run by people that aren’t familiar with technology or social media. Submissions should be made online — having to email someone is just annoying. Ideally, a website should post submissions for ranking and comments by other users, as this would fully capitalize on the potential of internet technologies. Campaigns need to be appropriately incentivized; just because YouTube is free, doesn’t mean a $20 gift card is sufficient. Don’t be too restrictive or too quick to censor. The most effective messages may make you squirm:

So despite my few critiques, I’m hopeful this style of health promotion is effective and am excited about what kinds of messages will be generated!

We received an epidemiology update, with additional information from the disease investigator (DI) interviews. The DIs managed to interview about 50% of newly diagnosed cases to obtain additional information about risk factors relating to their infection and recent partners. I’m not sure if that’s a high/low/average rate, and we certainly don’t know if the responding population was different than the non-responders (e.g., were non-responders at higher risk than the responders?).

Minnesota saw 35 more cases of newly diagnosed YMSM in 2009 compared to 2008. That increase was driven largely by African American and white youth. About 20% report only having sex with one person in the last year or since their last negative (whichever is shorter?), and about 50% report having sex with 3-4 in that time period. Approximately 20% of young men had sex with BOTH men and women during that time period. 64% reported anonymous sex, 30% reported meeting partners online, ~60% report infrequent condom use, 13% report non-injection drug use (mostly marijuana, some meth), and 25% report alcohol use.

Additionally, MDH and Hennepin County put together a couple of small focus groups for HIV+ and college-aged guys. I’ll eventually post the results of the focus groups, but there were a couple of comments that stuck out to me:
“People are dying with HIV, not from it. Honestly I couldn’t care less if I keeled over and died tomorrow, I’ve had a fun run, people have nine lives… and I’m running out.”
“HIV meds or car payment — good campaign message.”
“When you’re 5 years old you start to experiment too, it’s just human sexuality. We’re here to procreate or to get off basically.”
“A lot of people don’t want to hear about [HIV] and right now a big trend is barebacking.”
“A lot of younger people are sluts.”
“I never had unprotected sex and just recently got really drunk and got date raped and am now poz.”

I don’t think any of this information is earth-shattering. However, it does provide a little data around the situation we’re in. We spent the remainder of the day listening to speeches and breakout panels. Ultimately, it was a good day for networking, but there weren’t many (any?) concrete next steps. Personally, I’m still trying to process the conversations that I had yesterday, and am waiting for clear direction and need to emerge. Any guidance or thoughts would be greatly appreciated…

In response to this spike in incidence, the Department of Health, Department of Human Services (Ryan White Part B Grantee), and Hennepin County (Ryan White Part A Grantee) brought together a group to start raising awareness around this issue and start thinking about new solutions. This group, which I am a part of, has been meeting since November in preparation for a series of events happening at the end of February (not coincidentally the end of Part A’s fiscal year). This includes YMSM focus groups, a provider summit (open to all youth workers), and a youth PSA contest.

Obviously, this increase has been all over the blogs and newspapers in the past weeks. The response from many providers has been: youth like risky behavior, the interwebs gives you AIDS, and USE CONDOMS DAMMIT. Maybe I’m being a little overdramatic.

My point is that I don’t think this is a productive conversation. Adolescents are risky, but not necessarily intentionally so. I doubt any 17 year old is thinking, “if I have sex tonight, I might get HIV … that’s so risky.” No, they’re thinking, “Gee golly, that’s a really hot person that I’d like to touch inappropriately.” The internet doesn’t promote unsafe sex, it provides a medium for people to pursue something they’re pursuing anyway. This goes both ways — there are dating-oriented websites that connect people who may not have otherwise met.

And then there’s condoms. Yes, they’re effective, but they’re only effective if they’re being consistently used. The problem is that it’s really hard to tell a teenager that they need to use condoms for the rest of their life. We can put millions of dollars into education and advertising, but it doesn’t make it any easier to carry out.

I don’t have the solution, but I know we have a problem. We can’t blame the internet for this increase, we can’t blame the youth, and we can’t expect condoms to continue to be the solution. We, as a society, need to figure out a reasonable, life-long prevention plan for not just gay/bi men, but for everyone. I really wish I had a magical answer for this one…

I couldn’t find much about the DigMe program in particular, but here’s the video from the U:

“It takes the sting out of potential failure. ‘I feel like, Even if I do poorly here on this test or in school, I am still fundamentally a good person. It anchors my sense of self-integrity.’”

Another study released last week suggests that Facebook users have lower grades than non-users. Although the researcher admitted to Time that it could be bad students are attracted to Facebook:

“Maybe [Facebook users] are just prone to distraction. Maybe they are just procrastinators.”

With any study, remember that correlation does not imply causation — just because depressed youth watch more TV doesn’t mean TV causes the depression. This is acknowledged in the news article by a psychologist not associated with the study:

“A warning sign would be a teen who doesn’t seem to enjoy doing anything else. A teen who watches a lot of TV, but is also on the football team or belongs to clubs, they may just be using the TV to relax and enjoy some down time.”

This doesn’t invalidate the study. The psychologist is right: TV usage, combined with other factors, might make for a quick screen for depression. My problem regarding this article lies with the conclusions (”red flags”) noted in the article:

Is your teen interested in socializing with others? Be concerned if he doesn’t want to do anything other than watch TV or get on the computer.

Watch for other signs of depression: changes in sleep habits, significant weight gain or weight loss, irritability, pessimism, indifference.

There’s a significant chunk of the youth population that primarily utilizes the computer to socialize with people. Their parents may truly not understand this, and perceive them to not be “socializing” as they aren’t playing sports or musical instruments. I think one of the biggest differences between this generation and their parent’s generation is the use of technology — the kids that used to be ostracized by their peers can now find friends on the internet. Those friendships are just as valuable and rewarding as the relationships established in “real life.” To downplay the importance of this, and completely write these youth off as being “depressed” is unfortunate. After all, the time I spent on the computer growing up has helped me network, gain skills, and get jobs, while I haven’t touched my clarinet since middle school.

And about those symptoms of depression: find me a teen that isn’t irritable, pessimistic, or indifferent, and I’ll show you a youth who hasn’t hit puberty yet.