Young men of color who have sex with other men are most at risk for HIV and AIDS and account for more new sexually transmitted infections than any other gay and bisexual subgroup in the East Bay, according to Alta Bates Summit’s East Bay AIDS Center.
Within Alameda County, HIV infection rates are consistently highest for people living in Oakland, Berkeley, San Leandro and Hayward.
“This is a really big deal,” said Dr. Jeffrey Burack, co-medical director of East Bay AIDS Center. “It’s particularly worrisome because rates have gone up sharply amongst young people, which really bodes poorly for the future.”
According to the Alameda County Comprehensive HIV Prevention Plan, nearly 70 percent of people with HIV in Alameda County were persons of color as of 2013. From 2010 to 2012, almost two-thirds of new HIV diagnoses were among young people ages 13-29, 87 percent of whom were persons of color. Within that age group, men who have sex with men made up 81 percent of the diagnoses.
To combat the problem, EBAC founded the CRUSH Project — Connecting Resources for Urban Sexual Health — to provide sexual health services for high-risk, young East Bay residents who do not have HIV. Funded by a $6 million grant from the California HIV/AIDS Research Program, the project has been operating for more than a year and has roughly 120 participants enrolled. It is tailored to young men of color age 18-29 who have sex with men. This population is not only the greatest at-risk for HIV infection within Alameda County, but it is the most underreached.
Since the late 1990s, an EBAC program called the Downtown Youth Project has provided sexual health services and counseling for HIV-positive youths, but before CRUSH, none had existed for uninfected young people. As a result, the program is focused not only on providing treatment and services but on studying how best to reach this population and link them to available resources.
Before CRUSH, “nobody knew how to effectively deliver HIV-prevention services to this particular population,” said Burack, the principle investigator for CRUSH.
It’s not uncommon for young men of color to go untested, and many of CRUSH’s participants had never been tested for HIV or other sexually transmitted infections before visiting the program. In fact, at least 20 percent of people with HIV aren’t aware that they are infected, according to the National HIV/AIDS Strategy.
“It’s alarming,” said Anthony Lucas, CRUSH’s linkage and outreach coordinator. “Obviously, we’re identifying a need.”
In addition to sexual health education and free testing, the program offers access to two revolutionary HIV-prevention medications: Truvada reduces the risk of HIV infection, and Stribild is an emergency post-exposure pill to suppress HIV infection. Although both medications can be obtained through primary care doctors, they are available at no cost through CRUSH for eligible persons. Preliminary data from CRUSH has also shown that those enrolled in the program are more likely to regularly take Truvada than those doing so on their own.
Given these prevention tools, HIV infection rates should not be on the rise, Burack said, but due to the lack of education and awareness they are.
“It’s not on the public consciousness,” Burack said. “Young people, in particular, don’t know that they should be scared of it for that reason.”
Andre San-Chez, a 26-year-old participant in CRUSH who takes Truvada, learned about the drug two years ago through an advertisement at a bar in Texas. But there are still many people, including his friends, who don’t know that the medication exists. “It’s a shame,” he said. “If it’s something that can help in protecting you, I feel like it should be more widely known.”
According to Burack, there are even some doctors who don’t know about the drug.
CRUSH believes that the key to filling this information lag and reducing HIV-infection rates is better communication and more outreach. Instead of passively handing out fliers, Lucas visits neighborhoods on a regular basis and meets with young men in person. CRUSH patients are encouraged to tell their friends and acquaintances about the program and to share information about Truvada and other prevention tools through their social network sites.
So far, the numbers have been encouraging. CRUSH has enrolled more than a quarter of its goal in only nine months. “Our project has been very successful,” Lucas said. “There’s something good happening right now.”
For more information about CRUSH, call 510-863-0021 or go to www.crush510.org. The CRUSH clinic is at 3100 Summit Street in Oakland.
