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A study revealing an increasing number of HIV infections among black male college students in North Carolina has shocked researchers and educators concerned about the future of some of the "best and brightest" young African-Americans.
Though Georgia doesn't have much HIV data, the trend is likely occurring in the state, throughout the South and perhaps the nation, scientists say. The main cause, researchers say, is young black men having unprotected sex with other men --- even though many of them don't identify as gay and some have girlfriends, who often are put at risk without knowing it.
North Carolina, which initiated HIV reporting in 1990, started a method of detecting early HIV infections in 2002 for everyone who voluntarily gets tested at public clinics. The new approach led to the discovery in four years of data, released last month, of 84 newly infected male college students in the state, 73 of whom were black. The study found HIV infection rising among the male college students from six cases in 2000 to 19 in 2001, 29 in 2002 and 30 in 2003.
Of the black men, 67 said they had sex with men --- some of them traveling to Atlanta to meet men --- and 27 of them said they also had female partners.
North Carolina colleges --- especially the state's 11 historically black campuses --- have responded with "an explosion of activity," including more HIV testing, said Phyllis Gray of the North Carolina Department of Health and Human Services.
Students and the presidents of the 11 colleges have been invited to a gathering March 19-21 at North Carolina Central University in Durham to address the HIV issue.
In Atlanta, student leaders at predominantly black colleges said they weren't surprised by the findings. While well aware of risky sexual activity by their fellow students, they say they don't hear enough about preventing it.
"I can say without a doubt that it does happen in the AUC," said Desmond Drummer, a junior at Morehouse College, a school for men that is one of the traditionally black colleges of the Atlanta University Center. Drummer, who is straight, is president of a student public health association.
"Our school, with a significant homosexual population, doesn't want to face the facts," he said. "It's not something we are ready to deal with, but we need to." Anti-gay sentiment
Kendrick Long, a gay Morehouse student who is also a junior, is co-coordinator of Safe Space, a gay student group with two dozen members. He said most of the male students at Morehouse who have sex with men consider themselves "on the down low" --- a slang term meaning they conceal their sexual behavior behind an outwardly straight identity, largely because of anti-gay sentiment among many African-Americans.
"Most of them have boyfriends and girlfriends and are actively sexually involved with both," Long said. "But it's not talked about, and most of them don't consider the safety of the female."
The North Carolina study is "shocking," said Tola Thompson, spokesman for the National Association for Equal Opportunity in Higher Education, which represents 120 historically black colleges and universities.
"It was an exclamation point at the end of the sentence confirming what we'd already suspected," he said. "The best and brightest in our community must be preserved to further the effort of the black community." Findings indicate trend
Georgia didn't start tracking HIV diagnoses until this year --- gathering data on AIDS cases instead --- so state health officials don't know how prevalent HIV is among any group, said Dr. Luke Shouse of the Georgia Division of Public Health. But black men who have sex with men account for 22 percent of the state's cumulative cases of full-blown AIDS, Shouse said.
That figure, which has been rising, is probably an underestimate because many black men don't acknowledge having sex with men, Shouse said.
"We suspect that the same thing is happening in Georgia, but we don't have surveillance data to prove it," Shouse said of the North Carolina findings.
North Carolina health officials say the numbers probably capture only a fraction of the real scope of HIV among all college students, including black men, because many people don't get tested or get tested in other cities, or are not identified in tests as college students. But the study is the first to point out that some young men contracting HIV are college students, training to be tomorrow's leaders.
"It was alarming," said Dr. Peter Leone, medical director of the HIV/STD Prevention and Care Branch of the North Carolina Department of Health and Human Services, who led the study. "This could have a devastating impact on the black community."
Across the country, the disproportionately high rates of HIV and AIDS among African-American men and women has gained attention in recent years, as public consciousness has begun to shift away from AIDS being thought of as primarily a gay white man's disease. Breaking the silence
Today, blacks make up 12 percent of the national population, but they account for 39 percent of AIDS cases and 54 percent of new HIV infections. Black men are nine times more likely than white men to get AIDS; black women are 23 times more likely than white women. And blacks die from the disease more quickly than whites.
While the statistics speak loudly, the leading cause of HIV among black men --- risky sex with other men --- is often reduced to a whisper.
The silence lingers despite increasingly alarming data: A Centers for Disease Control and Prevention study in 2001 found significant racial differences in HIV rates among men ages 23-29 who have sex with men. In the six cities studied --- Baltimore, Dallas, Los Angeles, Miami, New York City and Seattle --- 30 percent of the black men tested had HIV, compared to 15 percent for Hispanics and 7 percent for whites. Students concerned
In Atlanta, college officials have had mixed reactions to the North Carolina findings and the HIV issue in general.
Morehouse spokeswoman Elise Durham said nobody at the college would discuss the topic. The director of Morehouse's student health center did not return phone calls.
Dr. Daniel Blumenthal, chairman of community health and preventive medicine at the Morehouse School of Medicine, a separate institution, said the medical school has held HIV education sessions with African-American women in southeast Atlanta and plans to do the same with black men. The rise of HIV among blacks, especially college students, "is a cause for concern," Blumenthal said.
At Spelman College, a predominantly black women's school, HIV education is included in first-year orientation sessions, said Brenda Dalton, director of student health services. The issue of men having sex with men and also with women "is very much a real concern," Dalton said. "It is happening not only on this campus but on a number of campuses."
Dalton said a female student recently told her that she was getting involved with a man, but she insisted that he first bring her proof that he was HIV-negative. "I thought, 'Good for you,' " Dalton said. "That may be the trend that we will be seeing."
Erin Bradley, a Spelman junior who organizes discussions about safe sex and condoms in dorms, recalled a talk by an AIDS advocate to a large group of Spelman women two years ago. When the speaker mentioned men who have girlfriends but also have sex with men, "there were gasps all over the room," she said, "especially with Morehouse right across the way."
Bradley said Spelman students seem more aware today that boyfriends could potentially put them at risk for HIV.
"It is a huge, huge, huge concern," Bradley said. "But it's a difficult matter to discuss because it brings up homosexuality, and that opens a whole can of worms."
It's not just black colleges that are affected. More than half of North Carolina's HIV cases among male black college students involved students at mainstream campuses.
At Georgia State University, the administration sponsors several efforts aimed at preventing HIV and other sexually transmitted diseases, but no program specifically targets black students, said Becky Laurens, director of the student health clinic. A black student group recently held an HIV education and testing session, she said. Some resistance
The HIV issue is often met with resistance, especially on black campuses, because black churches wield a lot of influence and because many parents don't want colleges talking to students about sex, said Thompson, of the National Association for Equal Opportunity in Higher Education.
The association launched a "Stop the Silence" campaign a year and a half ago to encourage discussion of HIV, adding a Web site late last year.
"We've had our heads in a hole in the ground," Thompson said. "We need to talk about it."
HIV prevention workers say other factors also affect black college students.
Kevin Bynes, who directs an outreach program for young African-American men at AID Atlanta --- a nonprofit organization that focuses on AIDS treatment and prevention --- said many first-year students at Atlanta black colleges mistakenly believe condoms aren't useful in protecting against HIV because they can leak. Bynes attributes that belief to abstinence-only education programs in high schools.
"It's the conservative South's obsession with abstinence-only education for high school students that's driving this epidemic," Bynes said. "Kids aren't prepared for their freedom once they get to campus." Risky behavior
The CDC, which calls abstinence and monogamy the "surest way" to avoid sexually transmitted diseases, says condoms are "highly effective" in preventing HIV transmission when used consistently and correctly.
Another issue is that men who don't use condoms early on with their girlfriends may be reluctant to start using them after they begin having sex with men or learn they have HIV.
"He can't suddenly say to her, 'Let's put on a condom.' She'll wonder why," said Ronnie Bass, executive director of Someone Cares, an AIDS awareness agency in Smyrna that targets African-American men.
Greg Smith, with the AIDS Survival Project in Atlanta, said the beating of a student at Morehouse a year and a half ago illustrates another obstacle: a hostile environment for gay men on campus, including those who might have HIV.
In the incident, a student attacked another with a baseball bat in a dorm shower after claiming the man had stared at him. The victim underwent surgery for a blood clot on the brain and recovered, but he has a scar from his hairline to his ear.
"Is that a safe environment for a person who may become infected? The reality is no," Smith said. Message ignored
Dr. Lisa Fitzpatrick, director of the CDC's HIV/AIDS Research Initiative, who assisted with the North Carolina research, said many black people still view HIV as a white gay man's concern. "If they see a billboard or an ad on TV, the message doesn't resonate with them," she said.
Fitzpatrick said several of the colleges in North Carolina where the HIV cases were discovered were upset that researchers were bringing attention to the issue, saying it stigmatized them.
But the only way to solve the problem is to acknowledge it --- a challenge made more difficult because of a lack of adequate federal funding for HIV prevention, Fitzpatrick said.
"We're very concerned that this is not unique to North Carolina," she said. "This needs to be addressed throughout the South, and probably throughout the country."
Copyright 2004 The Atlanta Journal-Constitution