The AIDS epidemic in America is rapidly becoming concentrated among poor, young black and Hispanic men who have sex with men.
Alex, 20, says, “I have three strikes against me: I’m black, I’m gay, and I’m in a wheelchair.”
Despite years of progress in preventing and treating H.I.V. in the middle class, the number of new infections nationwide remains stubbornly stuck at 50,000 a year — more and more of them in these men, who make up less than 1 percent of the population.
Giselle, a homeless 23-year-old transgender woman with cafe-au-lait skin, could be called the new face of the epidemic.
“I tested positive about a year ago,” said Giselle, who was born male but now has a girlish hair spout, wears a T-shirt tight across a feminine chest and identifies herself as a woman. “I don’t know how, exactly. I was homeless. I was escorting. I’ve been raped.”
“Yes, I use condoms,” she added. “But I’m not going to lie. I slip sometimes. Trust me — everyone here who says, ‘I always use condoms’? They don’t always.”
Besides transgender people like Giselle, the affected group includes men who are openly gay, secretly gay or bisexual, and those who consider themselves heterosexual but have had sex with men, willingly or unwillingly, in shelters or prison or for money. (Most of those interviewed for this article spoke on the condition that only their first names be used.)
Nationally, 25 percent of new infections are in black and Hispanic men, and in New York City it is 45 percent, according to the Centers for Disease Control and Prevention and the city’s health department.
Nationally, when only men under 25 infected through gay sex are counted, 80 percent are black or Hispanic — even though they engage in less high-risk behavior than their white peers.
The prospects for change look grim. Critics say little is being done to save this group, and none of it with any great urgency.
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