# Presentation: 310092

## 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

## Acknowledgement

- Lisa Hightow
- Justin Smith
- Andy Kaplan

## African Americans as Percent of People Living with AIDS:  Top 10 States, 2003

- 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%*

_**10 of top 10 in the South**_
**(U.S. percent = 42.4%)**

- 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](http://www.statehealthfacts.org/)_

## African Americans as Percent of Estimated AIDS Prevalence, Incidence and Population by Region

- 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.

- United States

- South

**Northeast**

**Midwest**

**West**

**AIDS Incidence**

**AIDS Prevalence**

- Population

**48%**

**43%**

**12%**

**61%**

**55%**

**19%**

**49%**

**45%**

**11%**

**48%**

**44%**

**10%**

**19%**

**17%**

**5%**

## NC Persons Living with HIV as of December 31, 2005 - genderN=18,900

## New females reported with HIV disease in 2005 - race/ethnicity N=498

## New females reported with HIV disease in 2005 - mode of transmission N=498

## New males reported with HIV disease in 2005 - race/ethnicity N=1,308

## New males reported with HIV disease in 2005 - mode of transmission N=1,308

## Detection of Outbreak

**November 2002: ****NC’s 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 <3 months, 2 were male students attending college in the same city. **

**Hightow et al, JAIDS, 2005**

## 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**

## Increasing Percentage of College Cases by Year of Diagnosis

## Network Diagram: College Cases (n=140)

## Network Diagram: Colleges

## 157 College Students

**133 African American**
**(84.7%)**

**6 Female sex partners**
**(4.5%)**

**79 Male sex partners**
**(59.4%)**

**44 Male and female **
**sex partners**
**(33.1%)**

**Hightow et al, JAIDS, 2005**

## Factors Associated with College

**College students more likely......**
- 				_**OR**_**	****	**_**95%CI**_
**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**

## 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

| CTS | DIS | No. |
| --- | --- | --- |
| Male | Male | 26 |
| Female | Female | 4 |
| Both | Both | 13 |
| Male | Both | 7 |
| Male | Female | 1 |
| Both | Male | 15 |
| Both | Female | 0 |
| Both  | Unknown | 1 |
| Female | Both | 7 |
| Female | Male | 4 |
| None | Male | 4 |
| None | Both | 1 |

## 6 Separate Networks

**6 Separate Networks**
**17 schools**
**58 students**
**2 contacts**

**Hightow et al, STD, 2006**

## Hightow et al, STD, 2006

**1 Connected Network**
**26 schools**
**95 students**
**8 contacts**

**Hightow et al, STD, 2006**

## (Strength Through Youth Livin’ Empowered)Justin Smith

## 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

## 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”

**Notes:**
This quote speaks to how sexual activity is used to affirm masculinity systematically stripped from black men by 
The predominant culture:

## 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. They’re walking around with tight jeans on, switchin, head movin’ all around, nails painted, toes all done up. Actually, he’s white.” (23)
-    “Gay is not a positive word to me. It just doesn’t ring positive when I hear ‘I’m gay.’ It just doesn’t.” (27)

## Rejecting “Gay” – “I’m just me”

-    “I just live, ya know what I mean? I don’t broadcast who I am - Even on the form I don’t put down that I was gay, straight, bisexual.  I’m just me.  I’m just a person. There are so many other qualities about who I am that, that’s just so incidental, you know what I mean?” (39)

## 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 I’d tell him it’s just proving people who think negative of you wrong, letting them know just because I’m Black I ain’t gotta be like the others.  I can make something of myself and help you and the others.” (22)

## Conflict between black and “gay”

- “I think coming from the black community, you’re 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 that’s why a lot of black men are in the closet, because the black community associates gay with being inferior.” (34)

## 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