HIV infection among younger gays have shot up in New York city though overall infection rates declined in the last five years.
The trend is particularly noticeable among blacks and Hispanics under 30, according to figures from the city's Department of Health and Mental Hygiene.
The annual number of new infections among black and Hispanic men who have sex with men rose 34 percent between 2001 and 2006, and rose for all men under 30 who have sex with men by 32 percent, points out SARAH KERSHAW, writing in the New York Times.
At a time when the number of new cases among older gay men is dropping — by 22 percent in New York City during the same period — AIDS experts are bearing down on what they say is a worrisome and perplexing growth of H.I.V. infection among young men.
So far, they say, the significant factors feeding the trend appear to be higher rates of drug use among younger men, which can fuel dangerous sex practices, optimism among them that AIDS can be readily treated, and a growing stigma about H.I.V. among gays that keeps some men from revealing that they are infected. There has also been a substantial increase in the number of new infection cases among young white men who have sex with men, but still that group had fewer new cases in 2006: 100, compared with 228 among blacks and 165 among Hispanics.
The rising rates for young men in New York City come as federal health officials acknowledge that infection rates nationwide, while flat, may be substantially higher than previously thought because of underreporting.
The highest rates of H.I.V. infection nationally are among gays, blacks and Hispanics, with a recent trend toward a younger infected population mirroring New York City's experience, according to AIDS researchers, who say they are concerned that the country's infection rates over all have not declined in the past 10 years.
AIDS activists and medical providers say the rates among young men could signal a new wave of the disease.
"Unless you start pulling it apart, unless you start looking at really addressing this and talking honestly, unless you start talking about it in a real way," said Soraya Elcock, deputy director for policy at Harlem United Community Aids Center, in a neighborhood that has one of the highest infection rates in the city, "we'll be here in another 20 years having the same conversation."
As a young, black gay man, Lynonell Edmonds says it seems like a miracle that he has not contracted the AIDS virus. Before he turned 20, he had a haunting realization: in his group of 20 close gay friends, he was the only one without H.I.V.
Mr. Edmonds, now 25, does outreach work for the Harlem AIDS center, trolling Craigslist and other online meeting spots as a "sexpert," encouraging men to be tested
Edmonds said that for many gay black men there is a sense that getting the virus is almost inevitable.
"A lot of guys say, 'I'm going to get it anyway,'" Mr. Edmonds said.
Kyle, who found out that he had the virus two years ago, at the age of 23, said he had grown weary of what he called "pity dates," men who agreed to go out with him after he revealed he was infected, but had no intention of pursuing a relationship. He said that out of about 10 men he had dated in the last two years, only one — who was, at 40, the oldest — was willing to go beyond pity dates.
He said he was infected by someone who did not reveal that he had the virus until after they had unprotected sex.
As the face of the epidemic grows younger, city health officials acknowledge that their efforts — including a widespread condom distribution program, new investments in education programs at places including churches, and more availability of H.I.V. testing — are falling short.
The city, which has the highest number of AIDS cases in the nation, about 100,000, and one of the highest H.I.V. infection rates, according to the health department, has made great strides in bringing down H.I.V. rates among intravenous drug users and pregnant women. The department, which is giving out three million condoms a month in a program begun last year, has also recently announced several efforts to expand rapid testing, which provides results within a day.
The city's health commissioner, Thomas R. Frieden
, said in an interview that the increasing rates among younger men was being driven by stubbornly high rates of substance abuse, involving drugs like crystal methamphetamine and cocaine, which not only reduce inhibitions but can also lead to "hypersexuality": extended periods of sexual activity, potentially with multiple partners.
"People who grew up watching their friends die of AIDS are a lot more careful than those who didn't," said Dr. Frieden, who said he cared for large numbers of AIDS patients in his earlier medical practice.
He said the department was planning to begin a new H.I.V. prevention campaign aimed at younger men, and a new marketing strategy for their condom campaign later this year.
Health officials said they were concerned about the growing number of patients receiving concurrent diagnoses of both H.I.V. and AIDS, after waiting too long to be tested. And while some policymakers say more aggressive testing could partly explain the higher infection rates, experts say one in four people with H.I.V. do not know they are infected, so the actual rates could be much higher.