Most People with HIV are Straight

Don’t believe me? Fine, but don’t shoot the messenger

What? But isn’t there a connection? Aren’t people who say gay men aren’t to blame for AIDS just being politically correct?

I write about HIV a lot. I used to be a professional HIV educator. I’m more than just casually familiar with the world-wide epidemic. I originally wrote this article for Quora.com in response to a series of hostile queeries I received a few months into a period of about a year taking questions about HIV testing, treatment, and public health strategies.

None of my writing gets a more hostile response than my pieces in which I point out that HIV is overwhelmingly transmitted by straight people having vanilla vaginal sex.

So, what’s the deal? Everybody knows HIV is a gay disease. Right?

Wrong.

Look, I’m not aware of anybody who rejects the premise that gay men can become infected with HIV if they have sex with other men who are infected with HIV.

In fact, gay men with AIDS is how HIV infection first came to public attention in the United States and Europe.

Worldwide, however, HIV is primarily transmitted by vaginal sex. A very large majority of people in the world with HIV became infected by heterosexual transmission.

For example, in large parts of sub-saharan Africa, HIV prevalence ranges from 10% to more than 25% of the adult population.[1] Almost all of those infections are attributable to penis/vagina sexual transmission.

In the United States, HIV prevalence falls somewhere around only 0.3%. While a majority of the people infected are gay men, the numbers are tiny compared to places where the epidemic is raging.

That’s prevalence. What about total numbers of people living with HIV?

Sub-saharan Africa: 25.5 million people.

US and western Europe: 2.1 million.[2]

Even if every case of HIV in the US and western Europe resulted from men having sex with men, then the overwhelmingly heterosexual epidemic in Africa still accounts for over 10 times more cases.

Additionally, in the United States and Europe combined, there were 72,000 new HIV infections in 2016, with something like 80% of them probably the result of men having sex with men.

In Africa, there were over 1.2 million new HIV infections, almost all of them resulting from men having sex with women.

So, if somebody were to tell you that the HIV epidemic is mostly not about gay men, they’d be entirely correct. Overwhelmingly correct.

If they were to tell you there was no connection at all, they’d be wrong.

HIV is a virus.

It doesn’t care about your sexual orientation.

The reason that it took off in gay male populations in the US and Europe is that nobody knew it was happening. Gay male populations were centralized, dense, and insular. Once HIV got established, it was like the flu raging through a school. Except it took more than ten years for people to know they had it, during which time they could continue to pass it on.

Imagine. Really think about it. Ten years is a very long time.

That’s not happening anymore.

New HIV infections among gay men have plunged to very low levels in most populations, to negligible levels in many places.

Some at-risk populations still suffer disproportionately, but the effect in the US is much more correlated to socioeconomic status than to sexual orientation.

For example, young black gay men still get HIV at elevated rates compared to young white gay men, among whom HIV infection has become exceedingly rare.

The difference is probably tied more to access to health care than anything else. There’s also reason to believe that higher levels of homophobia in black communities in the US lead many young men to lead secret lives, which leave them vulnerable to infection due to lack of information, education, and peer support.

Loudly blaming gay men for HIV isn’t going to get you anywhere.

If anything, you may help perpetuate the problem by fostering shame and secrecy.

Stigma.

HIV will end when we can get everyone routinely tested and treated. People in antiretroviral treatment almost always see their viral levels drop to undetectable.

They won’t become ill. They can’t pass the virus on to others.

The HIV epidemic won’t end by self righteously blaming gay men for an epidemic that overwhelmingly affects straight people.

Footnotes