NEW YORK - For years he had numbed his pain and fear with drugs, alcohol and anonymous sex. But in a flash of clarity one day, when the crystal meth was wearing off, Javier Arriola dragged himself to a clinic to get an H.I.V. test, years after he stopped using condoms.
He knew the answer before he received the results, but it was far worse than he thought: At age 29, he had full-blown AIDS.
He had planned to have a party for his 30th birthday. Instead he was thinking of hanging himself in his apartment in Hell’s Kitchen.
“There were feelings of terror, like when you were a little kid and there’s that thing that terrifies you,” he said. “This was it. The worst nightmare, and I brought this onto myself.”
The number of new H.I.V. infections in men under 30 who have sex with men has increased sharply in New York City in the last five years, particularly among blacks and Hispanics, even as AIDS deaths and overall H.I.V. infection rates in the city have steadily declined.
New figures from the city’s Department of Health and Mental Hygiene show that 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.
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 like Mr. Arriola.
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.
“It’s really unconscionable that we haven’t had a decrease in new infections in the past decade in the United States,” said Wafaa El-Sadr, chief of infectious diseases at Harlem Hospital Center and a professor of public health at Columbia University. “It’s not anymore in the headlines; many people think it’s gone away, and it hasn’t gone away.”
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. He and a crew of outreach workers also go to gay nightclubs late at night, with a van carrying H.I.V. tests that can be conducted on the spot. The crew parks the van, which has no obvious signs of its mission, on the street. When they go into the clubs, they make conversation and delicately inquire whether a clubgoer would like to take the test.
Mr. 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.
Mr. Edmonds and other gay men say the stigma of being infected with H.I.V. is growing, and may be greater now than it was in the 1990s, when the AIDS epidemic became a unifying cause, a shared tragedy for gay men.
“I call it, ‘Don’t ask, don’t tell,’” Mr. Edmonds said. “People are not asking — it’s like it’s an offensive question.”
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.
“They blame you and want nothing to do with you; they put you at the end of the line,” said Kyle, who spoke on the condition that his last name not be used because he said he believed his condition would hurt him professionally. “The older generation sees AIDS as a tragedy, the younger generation sees it as self-destructive behavior.”
He said he was infected by someone who did not reveal that he had the virus until after they had unprotected sex.
For Mr. Arriola, who struggled with being molested as a child, the H.I.V. diagnosis put him at rock bottom, he said.
He continued to use drugs for several more months, but then, as his suicide plan was becoming an obsession, he called a friend who was a recovering addict. He got clean and sober, joined a 12-step group, started going to therapy and has slowly pieced his life back together.
“For me today, I’ve done a lot of work to accept myself. I don’t drink and drug, I meditate, there’s a lot of visualization of the person I want to be,” he said. “A lot of it is acceptance. I’m 32, I’m Latin, I’m gay and I have H.I.V. And I don’t feel bad about it. It’s very, very important for me to not feel shame about this.”
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.
“It leaves us a little bit scratching our heads: What is it that is going on?” said Christine C. Quinn, the City Council speaker. “Something clearly is not working, and it’s literally about life or death.”
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.
Dr. Frieden also said that another likely explanation was “treatment optimism,” and the many messages gay men receive through AIDS drug advertisements that people like Mr. Arriola can live long and normal lives.
“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. “When’s the last time we saw someone with lesions walking through Chelsea and Hell’s Kitchen?” said Victoria Sharp, director of the Center for Comprehensive Care, which is currently providing medical care and other services to 3,000 H.I.V. patients at Roosevelt Hospital and in Harlem. “You don’t see it, and we haven’t seen it since the mid-1990s, so there is a whole generation or two who have grown up without seeing the physical manifestations.”
Health officials said they were also 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.
Since receiving the AIDS diagnosis, Mr. Arriola, now 32, has developed a large group of sober friends, become a licensed real estate broker, repainted his apartment — all things that seemed impossible to imagine in the darkness of his drug use and when he learned he had the disease.
Then, he said he would look in the mirror and see the worthless person he believed he was. “I won’t make it to 35,” he would say.
But these days, with the antiviral drugs he takes, about five pills a day, his health is good, he said. Around his apartment, he has posted upbeat messages to himself, like the one on his mirror, where he has written “thank you.”
On the refrigerator he has a list of goals: “Write a book, own New York City property, spread love, own a business (20 million), get a college degree, run a triathlon, have a family (partner, car with driver and kids) and 190 pounds (muscle).”
from The New York Times
