HIV-positive gay and bisexual black men in the United States are 22 percent less likely than other HIV-positive gay and bisexual men to get treatment, the team said. They are also less likely to have health insurance, which is key because HIV drugs lower the amount of virus in the body and can significantly reduce the risk of transmission.
Lack of access is just part of the story in the African American communities Buckles now serves as an outreach worker at Chicago House, a social service agency that provides housing and support services to HIV-affected and at-risk families.
MORE TESTS, MORE HOPE
In Washington, a city with one of the highest infection rates in the country, CDC has been working with local health officials to increase testing.
Local health officials launched an HIV screening program in 2006 that expands testing to places like the department of motor vehicles, where individuals can get tested while they wait for a driver's license.
Since its start in 2006, HIV testing in Washington is up 400 percent, rising from fewer than 30,000 tests in 2006 to 122,000 in 2011.
At United Medical Center in the predominantly black, southeast part of the nation's capital, nurses saw they needed to reach a wide range of people who ordinarily may not get tested. They began offering free HIV testing through the center's emergency room 24 hours a day.
Patients get immediate results and those who test positive are connected with care before leaving.
Donna Landers, a 47-year-old grandmother, sought emergency care at the clinic forabdominal pain in October and agreed to have an HIV test as well. She had a negative test just two months earlier, so her positive result was a shock.
"I was stunned," said Landers, who is black. She believes she got the virus from her husband.
Although she felt quickly embraced by the clinic's staff, many others judge her, including some relatives, Landers said.
"My sister used to hug me; now she don't."
Dr. Lisa Fitzpatrick, who sees patients at the center after they are diagnosed, said more doctors need to make testing routine, especially in the black community.
"There's no reason why I should test someone fordiabetes and high cholesterol and not HIV," she said.
Fitzpatrick, who is black, said many of her patients have full-blown AIDS because they've avoided or delayed treatment. She sees religious influences making many people in the black community wary of discussing HIV and sex. They consider it a gay-only issue.
And the young gay men she sees are so convinced they will get HIV anyway that "they're not terribly concerned about it."
In New York, a group of mostly black, gay and HIV-positive men is trying to break the silence by handing out condoms and trying to educate other young gay men at risk.
Sexy With A Goal, or SWAG, is an affiliate of the AIDS Service Center ofNew York City. The group hopes its efforts will help young men understand "safer sex is sexy."
The CDC just launched a new national campaign aimed at overcoming the stigma called "Let's Stop HIV Together." Ads start running this week in six cities heavily affected by HIV, with others to be added later.
Other federal efforts may help. TheFood and Drug Administration this month approved the first at-home HIV test that some experts say may help reach people who don't want to be seen at a clinic.
In June, CDC launched a two-year pilot program to offer HIV testing in community pharmacies and retail clinics in 12 urban areas and 12 rural areas with high rates of HIV and low access to testing.
Researchers are also trying new tactics. One new study funded by theNational Institutes of Health offers gift cards to patients who follow-up a positive HIV test result with treatment and continue to take their medications.
Wafaa El-Sadr ofColumbia University in New York City, who is leading the trial, said it's not yet clear if financial incentives will work, but they are willing to try new approaches if it helps patients follow through.
Dr. Anthony Fauci, head of the National Institute ofAllergy and Infectious Diseases at NIH, said researchers do not know enough about how to reach those most at risk.
"They're still, relatively speaking, a disenfranchised population. Many of them are in inner cities; many of them don't have access to healthcare," he said.
Dr. David Malebranche of Emory University School of Medicine treats HIV/AIDS patients from a predominately black neighborhood in Atlanta. Researchers are just starting to understand that ending America's HIV crisis will mean addressing the same lack of healthcare access that puts blacks at higher risk forheart disease and diabetes, he said.
"We're realizing it's not just unprotected sex by itself. When you compare people of different genders, ages, races and sexual orientation, rates of unprotected sex are pretty comparable. So it's got to be something more."
(Editing by Michele Gershberg and Eric Beech)
U.S. blacks, gay and straight, have biggest struggle with HIV
An AIDS patient receives his medication at Broadway House for Continuing care in Newark. (Mike Segar/Reuters)