By DR. MONIQUE DUWELL

Despite decades of prevention efforts, HIV continues to increase among young gay men in urban areas, and most of these men are unaware they are infected, according to new data from the Centers for Disease Control and Prevention (CDC).

Researchers looked at survey data spanning 1994 to 2008 on gay, bisexual and other men who have sex with men ages 18 to 29 year old living in Baltimore, Los Angeles, Miami, New York City and San Francisco, recruited from bars and nightclubs. The study focused on HIV prevalence as well as HIV testing.

They found that among those ages 23 to 29 years old, there was a trend towards increasing HIV prevalence from 1994 to 2008, with an overall prevalence of 16 percent.

"The fact that new infections increased somewhat in the 23- to 29-year-old age group indicates that this is a population that we need to be extremely concerned about and that we really need to be trying to reach them early with prevention so that we can establish healthy behaviors early on," said Dr. Alexa Oster, lead author of the study and medical epidemiologist at the CDC.

Among gay men age 18 to 22, the overall HIV prevalence was 11 percent, and this number remained steady over the 14-year time span of the study.

Why is there a lack of progress in stemming the epidemic among young gay men? It turns out there are many factors that lead to higher rates of HIV disease in the gay community at large. As Dr. Chris Beyrer, director of the Center for Public Health and Human Rights at the Johns Hopkins Bloomberg School of Public Health, explains, "there are structural, social and biological features that enormously favor transmission over prevention [among men who have sex with men]."

For young gay men in the United States specifically, certain external factors may put them at particularly high risk for HIV.

"There may be socioeconomic reasons that men are less likely to get into testing and care," Oster said. "There may be issues related to stigma or homophobia. And all of those are important factors that may have a unique effect on the youngest populations."

For Adam Bocek, a 27-year-old gay man who contracted the virus through a sexual assault, stigma was a common experience after he was diagnosed with HIV at the age of 20.

"I felt like I wasn't a whole person," he recalled.

It took him more than a year to work through the initial shock of his HIV diagnosis, he said.

"It was very hard to open up," he said. He vividly remembers a nurse who refused to draw his blood because he was HIV-infected, an experience that only made the process of accepting his diagnosis more difficult.

Bocek said he has since moved ahead with his life, is on treatment, and is healthy.

"I don't need those types of people in my life," he said. "I try to keep a really positive outlook on things every day. Now I feel like I've changed from being a victim to being a survivor."

He now speaks with nursing students to teach them about living with HIV, "to help humanize the disease," he said.

Despite success stories of people living with HIV like Bocek, many young gay men are still not getting tested.

According to the CDC study, more than three-quarters of young gay men in urban areas were unaware they were HIV-positive, compared to 20 percent in the general population. While there were significant increases in the proportion of men who underwent HIV testing over the course of the study, "there is more work to be done," Oster said.

Those working on the front lines of HIV testing agree.

"Young [men who have sex with men] are the hardest group to get tested," says Meghan Davies, director of community health for Whitman Walker Health, a community-health center with a focus on serving the gay community in Washington, D.C. In her experience, the biggest reason for this is "a lot of stigma, especially in communities of color." She also notes that young men tend to be more mobile, making re-testing efforts more challenging.

The CDC recommends that all gay men, and others at high risk for HIV, get tested at least once a year.

"Getting tested early can help to get you into appropriate care and appropriate treatment, and whether the test is negative or the test is positive it is a way to move forward and make sure that you are doing the things that are right for you," Oster said.