The most recent report from U.S. government health officials reports that 50,000 new HIV cases were diagnosed in the most recent year, stable compared to four years ago overall. About two-thirds were men who have had sex with men, about 9% were IV drug users, the rest were classified heterosexual cases, something fairly typical of prior years.
Cases were up for adult men who have had sex with men and are under thirty years old, including an increase of 48% for black men in that category compared to just four years ago, and since the overall numbers were down, presumably down in many other demographics compared to four years ago.
The media has reported the 48% increase for black men who have had sex with men and are under thirty years old as "gay men." But, I suspect that a significant share of those cases reflects men who were raped by other men, probably mostly in prison. Why? The numbers are much larger relative to the size of the population involved than in other demographics and following completely different trendlines. There is no particularly good reason to think that the black men are that much more likely to be gay than other men. While it wouldn't be surprising if the unsafe practices rate for gay black men engaged in consentual sex outside prison was higher in black men than for other men, the differences in rates of HIV infection and other serious STDs is so much higher in young black men than in demographics with much lower incarceration rates. There may be racial divides in the 2010s gay social scene, just as there are in other parts of American life, but the numerical gap is what you would expect if Jim Crow were still in full force in America; while my perhaps naiive take is that young gay men are no more segregated by race, and perhaps a bit less so, than other American demographics. Also, the numbers seem to suggest that significantly more black women receive HIV from black men who have had sex with men than in other demographics, which would suggest, at a minimum a larger share of men who have had sex with men who also have sex with women in this demographic than other demographics. If would take only something on the order of 0.5%-2% of the black male prison population to have new HIV infections each year to account for the discrepency, which would not be out of line with these cases making up a minority share of all estimated for prison rapes of black men each year. An indepth analysis post from 2005 on the subject at this blog is here and there have been several posts in between.
However, my conclusions are based only on numbers and I haven't seen an in depth non-statistical analysis, despite its importance from a public health perspective. For example, focusing public information campaigns on bars frequented by young middle class African American gay men is not going to solve the problem if most of the new cases are coming of young African American men who have had sex with men are coming from prison rapes (or, for that matter consentual sex in a prison environment by gay men who don't have access to basics like condoms and have a limited choice of partners).
The good news, however, is that people who are infected with HIV are living about twice as long and at greater levels of health as they did when the outbreak started, roughly twenty years instead of ten, in round numbers, mostly due to new drugs, but perhaps to some small extent also because most new infectious diseases grow less virulent in subsequent epidemic waves because the most virulent strains tend to die out with the people who are infected while having caused fewer new cases in the meantime.