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The number of people who are female infected by guys has been steadily going up.

But the number of people infected because of IV drug use has been going steadily down.

This leads to the following conundrum: if the number of infectious people who got HIV from IV drug use is going down, please explain how the number of people being infected BY people who got HIV through IV drug use keeps going up? And not slowly.

Well, you could assume that for some reason people who get HIV from IV drug use are a lot less likely to get treated and this means the pool of people who are infectious via this route is larger. And that may be true. In which case we are not reaching people of color who are IV drug users very effectively with test and treat.

But the curve looks a little too steep for this to be the only explanation. The reduction in new HIV infections among IV drug users has been declining too rapidly for too long for this to be a persuasive case: and keep in mind, the fact you know the rates means that folks are in fact getting tested. So do we assume that some folks who are IV drug users are more likely to get tested than others? And if so which ones?

I have another explanation for what is going on. It doesn’t take a long time to notice that there are folks who want to play bottom to a gay top who are married. And some of them are black.

But let’s face it, if coming out was hard for the gay community, coming out is a nightmare by comparison for the bi community that is married.

If your wife gets HIV which would you use as an explanation: that you were ashamed to tell her that you used to use drugs cuz you thought that would ruin the chance to marry her, or that you secretly getting receptive sex from guys on the side?

So wouldn’t denial be a more likely path?

And wouldn’t you avoid being tested cuz you really don’t want to know?

And wouldn’t you feel negative about all of this and about yourself which dramatically increases the chance you don’t get the guy to use a condom?

Coming out as a bi for a person of color who may well belong to a Christian Church or Islamic temple and informing the wife and parents and kids and so forth that you like guys on the side is so difficult it would be avoided on pain of death.

So the transmission to women goes up.

How can we deal with down low?