This spring, the San Francisco Health Department is planning to conduct its third “Speak Out” HIV awareness campaign in the last 12 months, urging young men who have sex with other men to get tested for HIV in an effort to increase the number of people—men in particular—who are tested for the virus and referred for treatment if they prove to be HIV positive.

Awareness campaigns are, of course, part of the history of HIV/AIDS, but recently the campaigns have heated up as health officials worry too few people who are infected are getting treatment and protecting their partners.

Other recent campaigns have been even more narrowly targeted, including two by the U.S. Centers for Disease Control and Prevention including one developed specifically for Latino men, and one “Testing Makes Us Stronger” piloted in six cities in the U.S. including Oakland, Calif. And just a few weeks ago, the Kaiser Family Foundation, which is helping to fund San Francisco’s campaign, released new messaging and programming for a campaign with singer Alicia Keyes, to help increase awareness of HIV testing, treatment and protection among African American women.

The rush to get especially young people tested and then treated if necessary is underscored by a new study published late last month in the journal AIDS and funded by the National Institutes of Health, which reviewed blood work on close to 1,000 young men who had sex with other men but did not assume they were HIV positive. The researchers found that thirty percent of those in the study had high levels of HIV virus in their blood.

High levels of the virus are an indication that the infections were new, when viral loads can be highest, but also most effectively treated.  The study is important, says Bill G. Kapogiannis, M.D., head of the Adolescent Medicine Trials Network for HIV/AIDS Interventions and lead author of the study, because researchers have long thought that too many young men were unaware that they might be HIV positive and the new study offers evidence to confirm that concern.

“Not knowing they are HIV-positive can delay treatment, when it might be especially effective, as well as pose an HIV risk to partners,” says Kapogiannis.

The high levels of HIV found in the study participants suggest that HIV is highly likely to be transmitted among members of this group, according to the researchers. “This is not a time for complacency,” said Kapogianis. “Our results suggest that all health care providers who work with young people — particularly those who work with males who have sex with other males — should stress the urgency of getting tested, and, if infected, into treatment, which benefits their own health as well as reduces transmission to others.”

The study supports recent estimates from the U.S. Centers for Disease Control and Prevention, that 1 in 4 new HIV infections occur in young people from 13 to 24 years of age and about 60 percent of all youth with HIV do not know they are infected, are not getting treated, and can unknowingly pass the virus on to others.

Women also need targeted campaigns, which is the force behind the KFF work with Alicia Keyes.  “Men with HIV tend to have higher viral loads than do women,” says Kapogiannis, “but I think there is a timing issue here as well. It’s possible that the young men who have sex with men are being diagnosed earlier than are the women, because of greater awareness of the risks and more frequent testing.”

San Francisco’s Speak Out campaign is a strong example of the targeted messaging and placement needed to get the word out. The effort is being led by Greater Than AIDS, an advocacy group of which the Kaiser Family Foundation is a founding partner. The campaign was developed locally with the San Francisco Department of Public Health to engage gay and bisexual men and “confront the silence and stigma that too often surrounds the disease,” says Victor Fuqua, Health Program Coordinator, with the San Francisco Department of Public Health Community Health Equity and Promotion division.

A key theme of the campaign, which has relied heavily on posters in neighborhoods with many gay and bisexual residents, is to encourage more open communication about HIV in relationships, with health care providers and within the community generally. The tagline is “What You Say Matters,” and the campaign includes a video, “Let’s Bring HIV Out of the Closet,” in which HIV positive men talk about how HIV has affected their lives and the lives of those they know and love. The video is being distributed on the web and through social media.

“Speak Out is about bringing the energy and momentum of the gay movement to bear once again on HIV/AIDS,” said Tina Hoff, Senior Vice President and Director of Health Communications and Media Partnership, Kaiser Family Foundation.

The campaign has several messages including:

• SPEAK OUT For Our Relationships. Talking with friends and lovers about HIV, including using protection, getting tested together, and discussing HIV status.
• SPEAK OUT For Our Health. Asking to be tested, talking about treatment options and seeking support when needed.
• SPEAK OUT For Our Community. Confronting stigma and addressing misconceptions through open communication with the people in our lives.

“Speak Out is an opportunity to engage the Gay community to speak out around knowing their status, the importance of getting tested at least every six months, and getting into care and treatment,” says Fuqua, “and it’s also about finding our voice again in our community to ensure that we all find a healthy way to take care of ourselves.

The numbers explain the targeted campaigns: nationally, gay and bisexual men account for the majority (56%) of the more than 1.1 million people living with HIV today in the U.S., and two thirds (66%) of new HIV infections. In San Francisco, gay and bisexual men account for an even greater share of the local epidemic—making up 88% of all persons living with HIV in the city and 82% of new infections.

Testing rates have been increasing in San Francisco according to recent data, but surveys by the Department of Public Health have found that many men having sex with men in the city are not being tested as routinely as recommended—which is every three to six months.  According to a 2011 survey, 40 percent of sexually active MSM who were not already diagnosed as HIV positive in San Francisco had not been tested in the previous 6 months.

City health officials are also alarmed by the number of men who are HIV positive, but not receiving treatment after their diagnosis – which explains why San Francisco’s Victor Fuqua is hard at work designing the awareness posters on testing for HIV he’ll be hanging in the spring.