EDGE New York City

More, more, more. That’s the appeal -- and the curse -- of urban living. In a city of millions, the raw numbers greatly increase your chance of finding the job you want or the help you need or the likeminded soul who’s always up for some sexual play.

It’s no wonder why so many LGBTs who grow up in flyover country end up pursuing their dreams in the grass-is-greener settings of "Sex and the City" or "Tales of the City" or "Queer as Folk". Urban areas are 24-7 hubs of art, commerce, and fashion, where the thing you crave is just a short walk (or subway trip or cab ride) away.

But easy access can be a dangerous thing, especially when that "thing" is casual sex with multiple partners. According to New York City’s Department of Health and Mental Hygiene, the five boroughs of NYC have more documented cases of HIV than Los Angeles, San Francisco, Miami, and Washington, D.C. combined. It’s estimated that 20 percent of NYC residents living with HIV are diagnosed with AIDS.

Ramani Durvasula, PhD, (familiar to national audiences as a contributor on "The Dr. Oz Show") is a Professor of Psychology, California State University, Los Angeles, and Licensed Clinical Psychologist. She said that, "Contracting HIV is a probabilistic event. And a man in an urban area like New York or Los Angeles is more likely to encounter a positive partner."

Likening unprotected sex to a game of Russian Roulette, Durvasula noted that the big city’s blessing of many potential partners is counterbalanced by the fact that for those who play the risky game of unprotected sex, "The gun has more bullets in urban areas."

What’s more, today’s young gay men have grown up in an age where HIV medications prolong life for decades. So despite being bombarded with social marketing campaigns designed to practice safe sex and protect HIV negative partners, the specter of HIV contraction as a deterrent, Durvasula said, "has lost some of its menace.

Sadly, HIV still has long-term health consequences and no cure, so prevention can still pay dividends. That said, it always has been and remains, really difficult, especially when the deleterious consequences loom so many years down the road, and in big cities, treatment is very accessible."

Perry N. Halkitis (PhD, MS) is Associate Dean for Research and Doctoral Studies at NYU.

He’s also Director of NYU’s Center for Health, Identity, Behavior and Prevention Studies. Citing New York City’s Gay Men’s Health Crisis (GMHC) and Harlem United as examples, Halkitis noted that for the HIV positive, the city’s wide variety of "AIDS Service Organizations provide HIV-positive individuals a context in which to find support and acceptance for their health conditions, and to be themselves without fear. This in turn helps to ameliorate HIV-related stigma and, in turn, improves emotional well-being."

Marjorie J. Hill, PhD, the CEO of GMHC, observed that NYC has more AIDS service organizations simply because of its high percentage of HIV positive individuals -- many of whom haven’t even been tested. Hill said that NYC’s racial and ethnic diversity presents a unique challenge: "Doing effective outreach and interventions with so many people means casting a wide net while simultaneously targeting a specific population such as women of color or young gay men."

Denise Heath, HIV positive since 1994, said that at GMHC’s women’s support group, she finds a welcoming environment "which helps me to speak on issues that are relevant to me and my living with HIV, which I probably couldn’t do outside of GMHC." Heath said she enjoyed the commonality she found with other HIV-positive women.

Referencing a period in 2005 where she was living in Arlington, Texas, Heath recalled that, "There was one AIDS service organization and a couple of doctors in Fort Worth. If you had a car to drive from Arlington to Fort Worth, it would take about 45 minutes. But I didn’t have a car. So I felt isolated a lot."

In addition to having no HIV support or medical services in Arlington, the city had no public transportation. "The nearest store was about three miles away," Heath recalled. "I had to walk 5.2 miles just to go to the bank. To take a cab to the bank was $40 one way. Strangers would offer rides, but my cousins warned me against that. There were stories about finding bodies along the highway."

Finding quality care wasn’t a problem upon her move to NYC. Her quest for medical care, she recalled, first led her to Morris Heights Health Center in the Bronx. "Then I went to Exponents, which helps people recover from drug use. From Exponents, I went to Village Care of New York for medical care and GMHC for services like the support groups."

The combined effect of these services, Heath said, has helped her become more confident and acquire the resources necessary to further her education while accessing a wide variety of medical care.

But Hill said that despite the confidence gained from being surrounded by those facing similar challenges, the anonymity of cities could lead to loneliness and isolation.

No matter where you live on the map, Hill observed, "HIV is still a small-town disease. Whether there are 80 million people or 80, folks are still quiet about their HIV status because there is still stigma. In an apartment building with hundreds of neighbors or just two, people still don’t want their next-door neighbor to know about their HIV status."