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Two Decades of AIDS

Anniversary marked by upswing in risky sex, alarming rise in disease

THURSDAY, May 31, 2001 (HealthDayNews) -- The AIDS epidemic turns 20 in June, but after two decades of pushing safer sex, health officials say they're witnessing an alarming rise in infections among young men at high risk of the deadly disease.

A survey of nearly 3,000 gay and bisexual men from six large U.S. cities shows 4.4 per 100 are newly infected with HIV, the virus that causes AIDS. That figure is well above the rate of 2 to 3 per 100 in the 1990s and close to the rate of the 1980s, officials say. Among gay and bisexual black men, the rate of new HIV infections is 14.7 per 100, or roughly one in seven. Since 1996, more AIDS cases have been reported in blacks than among any other racial or ethnic group in this country, officials say.

The results "highlight the fact that we need to have more prevention programs and better prevention programs, with more of a focus on African-American men who have sex with men," says Linda Valleroy, an epidemiologist at the Centers for Disease Control and Prevention and a co-author of the study. It appears in the agency's latest Morbidity and Mortality Weekly Report, which is devoted to the 20th anniversary of the AIDS epidemic in America.

The first cases of Acquired Immune Deficiency Syndrome in the United States were reported to the CDC in June 1981. Since then, nearly 775,000 AIDS cases have been reported, resulting in more than 448,000 deaths. The CDC estimates that between 800,000 and 900,000 Americans are infected with HIV, roughly 320,000 of whom have full-blown AIDS. As many as one-third of HIV patients don't know they have the virus.

Safe-sex messages, including the importance of wearing condoms during intercourse, clean needle programs and other public health interventions were credited in part with driving the rate of HIV infection down from 150,000 cases a year in the 1980s to about 40,000 a year in the 1990s.

But the availability of drugs to control the virus, including highly active antiretroviral therapy (HAART), has given some young gay men the impression that if they catch HIV, they can simply take medication to avoid AIDS, experts say. This misplaced confidence has, in turn, led to extremely risky practices, such as "bareback" sex, in which gay men dispense with condoms completely.

"Twenty years into this epidemic we know how HIV is transmitted, and there should be very few if not no new HIV cases in this country," says Marty Algaze, a spokesman for the Gay Men's Health Crisis, a New York City AIDS awareness group. "But there are still people who believe it's not going to happen to them, and some believe that if it does happen to them they'll just take the drugs."

Although much of the evidence about the surge in risky behavior is anecdotal, the CDC report shows that the incidence of HIV infection is indeed rising among young gay and bisexual men. The study, an anonymous survey of men in Baltimore, Dallas, Los Angeles, Miami, New York and Seattle, conducted between 1998 and 2000, found that 13 percent were infected with HIV. Among blacks in this group, the infection rate was 32 percent.

Analysis of blood samples from the men revealed that 4.4 percent of HIV cases overall, and 14.7 percent among blacks, were newly acquired. For Latinos and whites the prevalence was 3.5 percent and 2.5 percent, respectively.

Black men didn't report having markedly riskier sex habits than white gay and bisexual men, Valleroy says, indicating that perhaps the prevalence of HIV infection is even higher in the African-American community than figures reflect. "There's a lot of stigma in the African-American community about being gay and bisexual, and about having HIV and AIDS, and there need to be efforts to combat this stigma," she says.

The researchers note that their sample, taken from night clubs, discos, urban shopping areas and clubs for young gay men, might not accurately reflect the true incidence of HIV infection among all gay men.

Paralleling the rise of HIV among gay and bisexual men has been an increase in cases of other sexually transmitted diseases, including gonorrhea and syphilis.

Earlier this year, for example, California health officials said that between January and July of 2000, Los Angeles recorded 130 cases of syphilis, 51 percent of which involved homosexual or bisexual men, a figure nearly twice that of the previous year.

Globally, AIDS experts also have expressed concern about the problem of tuberculosis, especially drug-resistant TB, which often complicates HIV infection. An estimated 36 million people worldwide carry HIV, and AIDS has claimed 20 million lives.

What To Do

While the AIDS epidemic is 20 years old, the first case of the disease is believed to have crossed from monkeys to humans as early as the 1930s, scientists say.

To learn more about the biology of HIV, try the University of California at San Francisco.

For more on AIDS, visit the Centers for Disease Control and Prevention, or the World Health Organization.

To find out what clinical trials are being done on AIDS, check Veritas Medicine.

SOURCES: Interviews with Linda Valleroy, Ph.D., epidemiologist, Centers for Disease Control and Prevention, Atlanta; and Marty Algaze, spokesman, Gay Men's Health Crisis, New York City; Morbidity and Mortality Weekly Report, June 1, 2001
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