FRIDAY, Sept. 12, 2003 (HealthDayNews) -- Advances in the treatment of AIDS are contributing to higher levels of unsafe sex among intravenous drug users in Baltimore, with many users reporting they've grown tired of engaging in safer sex and safer drug use.
According to a new survey, addicts who think AIDS has become easier to treat are more likely to not wear condoms and not go out of their way to find sterile needles.
"The general word out on the street is that things are safer now," says study co-author David D. Celentano, director of the Infectious Diseases Program of the Department of Epidemiology at the Johns Hopkins University Bloomberg School of Public Health. "It's one of those unintended consequences of very good medical treatment."
While gay and bisexual men continue to make up the largest single segment of people with HIV and AIDS, safer sex practices have reduced the number of those newly infected in that group, Celentano says. According to him, infections among IV drug users have not fallen, and they -- along with their sex partners -- make up between one third and a half of all new HIV cases in the United States. "It's a big deal," he says.
Needle exchange programs are in place in a number of cities around the country, letting drug users avoid the risky practice of sharing needles that may be contaminated with infected blood. But the programs are controversial, and federal funds cannot be used to support them, Celentano says.
In Maryland, where the study was conducted, drug stores sell syringes, but they cost about 20 cents each when bought in bulk, he says. Drug users who shoot up a mix of cocaine and heroin -- the drug of choice in Baltimore -- may have to use several needles a day, Celentano says.
In 2000-2001, researchers in Baltimore interviewed 593 HIV-negative and 338 HIV-positive IV drug users. The findings of the study appear in the Sept. 5 issue of AIDS.
Almost two-thirds of the sexually active participants said they engage in unprotected sex, and about half admitted to sharing needles.
Thirty-seven percent of HIV-positive and 32 percent of HIV-negative drug users said they were "tired" of always having to practice safe sex. Thirty-eight percent and 33 percent of the HIV-positive and HIV-negative users, respectively, said they were "tired" of having to make sure they don't share needles while shooting up.
Meanwhile, the HIV-positive users surveyed were 6.5 times more likely to have unprotected sex if they believed that it's harder than it used to be to transmit AIDS through intercourse.
"The generalized belief is that things are less risky than they used to be because of the medications," Celentano says. Over the past decade, a new generation of AIDS drugs has helped many patients survive and thrive.
"We have to really redouble our HIV prevention messages, given the existence of these beliefs about the positive aspects of the current medical therapies," Celentano says.
Steve Koester, who studies the behaviors of IV drug users, says the results of the study aren't surprising. "It's extraordinary that they've been able to make any changes whatsoever given the fact that we've defined their lives as criminal and done everything in this society that we can to stigmatize them," says Koester, an associate professor of medical anthropology at the University of Colorado at Denver.
"We're asking them to make behavioral changes that are difficult [enough] for people whose lives are not that chaotic," he says. "To always try to use a condom every time they have sex is not the easiest thing to do."
He adds the research presents a dilemma: The drug users who think drug therapy has made AIDS harder to transmit "may not be completely off the mark."
"Clearly the risk is still there, but it's conceivable that the risk is not as great," he says. "I really don't know where to go with that one."
More information
Learn more about IV drug use and HIV from Acadiana Cares, a Louisiana advocacy organization. Learn about AIDS treatment from the Johns Hopkins AIDS Service.
