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Many HIV-Positive Men Don't Realize It: Study

British findings, which mirror U.S. trends, suggest one in 10 might be infected

WEDNESDAY, June 2, 2004 (HealthDayNews) -- A new British report suggests that one in 10 homosexual men who visit popular gay venues in London are infected with the AIDS virus, and a third of them don't realize it.

In another disturbing finding, the researchers found the percentage of gay men who admitted engaging in the most dangerous form of unsafe sex increased at a fast clip over the four-year study period.

The numbers won't come as a surprise to American researchers, who have been tracking similar trends in this country.

While it's easy to tell people what they should do to protect themselves from AIDS, encouraging change is a challenge because "there's a complex of factors that lead to people to engage in activities that are harmful," explained Tom Coates, an AIDS specialist and a professor of infectious disease at the University of California at Los Angeles.

British researchers surveyed 8,052 gay men in London five times between 1996 and 2000 at a variety of locales, including bars, nightclubs and bathhouses. The participants completed anonymous questionnaires. At the end of the study, 1,206 men provided samples of their saliva to be tested for HIV, the virus that causes AIDS.

The findings appear in the June issue of Sexually Transmitted Diseases. The long delay in the release of the results is not unusual in the academic world, where it can take years for studies to become published.

Of the men tested in 2000, 11 percent turned out to be HIV-positive. But only a third knew it. The surveys didn't ask why the men hadn't gotten tested recently enough to find out that they were infected.

Researchers also found that the percentage of men surveyed who engaged in unprotected anal sex grew from 30 percent in 1996 to 42 percent in 2000.

However, the men who engage in the riskiest unsafe sex practices don't appear to be developing higher rates of HIV, said study co-author Julie Dodds, a research fellow at the Royal Free & University College Medical School in London.

The reasons for this discrepancy aren't clear, but she speculated that men may be more willing to openly discuss their sexual practices with researchers. Another possibility is that they're turning to strategies other than condom use to reduce their risk of infection, she added.

In the United States, a similar study completed from 1994 to 2000 suggested that one out of every 10 young gay men in the United States is HIV-positive, and 80 percent of them don't realize they're infected. In that study, researchers interviewed 5,719 gay and bisexual men aged 15 to 29 at bars, clubs and other venues in six large American cities.

Experts caution it's impossible to extrapolate survey-based findings to the entire gay male population because researchers only interview men at specific venues.

Other studies have suggested that American gay men are having more unsafe sex, perhaps because they aren't as worried that AIDS will kill them. The disease has largely become treatable over the last decade, and many HIV-infected people are living with few or no symptoms.

One major problem facing public health officials is the failure of HIV-infected men to refrain from unsafe sex. Often, the infected men feel they don't have a responsibility to disclose their illness. "We don't seem to be able to get ahead of that issue," Coates said.

Other factors, such as methamphetamine and alcohol use and depression, contribute to the spread of AIDS, he said. "Those of us who think about public health need to think about not just motivating people (to avoid AIDS), but dealing with substance abuse and mental health issues as well."

Another complication is the lack of access to health care among younger men, especially minorities, Coates added.

Medical researchers are developing new ways to prevent AIDS, such as microbicide creams and drugs that people could take before they have sex. But they "may or may not help," Coates said, depending on whether people bother to use them.

More information

Get details about everything from AIDS treatment to vaccine development from the federal HIV/AIDS Education & Research Center.

SOURCES: Tom Coates, Ph.D., professor, infectious disease, University of California at Los Angeles; Julie Dodds, research fellow, Royal Free & University College Medical School, London; June 2004 Sexually Transmitted Diseases
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