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A spate of studies has indicated a rise in the HIV infection rate
among gay men in San Francisco.
A CDC study conducted last year showed an increase in the HIV infection
rate among young gay men. That study, and additional studies since
have heightened the concern that HIV is once again on the rise, due
to a host of complex reasons, including shifting attitudes about sex
among gay men, as well as substance abuse problems in the gay community
leading to riskier sexual practices.
While AIDS deaths have decreased because of advances in retroviral
drugs which are successful in prolonging life, as well as because
of prevention efforts, the rate of HIV infection has plateaued at
40,000 cases a year. However, new rates of infection among gay men
in San Francisco, the CDC study showed, translate to about 750 new
cases of HIV a year.
A recent survey of the San Francisco Department of Health raised
red flags for health workers. The survey polled 800 men attending
an STD clinic found that 32 percent of gay respondents reported having
used Viagra in the previous year, many in combination with illegal
drugs such as poppers, a nitrate-based liquid inhaled during sex to
increase sensation, as well as Ecstasy and methamphetamines. The gay
men who reported using Viagra also reported having greater numbers
of recent sexual partners than men who did not use the drug. They
were also more likely to have an STD, generally a warning sign of
unsafe sexual practices.
Such studies have spawned the health community to try to discover
the reasons behind the rise in infection rates. But these studies
point to trends that people in the gay community have long known about,
though haven't until more recently fully addressed. The reluctance
in part stems from a fear of public backlash. The gay community since
the first days of the AIDS epidemic in 1981, first labeled in the
press as "a gay plague," has fought the stigma of the disease.
A new study released this week by University of San Francisco's AIDS
Policy Research Center, examines the reasons behind the increase in
HIV rates, echoing experts in policy, prevention and research. The
study's findings indicate that gay men don't find HIV as threatening
as they once did.
After years of leading the efforts for prevention, safe sex as well
as for research and funding, the rise in rates in the gay community,
while perhaps puzzling to observers, is more complicated phenomenon.
A return to high-risk behaviors among gay men, such as unprotected
anal sex, could be a tiring of a rigid adherence to the rules of safe
sex in the face of a disease with no cure as well as not only better
life-sustaining, but life-maintaining drugs.
"Part of it is maintaining a behavioral change over a long period
of time. It was one thing to make it an initially over 10 years. People
thought perhaps a vaccine was on the way, or a cure was on the way,
and to a degree the treatments came, and though they are not a cure
or vaccine, they are viewed close to that," said Dillon. The
new HIV drugs alleviate some of the physical symptoms of the disease,
shielding a generation of young men from the realities of the disease.
In addition, high rates of isolation and substance abuse among gay
men may lead to the desire to have more unprotected sex.
"Young people don't see people with lesions. They don't see
the wasting. They don't see a young person with a cane," said
Fred Dillon, director of policy at the San Francisco AIDS Foundation.
"Not seeing that takes away some of the fear that people had,
and they are much more likely to engage in risky behavior. We need
to fine tune prevention efforts throughout the city."
Executive Director of Health Initiatives For Youth Sharon Dolan says
prevention must be more holistic. "For young people, HIV prevention
needs to be done in context. Young people know the how in many cases,
but they need to know the why. The fact is that HIV prevention is
no one's primary issue - it's not the first thing on anyone's mind,
there was a time if you were a gay man living in San Francisco, it
might have been one of the top things on your mind, but that's much
less the case right now, particularly among young people not around
before height of the epidemic. They don't remember people dying all
over the place. The risk doesn't seem quite as big to them."