SAN FRANCISCO: Risky Sex on the Rise Among Young Gay Men
Unsafe sex between men may be increasing due in part to "complacency arising from advances in HIV therapy," federal health officials said yesterday. The CDC reported in this week's Morbidity and Mortality Weekly Report that the proportion of gay men reporting unprotected anal intercourse rose to 39.2% in 1997 from 30.4% in 1994, with men aged 26 to 29 reporting the largest increases. The number of men reporting multiple partners increased to 33.3% from 23.6%, with the largest jump among the younger age groups (Wall Street Journal, 1/29). Surveys analyzed by the CDC also found that "the proportion of men having anal sex who 'always' used a condom declined from 69.6% in 1994 to 60.8% in 1997." The CDC analyzed 21,857 one-page surveys distributed by volunteers in the Stop AIDS Project in San Francisco from 1994 to 1997. The survey defined unprotected anal intercourse as "insertive or receptive anal sex during the previous six months without always using condoms." In addition, researchers analyzed male rectal gonorrhea incidence data reported to the San Francisco Department of Public Health's Sexually Transmitted Disease Control Section, and found that the rate of male rectal gonorrhea rose from 21 to 38 per 100,000 adult men between 1994 and 1997, even as gonorrhea rates declined nationwide (MMWR, 1/29 issue). "Rectal gonorrhea among men who have sex with men is a clear indicator of unprotected anal sex in a population where unprotected anal sex is the highest risk factor for HIV," said Dr. Richard Steketee of the CDC's HIV/AIDS prevention division (Mays, AP/Contra Costa Times, 1/29).
Steketee said there is a "perception that because of better drugs available and because of the rapid advances that have occurred," traditional precautions against HIV are no longer necessary (Cooper, Reuters/Nando Times, 1/29). Dr. Helene Gayle, director of the National Center for HIV, STD and TB Prevention, said the younger generation of gay men "have come of age at a time when the death and debilitation caused by AIDS is less visible in the United States than it once was" (Sack, New York Times, 1/29). AIDS Action Executive Director Daniel Zingale said the federal government shares part of the blame for its lack of a national prevention effort. "I'm afraid that the evidence of the San Francisco study is indicative of a problem all around the country. While our investment in AIDS care and research is paying off through lower death rates, our divestment from HIV prevention is creating a new epidemic for a new generation of Americans," he said (AP/Contra Costa Times 1/29).
Drug Use+No Condoms = Extra Risky
Today's New York Times examines the study results in light of the rising use of illegal drugs among gay men, which is likely lowering their guard against HIV. AIDS activists and doctors say the "use of inhibition-relaxing" and "libido enhancing" drugs -- such as ketamine (K), ecstasy (X), gamma hydroxybutyrate (GHB), and crystal methamphetamine -- "is compounding" the trend noted by the CDC. But some AIDS advocates said the gay community is reluctant to discuss the problem. "It's hard to talk about things in the gay community that don't make us look good," said Mark King, director of education and communication at AID Atlanta (New York Times, 1/29). Today's San Francisco Chronicle takes a look at the practice of "barebacking" among gay men, in which condoms are eschewed for enhanced sexual pleasure. Web sites offer "extreme sex" parties and "Russian Roulette" parties, where the risk of becoming infected or infecting others with HIV "is part of the erotic allure." Robert Perez of the Stop AIDS Project in San Francisco said, "Groups of men engaging in high-risk sex with multiple partners, that is the kind of behavior that caused the epidemic to explode." Zingale added, "More than anger, I find it heartbreaking and tragic. ... Anything that glamorizes putting your own health at risk is irresponsible and threatens to unravel all our progress" (Russell, San Francisco Chronicle, 1/29).