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by Dan Aiello

Gay and lesbian docs hear about the HIV increase among gay men

“We are living through a remarkable time in gay history,” reported Ron Stall, an AIDS prevention expert with the Centers for Disease Control and Prevention (CDC), at the recent Gay and Lesbian Medical Association annual conference. “One out of four gay men who came of age during the 1970s now is either dead or living with HIV.”

Medical professionals at the October 30–November 1 conference in Miami Beach received even more disturbing news. Evidence indicates that prevention efforts and biomedical interventions have improved the long-term outlook for the AIDS epidemic but have not halted the increase in new HIV infections among gay men, especially men of color.

Stall presented case studies showing that an unprecedented rise in risky sexual behavior among gay men is occurring worldwide despite prevention education. New HIV infections “are likely to continue to increase worldwide,” Stall said, pointing to the increasing incidents of exposure to other STDs as one of the key indicators that world governments are losing the battle, especially those in Asia and the Caribbean, where infection rates have skyrocketed.

There “is nowhere in the world where numbers are decreasing” in HIV infection rates, Stall reported. The studies cited by Stall, who is chief of HIV prevention research at the CDC, indicated a more than 20-percent increase in gay men having unprotected anal sex between the years 1994 to 1999. During that same period, the San Francisco public health department reported a 14-percent increase in unprotected anal intercourse by men who were HIV positive having sex with men who were either negative or of unknown serostatus.

Stall noted that although the rate of infection among men of color can be as much as twice that of Caucasians, it has been found that behavior is not necessarily the cause. Instead, in this population the individuals in the pool of likely sexual partners are themselves more likely to be HIV positive and therefore at greater risk of transmitting the virus.

Among the reasons Stall cited for the increase in HIV infection rates worldwide are a new wave of drug use, especially involving crystal methamphetamine; an increase in the number of sexual partners (exacerbated by Internet “dating”); optimism about improvements in HIV treatments; depression and relationship status; and AIDS “burnout.”

Stall said he believes that the HIV prevention message often fails to be delivered effectively in targeted communities. He observed that the “monolithic” approach taken in the past to address the AIDS epidemic must change in order to address serious health problems that now confront the GLBT community. “There are multiple dangerous epidemics facing our community, and each one of them are interconnected,” he said, stressing that drug abuse, depression, domestic violence, and STD incidence disproportionately affect the GLBT community. The number of epidemics an individual is exposed to correlates directly to whether or not that person is HIV positive, he added.

Not all the news at the GLMA conference was bad. Presenters announced the Food and Drug Administration approval of a new drug, Fos-Amprinavir, a couple of weeks prior to the conference. Also, new once-a-day drug regimens have proven effective and increase the chance for strict drug adherence. And studies in Brazil have confirmed that post-exposure prophylactics (PEPs) have proven effective in significantly reducing the infection rates in men who participated in risky sexual behavior the night before.

California-based journalist Dan Aiello wrote about Charles Casillo, author of the new John Rechy biography, in the November issue.IS THERE A GAY DOCTOR IN THE HOUSE?

Founded in 1981, the San Francisco-based Gay and Lesbian Medical Association works to improve health care for GLBT people and to foster professional climate for GLBT professionals in medicine. Among its programs, the nonprofit group offers a free online referral service to health-care providers across the country. Info: www.glma.org.

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