Bay Area Reporter - June 1, 2001

We are angry that so many lives have been cut short by this disease. There's not a week that goes by that we don't have something AIDS-related in the paper, and we are angry that 20 years later, we still have to cover a disease that doesn't look like it will be curable in the next 20 years, if ever.

Tuesday, June 5 marks the 20th anniversary of the first mention of a strange infection among several gay men in Los Angeles, some of whom had died. The item in the Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report would be picked up by just a few reporters.

In San Francisco, public health officials were noticing "weird opportunistic infections" in gay men, who started dying.

Those early years of the AIDS epidemic saw thousands of people û mostly gay men û ravaged by a disease that had no cure and virtually no treatment. Today, two decades later, thousands are still dying, and outside of the United States in regions such as sub-Saharan Africa most are heterosexual. While there are improved treatment regimens, they don't work for everyone û indeed some can't even get access to them û and come with significant side effects.

So what has changed in 20 years? In some ways much has changed, in other ways, little has changed. People are still getting infected after nearly 20 years of safe sex messages, an indication that prevention messages need to be seriously revamped. Heterosexual Americans, for the most part, become squeamish when discussion of reducing HIV infections turns to anal intercourse, one of the main transmission routes for HIV outside of IV drug use. The LGBT community has always been more adept at talking frankly about sex, and in this age of AIDS that's a good thing. Unfortunately, we must deal with many in the scientific, medical, and political establishments who are extremely uncomfortable talking about sex. Thus, messages get diluted and lose their effectiveness.

San Francisco's openly gay health director, Dr. Mitch Katz, is correct when he says that the goal of being explicit about sexual practices has never really been fully achieved. Doctors talk about how gay men should be careful about unprotected anal intercourse, Katz told us in an interview last week, when in fact insertive anal intercourse carries a relatively low risk when compared to receptive anal intercourse.

For about the last year, Katz has been telling anyone who will listen that, "If you eliminate unprotected receptive anal intercourse by HIV-negative men when having sex with HIV-positive men, you would eliminate at least 95 percent of the seroconversions among men who have sex with men, everything else being equal."

The tired "wear a condom always" safe sex message, Katz says, has been much more political than epidemiologic. "It means you don't have to talk to your partner about his status à doctors and prevention people don't have to get into what kind of sex you have, the advice can apply to gay and straight people, you know, just wear a condom all the time. It's a perfect solution except that nobody will do it."

While the future in terms of treating AIDS looks infinitely better now than 20 years ago, the same can't be said for prevention. And all of the blame can't be placed on the gay community. Society must accept responsibility for perpetuating discrimination against gays, whether they are HIV-positive or HIV-negative. The great hypocrisy, as Dr. Donald Abrams has said, is that HIV prevention messages preach monogamy, yet many in this country oppose gay marriage.

So while people pause and reflect on AIDS at 20, this is one anniversary we certainly won't be celebrating.

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Always watch for outdated information. This article first appeared in 2001. This material is designed to support, not replace, the relationship that exists between you and your doctor.

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