Miami Herald - July 13, 2004
Fred Tasker, ftasker@herald.com

BANGKOK, Thailand - A new generation of U.S. gay and bisexual men is engendering a sharp increase in the number of newly diagnosed HIV cases, as the very drugs that keep alive those who are infected have encouraged risky sexual behavior, researchers said Monday.

This is contrary to the overall downward trend in U.S. AIDS diagnoses, which inched up slightly in 2002 after declining nearly 50 percent from a 1993 peak of 80,010 cases.

"The advent of powerful antiretroviral drugs has had unintended consequences," Dr. Waimar Tun, a researcher with the Centers for Disease Control and Prevention and recently of the Johns Hopkins School of Public Health, told an audience at the 15th International AIDS Conference in Thailand.

The number of new HIV cases diagnosed in the United States jumped 17 percent among gay and bisexual men from 1999 through 2002, compared with a 7 percent increase among men overall, according to a 29-state survey done by the CDC. Effective anti-AIDS drugs became widely available in the mid-1990s.

"Sure it's irrational; people do a lot of things that are irrational," said Dr. Jeffrey Parsons, an AIDS researcher at New York University who documented an increase in "barebacking," or unprotected anal sex. "You could say the same thing about cigarette smoking or riding without a seat belt or other health-damaging things people engage in."

Parsons attributed part of the increase to complacency among young gay men and bisexuals. 'It's certainly true of young people who have never lived through going to their friends' funerals and seeing the physical ravages of AIDS. They don't think it's that big a deal.

'There's also a kind of 'safe sex burnout' after a long time. They've been so careful so long."

Some of the causes of risky behavior -- some documented as increasing HIV infections, some not -- were presented at sessions in Bangkok and in pre-conference interviews:

* Barebacking: Unprotected anal sex is widely understood to be far more dangerous than, say, oral sex, Parsons said.

The practice has complex roots, he said: "Sexual compulsion is one. Loneliness. A desire for intimacy. There's a sense that by not having a piece of latex between you and your partner makes it more intimate."

Some seek safety by having sex with other men of the same HIV status. But they don't always do so rationally.

'An HIV-negative man thinks, 'If he didn't bring a condom, he must be [HIV] negative; I assume he wouldn't put me at risk,' " Parsons said. 'A positive man thinks, 'If he didn't bring a condom, he must be positive too.' It doesn't always work."

* Multiple partners: A 2003 University of Miami School of Medicine survey of 262 gay and bisexual Hispanic men in South Beach and Miami nightclubs indicated that the average gay or bisexual man had had sex with 6.4 partners in the previous year. The range: Zero to 203 partners.

Is such a high number credible? "Oh, yes, absolutely," said Isabel Fernandez, a University of Miami researcher and the study's lead author, who presented her findings in Bangkok. "Of those who had sex, 35 percent had one partner, 35 percent had two or three and 30 percent had more."

* Drug use: A study of 85 black American and 57 Cuban-American youths ages 13 to 19 detained on drug charges at two Miami-Dade juvenile detention facilities showed the average black youth had had unprotected sex 24 times in the previous six months; the average Cuban-American youth, 44 times. The study involved homosexuals and heterosexuals of both sexes.

"That's a huge exposure to risk," said Jessy Devieux, the study's lead author and a researcher at Florida International University.

Nationally, blacks accounted for more than half -- 55 percent -- of the new HIV cases diagnosed in the United States between 1999 and 2002, according to the CDC's 29-state survey. (Florida was one of the 29 states surveyed.) The number of new HIV cases diagnosed among Hispanics increased 26 percent during this period.

* Sex chat rooms: "The virtual bathhouse" is the term researchers use for Internet chat rooms that help gay and bisexual men find partners for sex. Studies have indicated that the resulting anonymity has increased HIV transmission, a California researcher says.

Researchers are trying to intervene. One new study shows that in San Francisco, most men using the chat rooms didn't mind -- in fact, appreciated -- finding AIDS-prevention information there. The study was done by the Center for AIDS Prevention Studies at the University of California at San Francisco.

"Most were receptive," said researcher Gregory Rebchook. "We made concrete suggestions, we had testimonials by HIV-positive men, let them share experiences."

Such programs are fine if they get input from gay men themselves, said Frank Strona, who said he is gay, and who runs a gay men's website -- SafeSexCity.Com.

But the programs must be focused on helpful information, not scolding, he said.

'We've been castrated and labeled as 'men who have sex with men,' " he told a Bangkok audience. "It's not easy being young and sexually active and being told to stop having sex."

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