San Francisco Chronicle - Friday, August 27, 1999
Sabin Russell, Chronicle Staff Writer

Of greatest concern to researchers is that nearly a quarter of those participating in a University of California at San Francisco survey said they had had unprotected anal intercourse with a partner whose HIV status was either unknown to them or different from their own. Epidemiologists consider that to be the most likely behavior to reignite a new round of infection in the gay population.

"I feel sad for my community," said Dr. Mitchell Katz, director of the San Francisco Department of Public Health and a gay man. "I do think that this could have been the time when we made significant progress in the elimination of this disease."

Katz describes the current trend toward less safe sex a lost opportunity. New AIDS therapies that have cut the death rate from the disease may be making those who harbor the virus less infectious -- but instead of HIV infection rates going down, they have remained stable at about 500 per year in San Francisco.

"If behavior had stayed the same, with (the new drugs) we might have been able to see a decrease to perhaps 250. This was our time to truly make inroads against infection," he said.

The study published in the international journal AIDS is the latest in a string of reports that portray the unraveling of the safer-sex ethos that emerged when AIDS was first identified as a viral disease in the mid-1980s.

"All of these studies are pointing in the same direction, which is very disturbing," said Maria Ekstrand, a UC San Francisco psychologist and lead author of the new report.

A recent study by the San Francisco Department of Public Health noted that the level of risk of infection in unprotected sex varies according to the type of sexual act involved. Insertive anal intercourse, for example, is substantially less risky than unprotected receptive anal sex.

The latest study suggests, however, that the number is growing of gay men who practice the most dangerous forms of unprotected sex. In 1994, for example, 31 percent reported unprotected receptive anal intercourse. In 1997, the number grew to 41 percent.

Ekstrand and her team of researchers interviewed at random 510 young gay men -- part of a highly studied group who have been followed since 1992, when they were ages 18 to 29.

The study found that the percentage of men who acknowledged having had more than one episode of unprotected anal sex per year rose to 50 percent from 37 percent in just a three-year period. The report compared data gathered in 1996 and 1997 to similar data collected in 1993 and 1994.

One-quarter of the men also acknowledged that when they engaged in unprotected anal sex, they did so with partners whose own health status was either unknown, or the opposite of theirs.
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