Important note: Information in this article was accurate in 2000. The state of the art may have changed since the publication date.
San Francisco Chronicle - Sunday, December 3, 2000
Dan Wohlfeiler
First, let's stop saying "AIDS is not a gay disease." That may have made it easier to get funding from a government which dared not speak its name. But gay men -- including those of us who self-identify as such and those who don't --make up the the majority of male AIDS cases in all ethnic groups in California, and we will continue to do so for the foreseeable future. Gay intravenous drug users face the highest risk of all. In San Francisco, gay men account for no fewer than 85 percent of new HIV infections.
This is important because if we're going to avert as many infections as possible, we need to target our efforts appropriately. A recent study found that in 1999, gay men accounted for 46 percent of all AIDS cases in the United States, but received just 28 percent of prevention funding. While it's true that all of us are at risk, some of us are at much greater risk than others.
Epidemiology teaches us that if you prevent disease among those at highest risk, those at lower risk benefit.
We as gay men also have to challenge some myths of our own, most importantly, our belief that "the number of partners doesn't matter." If we are consistently safe, then the number of partners makes no difference. Period. But if we are inconsistently safe -- as study after study has shown that a sizable minority of us are -- then the number of partners we have determines the course of the epidemic.
Most of us are safe most of the time. If we have unsafe sex, most of us have it with only one partner. Some of us have it with two or three. But some of us have a new partner, without using condoms, much more frequently, and not with people we know well enough to be sure they share our own HIV status. The results: More of us are getting infected. It's becoming harder for us to knock the virus out.
Which leads us to the next myth: "AIDS is over." Most who take the new treatments are grateful for their decreased viral loads and their extended lease on life. But they'd rather be uninfected, and not have to take dozens of pills every single day for the rest of their lives.
Among supporters of this myth are those who never believed the virus existed in the first place. Pharmaceutical ads showing HIV-positive men scampering up mountains don't help. The myth contributes to our collectively letting down our sexual guard, and caring less about AIDS.
Rather than too willingly hope that low viral counts mean AIDS is over, that those of us who are infected are not as infectious, and that we can all move on to other causes, we should consider ourselves blessed by this window of opportunity that new treatments provide. We don't need to be prudish; just prudent.
On World AIDS Day and every other day, we certainly need to be concerned by what's happening in Africa, Asia, and Latin America. In addition to supporting prevention efforts overseas, let us also cherish the precious victories we have won, and strengthen our resolve to continue a more honest, and better, fight at home.
Dan Wohlfeiler is a researcher at University of California, San Francisco.
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