San Francisco Chronicle - Friday, July 12, 2002
Dave Ford

For those of us who lived through the grim AIDS-besotted 1980s here, there's only one possible reaction: Uh oh. Followed by a string of really foul expletives.

First, a quick primer for the uninitiated and a brush-up for the rest of us. The human immunodeficiency virus, or HIV, weakens and ultimately destroys the body's immune system.

Once weakened, the body is vulnerable to a number of medical syndromes. A person who contracts any combination of two or more of these is said to have acquired immune deficiency syndrome, or AIDS.

HIV (no, not "the HIV virus," a redundancy) is most effectively transmitted from one body to another through the intermingling of body fluids such as semen and blood. (It has a low-to-negligible transmission rate through saliva.)

Drug users who share needles are at risk for contracting the virus because HIV-infected blood can coat the barrel of the hypodermic or needle and thus be passed to the person next using it.

Folks who have unprotected sex -- that is, sex without a condom -- also are at high risk for HIV transmission. Historically, HIV in the United States has disproportionately affected gay men, but heterosexual sex is the most common transmission route in many other countries -- especially in developing nations.

When the so-called anti-HIV drug cocktail hit the U.S. market in the mid- 1990s, the mixture of medicines appeared to turn HIV infection into a manageable, long-term illness. Those who had previously faced certain death within a predictable time span of contracting HIV were able to delay the onset of AIDS seemingly indefinitely.

It was a breakthrough of epic proportions: Friends I had expected to lose then are alive and well now because of the cocktail. Still, it was a good news/bad news situation. The good news was that it promised longevity. The bad news, besides the side effects (diarrhea is common), was that the cocktails weren't proven out over time.

Now comes a five-year UCSF study showing that increasing numbers of newly infected gay men in San Francisco are carrying HIV strains resistant to two classes of new AIDS drugs. In 1996, 2.5 percent of those tested in the study carried a resistant virus; in 2000, that number rose to 13 percent. That's the "over time" in "weren't proven out over time."

Which brings us to another point, an especially touchy one.

In the wake of the cocktails' appearance, some gay men felt unburdened from the need to always wear a condom during sex.

Others, including a whole generation of young gay men, felt that, since HIV was now a manageable condition, condom use wasn't necessary. Hence the rise of "barebacking," the practice among some gay men of having unprotected sex.

If, in the UCSF study, 13 percent of gay men are infected with a drug- resistant strain of HIV, that means they are, first and foremost, getting infected.

I have two reactions to this. One, it drives me nuts. Two, I completely understand.

It drives me nuts because gay men are still putting themselves at high risk for contracting HIV. But I understand it because humans are complex.

The human heart is strange, the psyche stranger. Sex is the most mysterious of all human connectors, and what human doesn't want to feel connected?

A condom, as the educational messages say, is an effective barrier against HIV. But it's a barrier; if sex is about getting as close as possible to another human being and experiencing pleasure along the way, who wants a barrier? And who wants a barrier for the rest of his whole damn life?

Which is not to excuse the behavior, especially in light of a study conducted by the Centers for Disease Control and Prevention in Atlanta and recently quoted in the New York Times.

The study involved 5,719 men interviewed at bars, dance clubs and other meeting places in six cities. It found that 90 percent of African Americans, 70 percent of Latinos and 60 percent of whites who were found to have HIV did not know they were infected -- and perceived themselves to be at low risk for HIV transmission.

Blacks are disproportionately at risk for HIV infection in the United States:

55 percent of new infections in 25 states between 1994 and 2000 were among African Americans, who make up 12 percent of the nation's population. Since 1995, blacks have had higher HIV infection rates in the United States than whites.

So reaching young gay men of color with pertinent educational messages is proving to be a complex challenge.

The solution? No one yet knows. But this might be an instructive moment to think globally and act locally.

You may not have an extra $10 billion to lend to the fight against AIDS. But you can arm yourself with facts, know your limits -- and, if it's pertinent to your life, be sure you and those you love play safe.

That way, maybe someday we'll turn uh oh into whew.

E-mail Dave Ford at dford@sfchronicle.com.

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Always watch for outdated information. This article first appeared in 2002. This material is designed to support, not replace, the relationship that exists between you and your doctor.

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