AIDS infections start to swing upward again
Public-health officials have one thought in mind: The AIDS message needs new life because HIV infection can still mean death.
Monday, October 22, 2001
Dispatch Medical Reporter
Gone is the idea of inevitable death soon after infection.
Also gone, for an increasing number of young gay males, is the notion of important questions before an intimate encounter, of a condom as a prerequisite for intercourse.
While its reputation as a heavyweight killer in the gay community has subsided thanks to drug cocktails, AIDS continues to affect young men, especially minorities, at alarming rates.
Two Seattle studies released this year showed a 17 percent increase since 1994-95 in unprotected sex among HIV-negative gay and bisexual men, and a 10 percent increase from 1998 to 2000 in unprotected sex among HIV-positive men.
"The era of dramatic declines is now over," said Dr. Helene D. Gayle, director of the National Center for HIV, STD and TB Prevention at the Centers for Disease Control and Prevention in Atlanta.
During the midsummer National HIV Prevention Conference, Gayle said she was troubled by recent studies showing infection rates comparable with those of the 1980s.
"Two decades into the epidemic," she said, "these latest data show us that we are at a turning point: We either move forward toward further reducing HIV or risk going back to a period of elevated infections."
The CDC wants to cut new infections in half by 2005.
To slice away at an epidemic that infects about 40,000 Americans a year, though, is a daunting task.
Distanced from the days of routinely losing friends and lovers, more gay teen-agers and young adults are testing positive.
They might stay healthy longer through medications, experts caution, but they shouldn't brush off the risks.
"In the past two or three years, we've seen an increase in STDs (sexually transmitted diseases), more risky behaviors, more partners and more use of drugs," said Michelle Headlee, supervisor of community services for the Columbus Health Department sexual-health team. "We've been talking to some younger men who don't care about having safe sex; they think they aren't going to get it (HIV). It's kind of scary."
Gay men also are coming out younger and, therefore, having sex and putting themselves at risk sooner.
Of the 1,391 Franklin County males reportedly living with HIV or AIDS at the end of 2000, 54 percent were younger than 39 -- and 24 percent had contracted the disease as teen-agers or young adults. (By nature, because some people are never tested, HIV and AIDS numbers are artificially low.)
Fifty-one percent, meanwhile, said they still have sex with other men.
AIDS, of course, is not exclusively the burden of homosexual men: More than 30 percent of the clientele served by the Columbus AIDS Task Force is heterosexual.
Still, the public-health community -- which thought it had convinced most gay men of the importance of safe sex -- can't help being shocked by the increasing cases of unprotected sex, not to mention the infection rates.
Billy Cardamon, 28, doesn't need experts to tell him about the shift in attitudes.
Openly gay for about eight years, he hasn't attended a single funeral for someone who has succumbed to AIDS.
"I know a couple people who are (HIV) positive, and a friend of mine found out he was positive not too long ago, but I don't know of anyone who has died," the Victorian Village resident said.
Yet the numbers could rise, he fears, before the infection rates dip again.
Cardamon attended junior high and high school in a world well-aware of AIDS, and in health classes received a healthy dose of prevention-oriented education, prompting him to take precautions that prevent the spread of the virus.
Having lapsed, however, he understands how others, particularly gay men in their late teens and early 20s, might engage in risky sexual behavior.
"People have just become really relaxed about the entire issue," he said. "There's a lot of people out there just living with HIV, and there are so many drugs available. I don't think people see it as quite as much a threat as they used to."
Young people of any sexual orientation, Cardamon said, tend to experiment and get "swept up in the moment," more so than their older counterparts.
"It's a young, invincible feeling and a lack of education," he said.
To his more carefree friends, Cardamon delivers a message: "I tell them to be safe and say, 'Whatever you're doing, it's not worth your life.' "
That message was everywhere a decade ago.
"During that era, we were all either standing by the bedsides of those we cared about or going to memorials," said Sue Crumpton, who has spent 10 years working in AIDS prevention and during the summer took over the post of executive director of the Columbus AIDS Task Force.
Her son, Nicholas, died of AIDS in 1995 at age 26.
These days, she said, too many men are frighteningly flippant about the risks.
"I heard somebody say the other day, 'Even if I get it, I'll have 30 good years,' and I thought, 'Oh, my gosh!' "
Passion, as Cardamon noted, sometimes fogs good sense.
"If anything," Crumpton said, "your sexual behavior is more primal than the other behaviors we struggle with -- like eating, smoking, etc.
"It's not some anomaly in the gay community. This is human behavior we all struggle with."
Among young gay men, other factors -- such as depression -- play into risky behavior, said Radu V. Saveanu, interim chairman of the Ohio State University Department of Psychiatry.
"I know of some men who became so depressed that they purposefully went out and tried to become infected," he said.
Some men allay their fears with misinformation.
"The attitude is that these meds are available: 'There are pills I can take that can stop it,' " said Chris Ahrens, an OSU research nurse in the AIDS Clinical Trials Unit who is embarking on a study involving the sexual behavior of high-risk gay men.
In fact, though seen as a godsend since they became available about five years ago, protease inhibitors offer no guarantees.
"They don't understand all the side effects," Crumpton said. "People are dying from side effects."
In the black and Latino communities, where homosexuality is more closeted and stigmatized, education is exponentially more difficult.
"The biggest problem . . . is that they won't admit to being bisexual or gay," said Headlee of the health department.
To provide information and protection to the most difficult-to-reach populations, the department tries to maintain a presence in meeting spots such as parks and bathhouses.
"We're all challenged as to what can be done," Crumpton said.
In recent months, the task force started a campaign -- one of in-your-face public service -- previously tried only in San Francisco.
The educational effort includes postcards distributed at nightclubs that depict men in sexual embraces and pose the question "How do you know what you know?"
Billboards posted this summer in the center of several of the city's gay hot spots reinforced the message.
As they face the specter of a resurgent, 20-year-old disease, public-health officials have one thought in mind: The AIDS message needs new life because HIV infection still can mean death.
"I think that at this point in the pandemic," Crumpton said, "we have to get people's attention."
"That campaign has got people talking," he said. "It gets the subject of HIV and AIDS back into our community."
Historically, the focus has centered on keeping people free of the disease.
An important part of the new campaign targets men who are HIV-positive.
"Now that they are living with it as a chronic disease," Ahrens said, "we need to educate them.
"If tested early, they have 1,000 options. Later, they don't have any options."
The rest of the world can do its part, too.
"In the big picture," he said, "if people were less judgmental about lifestyles and about disease status, that would be helpful."
|©2002 Billy Cardamon||Last update: July 31, 2003 11:33 AM|