Early Lessons Forgotten, AIDS Conference Told
Thursday, August 7, 2008; Page A02
MEXICO CITY, Aug. 6 -- Twenty-five years after AIDS was branded the "gay plague," the virus is again exacting a disproportionate toll on men who have sex with men, not only in the United States but also in countries where the epidemic is just emerging.
Globally, men who engage in homosexual relations are 19 times as likely to contract HIV as the rest of the population, according to data released at the International AIDS Conference. Here in Mexico, men who have sex with men are 109 times as likely as others to develop HIV, while in the United States, 53 percent of new infections in 2006 were in gay and bisexual men.
Homophobia, biology and misplaced confidence that AIDS has become a treatable chronic illness are contributing to a disturbing flashback among scientists and activists, who say much of the world appears to have forgotten the early lessons of the AIDS epidemic.
"We have come full circle," Michel Sidibe, assistant secretary general of the United Nations, said in an interview. "In the beginning, gay men in places like San Francisco and New York proved we could do prevention. When we moved from that and started talking about the broad scope of the epidemic, suddenly men who have sex with men became marginalized."
When the mysterious AIDS virus first appeared in the 1980s, it was labeled a homosexual disease. Conservative religious activists suggested the deadly illness was punishment for sexual behavior, and President Reagan remained silent.
Gay leaders, stunned by the rapid deaths of so many friends, mobilized an enormous grass-roots movement that sparked government action and, more significantly, effective prevention campaigns within the community. HIV infections among gay and bisexual men fell dramatically for a decade.
But since the mid-1990s, infection rates in gay men have been rising, especially in minority communities where homosexuality often still carries a powerful stigma.
The reasons for the rise include "prevention fatigue," confidence in new antiretroviral drugs, the use of methamphetamines and the arrival of a generation of young men who did not experience the ravages of the 1980s, said Richard Wolitski, acting director of the division of HIV/AIDS prevention at the Centers for Disease Control and Prevention.
"They haven't lived through the earlier days of the epidemic," he said. To them, AIDS may appear to be a manageable illness.
Many gay men in the United States employ a prevention strategy known as "serosorting" in which they try to calculate risk based on their own and their partner's HIV status. The problem with that approach, Wolitski said, is that a large number of men do not know they are infected and unknowingly spread the disease.
Simple biology also contributes to the problem, Wolitski noted. "This is a virus that is transmitted more easily via anal sex than vaginal sex," he said.
What worries public health leaders is that many countries, particularly in the developing world, appear to be repeating the early patterns of the epidemic.