Homosexual men, whose widespread adoption of safe-sex practices came close to halting the transmission of the AIDS virus in their communities during the mid-1980s, appear to be “relapsing” into unsafe sexual activities, threatening a new wave of deadly infection through their ranks.
Data presented here Thursday at the international AIDS conference--along with trends reported by venereal disease clinics around the country--shows that the level of unsafe sex among gays, while much lower than in the early ‘80s, is climbing.
In San Francisco, for example, the number of gay men in one study who were newly infected with the human immunodeficiency virus climbed to 2.6% in 1988 after hovering around zero in the survey group during the two previous years. In Chicago, the number of new HIV infections in one study group climbed to 2% in the year ending in June, 1989, from 1% a year earlier.
While these figures are far lower than the double-digit rates of transmission in the early ‘80s, before AIDS prevention campaigns took hold, they are worrisome to AIDS organizations based in the gay community and to public health officials. This is especially true in this city, where more than 50% of the gay men are HIV-infected.
Even though the overwhelming majority of gay men practice safe sex most of the time, “This is no time to declare victory and abandon the AIDS prevention field,” said Pat Christian, executive director of the San Francisco AIDS foundation. “The problem of relapse is real and must be addressed immediately.”
“The long-term maintainance of health-motivated changes--be it sobriety from alcohol, adherence to a low-calorie diet, or an exercise regime--is often more difficult than the initial phase of behavioral risk reduction,” said Ron Stall of the UC-San Francisco Center for AIDS Prevention Studies.
Stall said that most existing safe-sex campaigns aimed at the gay community are outdated because they emphasize adoption of safer practices--rather than their maintenance.
Stall and co-researcher Maria Ekstrand presented data from San Francisco showing that high-risk behavior among gays--defined as anal intercourse without a condom--declined steadily from 40.6% in 1984 to just 7.3% in 1988.
While 48% of the men in their survey were at low risk throughout the survey period, 19% of the men “relapsed"--that is, after adopting low-risk behavior, they engaged in one or more acts of unprotected intercourse during the study. A single act of intercourse can transmit the AIDS virus.
Relapse was most likely to occur among young men in their 20s, blacks and Latinos, men in relationships and men who use drugs or alcohol during sex. All four groups will be targeted in new campaigns if government funding can be secured.
“Some of these suggestions may make some people uncomfortable,” Ekstrand acknowledged. But, said Dr. Mervyn Silverman, president of the American Foundation for AIDS Research, which announced $145,000 in new grants to help prevent relapse, “the only people I am afraid of offending” are the gays who could benefit from life-saving behavioral changes.
“Safe sex is not a decision you make once,” said Martin McCombs, a health educator with the Stop AIDS Project in Los Angeles. “It is a decision you have to make every time you have sex.” The project, part of the Gay and Lesbian Community Services Center, will begin holding safe-sex maintenance workshops for gay men in August.