CDC stats show unsafe sex practices are increasing

AIDS group calls for greater HIV prevention focus

It’s becoming clear that Americans are returning to unsafe sex practices, which could lead to a new statistical bump in the HIV infection python, a national AIDS advocacy group says.

"It’s true we’ve done a good job on investing in AIDS research and treatment, and as a result the AIDS death rate is coming down dramatically," says Daniel Zingale, executive director of AIDS Action, a Washington, DC-based group that represents 3,200 community-based organizations that serve people with HIV/AIDS.

"But we haven’t invested in prevention, so HIV infection rates are going up," Zingale says.

Zingale specifically refers to the recent Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report1, which shows an increase in the percentage of men engaging in anal sex without using condoms between 1994 and 1997.

The MMWR referred to an annual street survey conducted by The Stop AIDS Project in San Francisco. The survey, taken of 21,000 men found in bars, neighborhoods, and at outdoor events in San Francisco, found that the percentage of men who have sex with men who reported having had anal sex increased from 57.6% in 1994 to 61.2% in 1997. Among those men, the percentage reporting that they always used condoms declined from 69.6% in 1994 to 60.8% in 1997. And the most pronounced decline in consistent condom use occurred among men in the 26-29 age group.

The same survey also found that the proportion of men who reported having had multiple sex partners and unprotected anal intercourse increased from 23.6% in 1994 to 58% in 1997. These increases occurred in all racial groups.

The CDC also reported that male rectal gonorrhea incidence declined from 1990 through 1993 from 42 per 100,000 adult men in 1990 to 20 per 100,000 adult men in 1993. However, the trend has been reversed. In 1997, the male rectal gonorrhea rate had increased to 38 per 100,000 adult men, and the rate was highest among men ages 25-34, with a rate of 83 cases per 100,000 men in that age group.

AIDS complacency takes a toll

The survey’s findings suggest that Americans are beginning to lose their fear of HIV infection, Zingale says. "It confirms our fears about AIDS complacency taking a toll," he says. "I think in part it’s driven by the misperception that the worst is over, and the good news about medical breakthroughs has raised some people’s hopes beyond reason."

Zingale’s group blames the trend partly on what they say is the federal government’s lack of interest in HIV prevention. "For the past four years the Clinton administration has invested no new money for HIV prevention," he says.

Specifically, AIDS Action reports that CDC funding for prevention efforts was $617 million in fiscal year 1997, $634 million in fiscal year 1998, and $657.8 million in fiscal year 1998, with $666 million proposed in the 2000 fiscal year.

Another controversy is that some communities and states are resisting programs that allow injecting drug users to exchange dirty needles for clean ones. A recent New York Times article reported that New Jersey officials not only prohibit needle exchanges, but also arrest volunteers who engage in the practice.2

AIDS activist Diana McCague, who had been distributing clean needles to drug addicts since 1994, has been arrested twice. Her last arrest in the fall of 1998 forced her organization, Chai Project in New Brunswick, NJ, to stop distribu ting syringes and resort to distributing condoms, brochures, and bleach kits to sterilize needles.

AIDS makes orphans of 9,100 NJ kids

Meantime, New Jersey has the nation’s highest rate of HIV infection among women and children, including 9,100 orphans whose mothers have died of AIDS. And even the businessman who heads the state’s Advisory Commission on AIDS has reached the conclusion that a needle-exchange program could cut the state’s number of new HIV infections by as much as 50%.2

State officials, such as New Jersey Gov. Christine Todd Whitman, say distributing clean needles will encourage people to become drug addicts. Zingale disagrees. "It’s the same mentality that making a condom available to a young person encourages them to have sex."

Adding to the controversy is the federal ban on needle-exchange funding, he adds.

AIDS Action has its own 10-point plan to reduce the HIV infection rate. The plan is as follows:

    1. Increase federal HIV prevention funding by 25%.

    2. Provide treatment on request to help stem the twin epidemics of drug abuse and AIDS.

    3. Launch national roll-out of proven HIV prevention counseling with CDC grants and comprehensive HIV prevention programs for adolescents.

    4. Make HIV testing safe, swift, and simple, including using CDC testing vans to reach people who might not go to a clinic or doctor’s office.

    5. Use state-of-the-art marketing to sell prevention efforts, including a new HIV prevention ad campaign; enlisting the help of adolescents to design and test ads intended for their generation; allowing condom ads on programs rated "S" for sexual content under the new TV rating system; and building comprehensive sexuality education curricula that are not limited to teaching abstinence.

    6. Put the AIDS hotline on-line to reach young people, such as an HIV/AIDS Prevention Web Page with links from popular Web sites used by at-risk populations.

    7. Launch an anti-stigma and healthy living campaign for people living with HIV.

    8. Have the surgeon general launch a nationwide campaign for HIV prevention for women and people of color.

    9. Promote physician patient dialogue about HIV risks, making grants available to AIDS Education and Training Centers to promote better HIV/AIDS knowledge in the medical community.

    10. Make HIV vaccine development a top priority of the federal government.

References

    1. Page-Shafer KA, McFarland W, Kohn R, et al. Increases in unsafe sex and rectal gonorrhea among men who have sex with men — San Francisco, California, 1994-1997. MMWR 1999; 48:45-48.

    2. Kocieniewski D. New Jersey takes hard line on needle exchanges. The New York Times, Feb. 2, 1999.