Why haven't we been able to reduce this number? Part of the reason is the epidemic itself is changing. The disease started mainly in gay men, spreading among them through unprotected sex. Now it's moving more and more to intravenous drug users and their sex partners, a group at the fringes of society that's harder to control and treat.
But the infection rate still remains alarmingly high among gay men. And new studies presented at the 8th Annual Conference on Retroviruses in Chicago show that unsafe behavior -- such as unprotected sex -- may be on the increase. Does this mean that more young gay men are contracting the virus?
"A FLUKE"? Linda Valleroy, an epidemiologist at the Centers for Disease Control, began trying to tackle this question way back in 1993. "We realized there were very little data on young men who had sex with men," she explains. At the time, the only information came from a survey in San Francisco of males 15 to 22, which showed that an alarming 7% of them already were infected. Of course, this was San Francisco, one of the original centers of the epidemic. "So we were hoping that was a fluke," says Valleroy.
Valleroy and her team planned to survey men in seven other cities. It wasn't an easy study to do. "You can't just knock on doors and ask, is there a young gay man in your house," she says. Neither can researchers only go to gay bars, because the nightclub hoppers might not represent a cross-section of the gay male community.
So Valleroy's first task was to find men who were willing to be interviewed about their sexual habits and to be tested for HIV. "We did a lot of research to see where gay men might go," she says. The likely places: beaches in Miami, and dance clubs, stores, restaurants, and health clubs in Baltimore, Dallas, and other cities. To make the study cost-effective, "We tried to go to a place where we could sample seven 15- to 22-year-olds in a 24-hour period," she says.
DEPRESSING RESULTS. Valleroy's crew then prowled the cities in a van, looking for men to ask about their sex lives. The approach had to be carefully planned. That's why her team itself included many gay young men. "They practiced being friendly, positive, and nonthreatening. After all, we had to convince these men to jump into a van at midnight and be interviewed about their lives, and tested for HIV," Valleroy says.
The researchers were successful in finding plenty of young gay men. But the results were depressing. The same high incidence of infection that had been found in San Francisco appeared everywhere from Dallas to Seattle -- an average of 7% among this age group. "We hoped we wouldn't find it, but we did," Valleroy sighs.
That wasn't the end of the study. Her team had developed the infrastructure for surveying gay men -- from a van by experienced interviewers -- so Valleroy wanted to continue. "The results were so shocking to us that we said, let's keep going and do the next age group -- 23- to 29-year-olds," she explains.
HOPES DASHED. Her expectation was that the rate among these older men wouldn't be much higher than among the younger group. "We hoped that they would be more protective when they get older and that the incidence would cap," she says. But again, the hopes were dashed. The average incidence across six of the cities was 12%, with 18% infected in Dallas.
Even more alarming was the staggering rate among black gay men in these cities -- nearly one-third of those tested were infected with HIV. The reason? Still a mystery. "It could be prison, or juvenile detention, or higher drug use," speculates Valleroy. "We really need to do something innovative for the African Americans."
Valleroy's study highlights a simple truth. AIDS is a preventable disease. All it takes is not having unsafe sex, or sharing needles, or otherwise being exposed to blood from infected people. But it's clear that the nation hasn't been able to get this message across. And as long as a significant number of young men keep getting the disease before they're old enough to vote, the epidemic won't go away.
For more information, see the Retrovirus Conference's Web site. By John Carey in Chicago