May #47 : The Bottom Line

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May 1999

The Bottom Line

CDC report on risky sex raises many fears, a few jeers

The Centers for Disease Control and Prevention (CDC) released a study in February that had AIDS groups across the country clutching their pearls: After years in decline, the number of San Francisco gay men who reported having unprotected sex rose from 30.4 percent in 1994 to 39.2 percent in 1997.

The data mirror what Gary Cohan, MD, a veteran AIDS doc at LA’s Pacific Oaks Medical Group, has been seeing  in his practice. “We’re witnessing a sexual recidivism unthinkable three years ago,” he said, having recently replaced the HIV treatment bulletins on his walls with vintage safe-sex posters à la 1987. “AIDS has become white noise. Everyone’s packing up their marching shoes and going out to party.”

The findings, culled from 22,000 surveys conducted by San Francisco’s Stop AIDS Project, corresponded with the CDC’s recent data documenting another indicator of unprotected sex: rising rates of rectal gonorrhea. The group most likely to eschew rubbers was 25-to-29-year-olds—“the impressionables,” said Spencer Cox of New York’s Treatment Action Group. “They’re least likely to have had a friend die of AIDS and most likely to be influenced by its appearance as a manageable disease.”

Not true, said Demetri Moshoyannis,  who works at the Names Project and was among those San Franciscans surveyed by Stop AIDS. “I’m 27, and I’ve seen several friends die of AIDS. Since we’ve been sexual, all we’ve known is safe sex. After 10 years, of course it’s going to break down, especially if support mechanisms aren’t there to catch it.”

Gay groups nationwide were quick to cry “Second wave,” mindful of a widely debated 1994 study by Columbia University epidemiologist Laura Dean, PhD, which posited that “even slight increases in unprotected sex—just one additional unsafe sexual partner per year—and the epidemic could again explode.” AIDS Action Council’s Daniel Zingale fired off a doomsday press release urging Clinton to increase federal funds for prevention. “An HIV infection iceberg is about to hit the bow of the U.S. epidemic,” Zingale wrote. “Let’s change course early this time.”

But not every gay leader was quick to raise the red flag. In a syndicated op-ed piece, activist Eric Rofes questioned the validity of the CDC’s conclusions, cautioning against the worst-case conclusion that more unprotected sex means more infections, since many gay men are practicing negotiated safety with same-serostatus partners. Moshoyannis also found “basic flaws” in the survey: “It never looked at why we’re seeing these supposed increases, what’s really going on between two people who have unsafe sex.”

So far, the CDC count is holding steady at an estimated 40,000 new HIV cases a year, though today’s infections may not be reported for years.

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