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90s seroconversion rates

Jan 22, 1998

There's been a lot of talk lately about gay men seroconverting at increasing rates in the 90s. But there don't seem to be many published studies documenting this. Do you know of any unpublished studies that do or don't confirm that gay men are seroconverting at higher rates?

If so, what kind of incidence rates are they reporting?

Response from Mr. Sowadsky

Hi. Thank you for your question. Anecdotally, there are reports of HIV once again increasing among Gay men, especially young Gay men. Unfortunately, there is not a lot of direct evidence thus far to verify this. This is because many places do not have HIV reporting (only AIDS reporting). Because the length of time from infection, to a diagnosis of AIDS is 10 years (on average), any risk factor statistics you will see for persons with AIDS, tells us how people became infected an average of 10 years before, not today. Until we have nationwide HIV reporting, data on the recent spread of HIV among any risk group (including Gay men) will be very limited. However, there is an increasing amount of indirect evidence that HIV is once again on the verge of infecting the Gay community at increasing rates. This is based on several studies.

One report that has raised significant concerns regarding HIV in Gay men, is a study that looked at rates of Gonorrhea infection among Gay men in several cities in the USA. Over the years, rates of Gonorrhea in the USA have been decreasing. Although overall Gonorrhea rates in the USA continue to decrease, a recent study has now shown that among Gay men specifically, rates of Gonorrhea are once again increasing. Like HIV, Gonorrhea is transmitted through unprotected anal intercourse and giving oral sex. The increase in Gonorrhea rates is strong evidence that Gay men are no longer practicing safer sex as much as they used to. Because Gonorrhea and HIV are transmitted in similar ways, an increase in Gonorrhea rates indicates that HIV rates would be expected to increase as well. This is especially true since there is a strong link between Gonorrhea infection and HIV. It has been found that having Gonorrhea can make one more susceptible to HIV infection. Having Gonorrhea can make it easier for HIV to get into the bloodstream. In addition, in men who have HIV and Gonorrhea, they are more infectious to others, as far as HIV is concerned. One study showed that approximately 25% of Gay men who had Gonorrhea, also had HIV. When one looks at all of this together, it strongly indicates that safer sex is on the decline among Gay men, and that HIV rates are expected to rise.

There are other studies that are also showing that Gay men are practicing safer sex less often. For example, a great concern among those working in AIDS prevention has been that, because of these new drug cocktails against HIV, Gay men will no longer fear becoming infected with HIV, and will go back to practicing unsafe sex. Until recently, that concern has been largely theoretical. Now, it has become reality. In a recent study in San Francisco among Gay men, researchers have found that some Gay men are no longer practicing safer sex as often. This was partly because some men no longer fear getting HIV, due to the new cocktails. In this study, 26% stated they were less concerned about getting infected with HIV, because of the new drug cocktails. 13% stated that they were willing to take a chance of getting infected when having sex. And 15% said they had already taken that chance. Some of these men specifically stated that they no longer feared infection with HIV, since they thought that they can take the cocktails to prevent becoming infected.

There are various other studies that have also indicated an increase in unsafe sex among Gay men. For more information on the increasing rate of Gonorrhea among Gay men, and the increase in unsafe sex among Gay men, let me refer you to the following report:

Gonorrhea Among Men Who Have Sex with Men -- Selected Sexually Transmitted Diseases Clinics, 1993-1996

Misclassification problems / Heterosexual misclassifications?
Am I immune?

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