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Why a rise in AIDS?
Sep 26, 1996

I am researching the rise in AIDS cases over the past ten years. If I have heard correctly, it is not due to rise in homosexuality. Can you please give me some insight on this topic? Thank You.

Response from Mr. Sowadsky

Hi. Thank you for your question.

When it comes to AIDS, we're really seeing 2 epidemics in the world....one in Developing/"Third World" Countries, and the other in "Westernized" Countries. The number of cases of HIV transmission among Homosexual/Bisexual men is radically different between the two epidemics.

In Developing countries, this has always been, and continues to be, a heterosexually based disease. Most cases of HIV infection are transmitted by heterosexual sex. In these parts of the world, condom use is very low. This is because condom use is often culturally unacceptable, and also because of the rare availability of condoms. The increasingly high rate of HIV/AIDS is consistant with the increasingly high birth rate in this part of the world. Most of the worlds AIDS cases are in this part of the world, therefore, most of the worlds AIDS cases are in heterosexuals, not in Homosexuals/Bisexual men.

In Westernized countries, the epidemic began in Homosexual/Bisexual Men, and IV drug users. Most cases of HIV/AIDS continues to be in this population in this part of the world. However cases of heterosexual transmission continues to rise in Westernized nations. The number of cases of HIV infection in Westernized countries has actually stabilized. This is because the number of new cases of HIV infection is now approximately equal to the death rate due to AIDS. Compare this to Developing countries, where the number of HIV cases continues to increase.

In previous years, especially in the late 1980's, the number of cases of HIV/AIDS was decreasing in the Gay community. This was due to an intense education campaign, getting Homosexual/Bisexual men to use condoms with all of their sexual partners. Unfortunately, this trend is now beginning to reverse itself. The rate of HIV infection is once again increasing among Homosexual/Bisexual men. This is due to a number of different reasons. Because the Gay community sees this disease affecting them so often, they have become desensitized to AIDS over time. In addition, young Gay men (incorrectly) perceive AIDS to be an older Gay mans disease. Young Gay men often will not use protection when having sex with younger Gay men. The Gay community is also less educated about AIDS and Sexually Transmitted Diseases (STD's) as compared to the late 1980's, and are participating in high risk sexual activities more often. Also, Gay men now perceive AIDS the same way cigarette smokers perceive lung cancer, emphysema, and heart disease. Both groups know very well that what they are doing today can ultimately kill them years later. However both groups are willing to take those risks today, and worry about their health later in their lives. The Gay community knows quite well that what they are doing now (having high risk sex with multiple partners) can kill them years later (by getting AIDS). However, like smokers, they are willing to take those risks today.

Since the average period of time from HIV infection to full-blown AIDS is about 10 years, we can expect to once again see an increase in AIDS cases among Homosexual/Bisexual men in the next 10 years. Remember, AIDS data tells us how the infection was spread an average of 10 years ago. HIV data tells us how the virus is being spread today.

So when we look at the HIV/AIDS epidemic worldwide, most of the cases of AIDS that we see continues to be among the heterosexual community. We expect this trend to continue. In Westernized countries, we are presently seeing a decrease in the number of AIDS cases in Homosexual/Bisexual men (because of education efforts 10 years ago), but we can expect to see this number rise again in the next 10 years. If you have any further questions, please feel free to call the Centers for Disease Control at 1.800.232.4636 (Nationwide). Rick Sowadsky MSPH CDS



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