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Are people now practicing safer sex more often?
Aug 24, 1998

Do you think people will sooner or later change their sexual behaviour to avoid HIV infection?

Response from Mr. Sowadsky

Thank you for your question. Anything that involves human behavior is often very difficult to quantify and control. The best way to determine if people are actually practicing safer sex more often, is to track the rates of new infections of HIV and other Sexually Transmitted Diseases (STDs) over time. The rates of new cases of HIV and other STDs varies significantly from one STD to another, and from one part of the world to another. Let me give a brief review of some of the information that is available tracking the number of recent cases of HIV and other STDs over time. I will use HIV/STD statistics from the United States as an example, and then compare this to worldwide HIV/STD statistics. This information can then indirectly be used to track if people are changing their behavior and practicing safer sex more often.

HIV rates in the United States:

Based on preliminary data, the rate of new cases of HIV infection per year has remained relatively stable over the past few years. This compares to a decrease in the number of AIDS cases per year (primarily due to improvements in treatments). Prevention efforts (safer sex campaigns, condom availability etc.) have either had no effect in preventing new infections in the past few years, or these efforts have at the very least, prevented an increase in HIV rates.

STD rates in the United States:

When we look at STD rates, we see some very clear trends over time for several of the reportable STDs.

Rates of Chlamydia had significantly increased since the early 1980s, but have now begun to level off in the 1990s. The increase in the 1980s may have been due to improvements in testing and reporting of Chlamydia cases over time. The recent leveling off of new cases may be due to prevention efforts (safer sex campaigns, condom availability etc.).

Rates of gonorrhea have significantly and steadily decreased since 1975, and that decline continued all throughout the 1980s and 1990s. The decline in gonorrhea cases has been due to a strong public health effort to reduce the incidence of this disease. Although this downward trend is continuing overall, a recent study has indicated that among Gay men specifically, the rate of gonorrhea cases has recently begun to increase, indicating a recent increase in unsafe sexual activity among Gay men.

Rates of syphilis have steadily decreased since the 1940s. In the late 1980s and early 1990s, there was a temporary increase in the rate of new cases, but rates have once again declined, and continue to decline today. The decline in syphilis cases has been due to a strong public health effort to reduce the incidence of this disease.

In regard to other STDs, rates of chancroid (a relatively rare STD in the United States) have steadily declined since the late 1980s, and continues to decline today. The rate of HPV (the virus that causes genital warts) has been relatively stable, but may now be beginning to decline. However, since HPV infection is not a reportable condition, HPV infection rates are only estimates. Genital herpes infection has been steadily on the increase since the 1970s and continues to be on the increase today. However, like HPV, genital herpes is not a reportable disease, so infection rates are only estimates.

Overall, in the USA, for some STDs, we are seeing a stable rate in the number of new cases (like HIV and chlamydia) over time. For other STDs, we are seeing a clear decline in the number of new cases (like syphilis, gonorrhea, and chancroid). So current public health intervention and current prevention efforts (safer sex campaigns, condom availability etc.) appear to be reducing the incidence of some STDs, and may be preventing an increase in other STDs. But it is clear that more needs to be done, especially as it relates to reducing the rates of chlamydia, gonorrhea in Gay men, herpes, and HIV. In the United States, we have indirect evidence that some people are indeed changing their behaviors, and practicing safer sex more often, but clearly, much more needs to be done.

HIV rates Worldwide:

When we look at worldwide HIV statistics, we have to be very cautious how we interpret these data, since reporting is very poor in many parts of the world (especially in Developing/Non-Western nations). In addition, many countries of the world only have reporting of AIDS cases (in which people became infected an average of 10 years before), rather than the reporting of HIV cases (which looks at recent HIV infections). It is estimated that approximately 30 million people are currently living with HIV worldwide.

Based on the best available estimates, HIV rates are rising rapidly in much of Asia, Eastern Europe and southern Africa. In Latin (Central) America, some countries have rising rates of HIV infection. In other parts of Latin America, as well as in Thailand, Uganda and some West African nations, the rate is either remaining stable or on the decline. In most parts of North America, Western Europe, and in other Developed (industrialized) nations the rate is either remaining stable, or is on the decline.

Therefore we can say in some parts of the world, people are reducing their risks of infection, but in other parts of the world, such is not the case.

STD rates Worldwide:

Once again, we have to be very cautious in how we interpret worldwide STD statistics since reporting is very poor in many parts of the world (especially in Developing/Non-Western nations). Worldwide, it has been estimated that there are 12 million new cases of syphilis, 62 million new cases of gonorrhea, 89 million new cases of chlamydia and 170 million new cases of trichomonas, for a total of 333 million new cases for these STDs alone. This statistic does not include STDs like Hepatitis B, Human Papilloma Virus (the virus that causes genital warts), herpes, and other viral (incurable) STDs. From what information is available, the rates of STDs varies significantly from one part of the world to another. Let me give you some examples.

In Sweden, and Norway, the rate of gonorrhea has significantly declined since 1981. A decline in gonorrhea has also been seen in Poland. In Costa Rica, the rate of gonorrhea has steadily declined since 1982.

In Chile, STDs (including gonorrhea) have been on the decline since the mid 1980s. In Zimbabwe, STDs in the capital city (Harare) have been on the decline since 1991. In Thailand, STDs have been on the decline as well.

Unfortunately, in other parts of the world (such as Eastern Europe and Central Asia), STDs are on the increase. For example, since 1991, rates of gonorrhea have been rising in Estonia, Latvia, Lithuania and Russia.

In certain parts of the world, people are changing their behavior (for example practicing safer sex more often), and as a result, STD rates are on the decline. In other parts of the world, people are continuing to put themselves at significant risk, and as a result, STD rates are rising.

In summary, when it comes to changes in behavior, some people are changing their behavior and others are not. Prevention efforts have successfully reduced the incidence (or prevented an increase) of some STDs in some parts of the world, but clearly, much more needs to be done.

If you have any further questions, please feel free to call the Centers for Disease Control at 1.800.232.4636 (Nationwide).



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