February 6, 2001
Despite advances in HIV treatment, the number of new infections remains constant and the number of people living with HIV in the United States is rising sharply. We have learned over the years that HIV is a complex mixture of different epidemics in each city and risk group. What is fueling new infections in young gay men? The answer, from a detailed study in Seattle, is a volatile mixture of new partners, unsafe sex, old-fashioned bacterial STDs with a dash of crystal meth and poppers.
This paper was a detailed examination of sexual mixing among HIV-infected and uninfected men having sex with men in Seattle. Participants were recruited in a variety of sites in Seattle, including public clinics, AIDS service organizations and a medical practice serving gay men. They were tested for gonorrhea, chlamydia, and syphilis and asked about sexual practices in the last two months. Of the 959 men who participated, 35% were HIV positive. The bottom line is that HIV-infected men who knew their status were engaging in a variety of behaviors that contributed to epidemic spread. Sex with an HIV-negative partner was reported by 44% of this group; 33% had a partner of unknown status. Seventy-two percent had receptive anal intercourse in the last two months, but about half reported using condoms less than 50% of the time. Bacterial STDs were present in about 10%. Predictors for having multiple partners of unknown status or serodiscordant partners were examined for HIV-positive and -negative men, and included younger age, amyl nitrate use, number of partners, and meeting partners in baths or public parks.
The message from this study was similar to that of another presentation that looked at gonorrhea and syphilis among gay men in Amsterdam (see abstract 261). Clearly there are focal outbreaks of rectal gonorrhea among gay men in many cities. Prevention efforts must be targeted at infected men -- the source of many new infections and who are also putting themselves at risk. As providers of care to HIV-infected people, we need to improve our screening for STDs and our efforts to decrease risky behavior among our patients.