| Shaky Ground Experts Question Recent Findings of Increased Transmission of HIV By Ryan Gierach Researchers reported "alarmingly high" rates of unsafe sex in gay men at a Feb. 16 UCLA conference. They also raised the specter that "bug-chasing" and "gift-giving"--the intentional exchange of HIV though unprotected sex--had become "significant" in the gay population. Los Angeles area AIDS prevention specialists immediately questioned the findings and assertions. "The data [on risky sex] is alarming because it suggests that there could be a resurgence of AIDS in high-risk populations," Dr. George Lemp, director of the AIDS Research Program of the University of California, told the Los Angeles Times. Another prominent AIDS scientist, Dr. Douglas Richman, director of AIDS research at UCSD told the San Diego Union-Tribune that he had found evidence of "bug-chasing and found it gruesome and distressing, a complex pathology." He blamed the bug-chasing phenomenon for a pattern of mutated HIV viruses being found in gay men. A nonempirical study he supervised found that 16 percent of new HIV infections were mutant viruses and resistant to one or more of the anti-retroviral drugs used to treat HIV. At the Retroviral Conference in Chicago in early February, several abstracts showed apparent increases in the rate at which gay men engage in sex without condoms. Three of the locally conducted studies that showed what researchers called "alarming levels of unprotected sex" were discussed at the UCLA gathering. One of the studies interviewed men at sex clubs and found "some" did not use condoms while engaging in sex with multiple partners. Another study done, as was the first study mentioned, by the Los Angeles County Health Services Department, showed that black men who identified themselves as heterosexual but engaged in anal sex with men did not use condoms 61 percent of the time. By comparison, those who identified themselves as gay or bisexual didn't use condoms 44 percent of the time. A third survey, conducted by AIDS Project Los Angeles, showed that 31 percent of 113 bisexual men interviewed continued to engage in risky sexual behavior, even after being informed of their HIV-positive status. Although the three studies focused on relatively small populations, other surveys nationwide have shown similar declines in safer-sex practices. Many researchers say fatigue with such practices and overconfidence in newer, more effective anti-AIDS drugs are to blame. Some experts wonder if the data is all that reliable. "If you look at these studies," said Lee Klosinski, director of education at APLA, "they all ask the same question: 'Have you engaged in sex with another man without a condom in the last month, or six months?' But they all neglect to ask whether the subject is in a monogamous relationship, or how many partners they have." Klosinski said he saw some small increase in risky sex, but not the dramatic increase researchers are trumpeting. "We saw 20 to 30 percent rates of unprotected sex in the early '90s," he said, "and now we see 30 to 40 percent. I believe that much of that 10-percent increase is in honesty rather than actual behavior. "We do not see, as these researchers suggest, a departure from the halcyon days of 100 percent compliance to this shocking rate of unsafe sex," he says. John Copeland, prevention programs manager at L.A. Shanti, had a similar outlook. "We see some increase in risky behavior because the drugs lower viral loads to undetectable and people feel safer, but we're also asking the questions better, and people are hiding less information." Both men were concerned that the harsh tone of researchers would derail attempts to uncover exactly what was going on in gay men's sex lives and efforts to address the issue of HIV and sexually transmitted diseases. Frontiers called Richman at his San Diego office to discuss his claims about "bug-chasing. He said that he used conjecture from looking at Web sites advertising such contacts and had no actual data or study results to support his claims. But, he said, "I know of several cases where the disease was passed intentionally." When pressed for a precise number of these incidents, he said, "I can't give you numbers, but we know it happens." Richman acknowledged that using such terms as "gruesome" and "pathology" to describe behavior he had no data to prove was taking place was "subjective language use, yes. I just feel so frustrated that people would undo the work I try to further." Klosinski does worry about the mutation of the virus. "We call it MDR/HIV, for mutant drug resistant HIV virus. It can become a serious problem, meaning that people who test positive should really get a geno- or pheno-typing done before beginning drug therapy." Meanwhile, according to wire reports, in late February, Orange County recorded a 5.5 percent increase in AIDS cases in 2000. The data was released by the county Health Care Agency. But officials say that could be attributed to more aggressive counting measures rather than a rise in risky sexual behavior. California counties only report cases of AIDS per se, therefore, the rise does not reflect the total number of people diagnosed with HIV infection. |