2541 The Twenty Fifth Anniversary

Intolerance and social stigma, privacy and discrimination, poverty and access to health care. That's what it's all about if you all you read or hear about the 25th anniversary of AIDS is the American primary media. Not much about how a very powerful lobby in the 1980s of special interest groups who advocated for voluntary testing and patient privacy rather than protecting the general public through the usual epidemiological procedures we've used to conquer other diseases. To read the USAToday story, you’d think it was all about poverty, being a neglected minority, and homophobia.

There's been a lot of craziness in this 25 years. Like doctors and dentists getting sued for refusing to treat AIDS patients and doctors and dentists who have AIDS suing to be able to continue in their practice of medicine. And AIDS patients claiming protection under the ADA which was never the intention of that legislation. And all the while, the men having sex with men play the victim while drumming up activism, advocacy and research grants with fund raisers by movie stars and the arts community so they can continue life as usual. Other non-life style diseases limp along with inadequate funding because there's only so much money to go around.

This disease isn't about poverty and homophobia. It started as wealth and self-loathing. It's about a group that loves to live in danger and on the edge. We have this disease in developed countries because an extremely small number of highly promiscuous men, many well-to-do with good educations, had sex with men in exotic locations. Then many of them passed it along to unsuspecting faithful male and female partners, who then passed it on to the children. Yes, eventually there were dirty needles. Yes, there are some prostitutes. Yes, there is homophobia--but mostly that state of mind is among the men having sex with men who refuse to acknowledge what they are (and they call US homophobic?) and spread the disease to their wives and lovers. Like Governor McGreevey who recently wrote a really disgusting book about all his one night stands and affairs with men which he kept from his wife so he could keep his political career. "I knew I would have to lie for the rest of my life - and I knew I was capable of it. The knowledge gave me a feeling of terrible power," he writes. I lead a pretty quiet life, but even I personally know at least five women who found out after years of marriage that their husbands were unfaithful with men--during the heighth of the epidemic in the 80s. And it is rampant in third world countries where women are sexually mutilated in adolescence by cultural custom compromising their health and their husbands are so homophobic, that they pretend they don’t have sex with men.

Here's some cites that you probably won't find in the NYT or WaPo, unless they are buried in the 25th paragraph.

"To avoid social isolation, discrimination, or verbal or physical abuse, many men who have sex with men (MSM), especially young and minority MSM, do not disclose their sexual orientation." JAMA. 2003;289:975-977. MMWR. 2003;52:81-86

"Twenty years after the first report on human immunodeficiency virus (HIV) infection in the United States, studies of sexually transmitted diseases (STDs) and sexual behaviors suggest a resurgent HIV epidemic among men who have sex with men (MSM)." JAMA. 2001;286:297-299. MMWR. 2001;50:440-444

"After declining steadily for 10 years, the number of reported cases of primary and secondary (P&S) syphilis more than doubled in New York City (NYC) from 117 in 2000 to 282 in 2001.1 The increases have occurred primarily among men who have sex with men (MSM)." JAMA. 2002;288:1840-1842, MMWR. 2002;51:853-856

"Of newly diagnosed HIV infections in the United States during 2003, CDC estimated that approximately 63% were among men who were infected through sexual contact with other men, 50% were among blacks, 32% were among whites, and 16% were among Hispanics." JAMA. 2005;294:674-676. MMWR. 2005;54:597-601

"Of an estimated 1,000 MSM in Chicago who stated that they had engaged in oral sex during the preceding 60 days, more than 75% never used condoms for either oral insertive or oral receptive sex (CDPH, unpublished data, 2003). Oral syphilitic lesions disrupt the protective epithelial barrier and recruit HIV target cells, increasing the risk for HIV transmission. Although oral sex might carry a lower risk for transmitting HIV than other forms of sex, repeated unprotected exposures, especially in the presence of syphilitic lesions, represent a substantial risk for HIV transmission. Syphilis might also increase progression of HIV disease." JAMA. 2004;292:2459-2461. MMWR. 2004;53:966-968

“Recent estimates of HIV diagnoses suggested a leveling of the downward trend in HIV infections nationally and increases in HIV infections among certain populations.2 Reports of syphilis outbreaks and increased unprotected sex raised concerns regarding increases in HIV transmission among men who have sex with men (MSM).” JAMA. 2004;291:417-419. MMWR. 2003;52:1145-1148

"Evidence suggests that since highly active antiretroviral therapy (HAART) became available, the prevalence of unprotected sex and the incidence of sexually transmitted infections (STIs) have increased." JAMA. 2004;292:224-236.

Safe sex won't save us; compassion and fund raisers won't either. But sensible epidemiology and public health measures might have.

HIV/AIDS
Men who have sex with men