HIV Infections Down in France--Except for Gay Men

Although HIV infections are declining among the general population in France, one demographic stands out as an exception to the trend: HIV infections are increasing among gay men in that country, according to a new report.

FoxNews.com reported on Sept. 9 that a new study issued by the French National Institute for Public Health Surveillance determined that instances of new infection among gay men continue to rise, even as the numbers are falling in France for the general population, with HIV rates among gays 200 times greater than that of heterosexuals. The study looked at infection rates for 2008, and found that half of new cases were gay men.

The story noted that more than 33 million people worldwide are living with HIV. In some places, such as sub-Saharan Africa, the disease is prevalent among heterosexuals. The trend in Western countries, however, has been for gays to be more affected by HIV rates.

That has been more and more true of young men in recent years. For some time, researchers have noted that despite efforts to promote safer sex, HIV rates are climbing among young gay men in Europe and in the United States. So are rates for other sexually transmitted diseases, such as syphilis; unfortunately, individuals already infected with one STI may be at an elevated risk for contracting others, including HIV.

While some of the blame may rest with younger gays not having access to safer sex messages, a perception among young MSMs (men who have sex with men) that AIDS is no longer a serious health concern may also be driving the increased incidence in HIV. Most serious of all, however, is a tendency toward unsafe sex and other risky behaviors, such as drug use, which affect judgment and may lead to more unsafe sex-and a higher rate of HIV infection.

MSMs in America are 44 times more likely than men in the general population to become infected with HIV, and 40 times more likely than women in general, the U. S. Department of Health and Human Services announced earlier this year. Syphilis rates for MSMs were 46 times greater than for other men, and 71 times greater than the rate of infection among women in general.

Among the factors for the disparities, the CDC noted, were a lack of safer sex precautions, such as condom use, and the ongoing stigmatization of HIV and AIDS that make gays, bisexuals, and other men who have sex with men (MSMs) less likely to learn about and use safer sex precautions, or to get tested. As a result, MSMs were also less likely to get treated. Moreover, younger MSMs are less likely to engage in safer sex practices; in addition, there is a lack of education around syphilis, in terms of recognizing symptoms of the disease.

The survey results were presented during the CDC's 2010 National STD Prevention Conference. A press release on the new results explained, "While CDC data have shown for several years that gay and bisexual men make up the majority of new HIV and new syphilis infections, CDC has estimated the rates of these diseases for the first time based on new estimates of the size of the U.S. population of MSM." The newly formulated estimates show that abut 2% of men in the United States have sex with other men, though the margin for error could mean that the figure is as low as about 1.5% or as high as nearly 3%.

"Because disease rates account for differences in the size of populations being compared, rates provide a reliable method for assessing health disparities between populations," the release said.

"While the heavy toll of HIV and syphilis among gay and bisexual men has been long recognized, this analysis shows just how stark the health disparities are between this and other populations," said the director of CDC's National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Kevin Fenton, M.D. "It is clear that we will not be able to stop the U.S. HIV epidemic until every affected community, along with health officials nationwide, prioritize the needs of gay and bisexual men with HIV prevention efforts."

Added Fenton, "There is no single or simple solution for reducing HIV and syphilis rates among gay and bisexual men. We need intensified prevention efforts that are as diverse as the gay community itself. Solutions for young gay and bisexual men are especially critical, so that HIV does not inadvertently become a rite of passage for each new generation of gay men."

And the trend is not confined to the United States: researchers in the U.K. and Europe have also noted the increase, reported British newspaper The Guardian on Sept. 7. "By investigating the genetic profile of the virus in more than 500 newly screened patients over nine years, scientists in Belgium have identified clusters of people with type B virus--not the one that is most prevalent in Africa," The Guardian reported. "Those infected are almost all white, male, gay and young," the article continued.

The researchers noted that, "Members of this cluster are significantly younger than the rest of the population and have more Chlamydia and syphilis infections," the article said.

That is not to say that heterosexuals do not also face the risk of contracting HIV; overall, just under half of the new cases of HIV in Britain were gay men, but straights were also getting infected. One main difference was that while gays seemed to be getting infected without traveling to other countries, heterosexuals--who were picking up a different strain of the virus--seemed to be contracting the virus while abroad, the article said.

"Gay men are still the most at risk of HIV infection in the UK," said Nick Partridge, the head of British AIDS charity the Terrence Higgins Trust. "We also know that more than a quarter of people with HIV in the UK are currently undiagnosed, and they're far more likely to pass the virus on than those who know they have it."

The Belgian study, which looked at HIV trends in Britain and Europe, was carried out by researchers at Ghent University. But health experts in the United States also cautioned that HIV remains a serious health threat here.

U.S. HIV Numbers Set to Rise?

An increase in known HIV cases in the U.S. is expected to come about due to more comprehensive testing policies. In a Sept. 3 release from New York-based Gay Men's Health Crisis (GMHC), Dr. Marjorie Hill, the group's CEO, warned, "A new wave of HIV infections is about to hit New York and we had all better get ready for it," and went on to echo that one major concern is the number of people living with HIV who have not gotten tested, and so don't know that they have it.

However, Dr. Hill continued, a new state law requiring routine HIV testing is likely to lead to a sharp uptick in reported new cases. "Previously, patients were required to sign a separate written consent form in order to get tested for HIV," explained Dr. Hill. "Now, if you agree to a quick swab test, you will only have to give oral consent.

"When undergoing routine medical procedures or check-ups, you will be offered a standard HIV blood test to sign off on along with the battery of tests that most patients receive. Once you give your consent, it stays in effect for all your future blood tests," Hill added, going on to cite the Centers for Disease Control and Prevention as projecting an estimate that says "100,000 people in New York City alone are currently living with HIV infection, but more than 25,000 of them do not know it."

Added Hill, "Most of these unknowing carriers of HIV feel and look healthy and are, in most respects. But they are missing out on treatments that could prevent them from progressing to AIDS. Plus, they are in danger of transmitting the virus to others, continuing to fuel the epidemic."

One crucial benefit of testing is that the sooner HIV+ individuals know their status, the sooner they can begin taking medication to keep the virus in check. Though there is no cure for HIV, modern treatment regimens can help many HIV+ people keep their viral loads down to undetectable levels, meaning that they have a better chance at a normal life span. But early treatment is the key, a Chicago specialist in HIV/AIDS, Dr. James Sullivan, said recently.

But young gays might not be getting a comprehensive picture of the epidemic, or of the health risks of unsafe sex. "HIV prevention was once driven in part by the fear of the horrible, disfiguring diseases that preceded the untimely deaths of our friends and loved ones," noted Hill. "Now, the number of older people living with AIDS is skyrocketing as new infections rise among the young.

"Today, fewer people even acknowledge having HIV/AIDS because they are experiencing relatively good health (if they have access to treatment) and do not want to complicate their employment or community lives," Hill added. "That has made HIV prevention much, much harder in 2010, especially among young people who are under the illusion that there is a cure for HIV that involves just taking a few pills. It in fact involves taking drugs almost daily that can have very debilitating side effects for the rest of your life."

The current economic downturn may also figure into the health equation, noted Hill. "This new AIDS crisis is coming at a time when state and federal funding for AIDS is being cut in the current economic crisis. While New York has one of the best AIDS Drug Assistance Programs (ADAP) in the country to make sure that all people with HIV can afford their drugs, other states have long waiting lists to receive these lifesaving treatments. And with most HIV infections disproportionately hitting poorer people of color and others who are disenfranchised, the challenge of getting them the treatment, services, and prevention they need is even more challenging."

Combating HIV and AIDS domestically and globally has been a priority for the current and past administrations. Earlier this summer, the White House Office of National AIDS Policy (ONAP) unveiled a National HIV/AIDS Strategy geared toward reducing transmission of the virus, helping HIV+ individuals stay healthy, and closing gaps in health care that can leave some people living with the virus underserved.

Globally, however, efforts to fight the spread of HIV have been hampered by anti-gay laws designed to punish people who have sexual relations with others of the same gender, according to the head of UNAIDS, Michel Sidib�. Worldwide, 85 nations regard same-sex intimacy as a criminal activity; seven of those countries mete out the death penalty for same-gender sex, with a possible eighth--Uganda, now mulling stricter laws against gays that include the death penalty--on the horizon.

Sidib� acknowledged that in some societies, an anti-gay sentiment is growing--but he warned that writing prejudice against homosexuals into law could result in a backlash in the form of a health crisis affecting everyone. "We must insist that the rights of the minorities are upheld. If we don't do that," Sidib� said, "I think the epidemic will grow again."