Are You Having Safe Sex?

Last Editorial Review: 1/30/2005

AIDS still kills. So why are so many people so complacent?

WebMD Feature

March 27, 2000 (Great Falls, Mont.) -- Powerful new AIDS treatments that became available over the last few years are helping people infected with the virus to live longer and better lives. That's the good news. Unfortunately, according to several recent studies, the bad news is that these treatments are lulling some people into a false sense of security and triggering a rise in unsafe sex. The end result, warn public health experts, could be higher numbers of people diagnosed with HIV and AIDS, as well as other sexually transmitted diseases (STDs).

The Evidence

In one study of 500 gay men in West Hollywood, Calif., the more optimistic the men were about new AIDS treatments, the less likely they were to use condoms, abstain from sex, limit their number of sexual partners, or ask about a partner's HIV status. The study was presented at the National HIV Prevention Conference in Atlanta in 1999.

"Because of the new drugs, they were less fearful of transmitting HIV to someone else, and they thought if they gave it to someone else, it was less bad because of the drugs," says study leader Sheila Murphy, Ph.D., a researcher at the University of Southern California in Los Angeles.

In another study, Stan Lehman, Ph.D., and his colleagues at the Centers for Disease Control and Prevention (CDC), surveyed 1,976 HIV-negative people in seven states who were at high risk for HIV infections, including gay men, injection drug users, and heterosexuals with STDs. About one-fifth were found to have let down their guard during sex or drug use, citing the better treatments for their riskier behavior. Drug users were the most likely to exhibit complacency, followed by heterosexuals, and then gays, although all groups seemed to have been affected, Lehman's team reported at the Conference on Retroviruses and Opportunistic Infections in San Francisco earlier this year.

Other Findings

Other studies have documented a rise in STDs following an increase in risky sexual behavior. For instance, a survey of San Francisco gay men, conducted from 1994 to 1997 and reported by the CDC, showed that as condom use declined, the number of cases of gonorrhea increased.

John, a 42-year-old gay man in Seattle, is not surprised that STDs are on the rise. He says he always tells potential partners he is HIV-positive but that he is rarely refused sex. With other HIV-positive men, "we usually have unprotected sex," he says. Many gay men are either tired of condoms, have given up hope, or assume they are immune if they are HIV-negative after years of unsafe sex, John says. He fell into the latter category, until he found out he was HIV-positive about three years ago.

Reducing the Risks

Public health officials are eager to counter this cavalier attitude. Part of the problem, they say, is that people may be confused by some of the terminology surrounding the new drug treatments. Take, for instance, some drugs found to lower HIV in the blood to "undetectable" levels. When people hear this, they may believe they are no longer infectious. However, patients with undetectable blood levels may still have enough HIV in their semen or vaginal fluids to transmit infection, says Thomas Hooton, MD, medical director of the Harborview HIV-AIDS Clinic in Seattle.

"No one really knows how low you can go and still be infectious," says internist Robert Wood, M.D., Director of the HIV-AIDS program at the Seattle & King County public health department. And the new drugs aren't perfect. Drug-resistant strains are continuously cropping up that defy all treatments, and unsafe sex could spread these strains, according to reports published in the New England Journal of Medicine in July 1998, and the Journal of the American Medical Association in September 1999.

Then there is the inconvenience and expense of treatment. Wood, who is HIV-positive, gulps down 25 pills a day. Since starting the regimen, he has developed high blood pressure, which he suspects is related to the drugs. The typical cost of these drugs, he says, is between $1,000 and $2,000 a month.

So how much can letting down our guard just a little affect public and personal health? According to a model proposed in the January 28, 2000 issue of Science, based on the San Francisco community, a 10% rise in unsafe sex could cancel out the benefits of new drug therapies. A rise of more than 10% could result in a higher incidence of HIV infections.

Carol Potera is a Great Falls, Mont., journalist who writes on health and medical issues for WebMD, Shape magazine, and other publications.

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