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  10th Conference on Retroviruses and Opportunistic Infections
Boston, Mass, Feb 10-14, 2003
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CDC Reports HIV Increases, AIDS Cases May Be Rising; Internet Sex and Released Prisoners May Contribute
  This article starts with a report from a study presented by the CDC at the Retrovirus Conference which finds the number of new HIV diagnoses is increasing. This CDC report suggests AIDS cases may be increasing. At the end of this report is the study presented at the Retrovirus Conference on the new trend of internet sex; and a report on released prisoners and their unsafe sexual practices and consequent risks for HIV transmission. These two latter issues may be contributing to increases in HIV and AIDS.
"AIDS-Virus Cases Rise in States, Suggesting Growing Complacency"
Reversing years of sharp declines, diagnoses of the AIDS virus have risen in 25 states, suggesting to public officials that sexually active Americans may be growing complacent about contracting the deadly virus.
Researchers also reported that new venues for finding sex partners -- namely the Internet -- may be contributing to a rise in infections.
The U.S. Centers for Disease Control and Prevention, which released the troubling data Tuesday (at Retrovirus Conference), concentrated on the 25 states with longstanding reporting records. In those states, diagnoses of HIV, the AIDS virus, rose 8%, from 15,754 to 16,949, between 1999 and 2001.
Among men who have sex with men, HIV diagnoses increased 14% during the same period, from 6,614 to 7,521. Among heterosexuals, HIV diagnoses rose 10%, from 4,973 to 5,468.
The survey didn't include some states with high HIV prevalence, such as New York and California, so may not be representative of a nationwide spike, the CDC said.
But the data on diagnoses -- the number of people newly diagnosed with HIV during a specific year, regardless of when they were infected - are consistent with other dangerous public-health trends.
Those include increases in high-risk sexual behavior among young African American gay and bisexual men and spikes in sexually transmitted diseases, notably syphilis, said Ronald Valdiserri, deputy director of the CDC's National Center for HIV, STD and TB Prevention.
"These data are concerning to us and really need to be looked at and followed carefully," he said.
Sharp declines in AIDS nationally began in 1996 but leveled off in the late 1990s, according to the CDC. In 2001, for the first time in several years, there was a 1% increase in AIDS cases, compared with the previous year.
Dr. Valdiserri said it is still too early to tell if this represents a reversal of previous AIDS trends.
Speaking at the 10th Conference on Retroviruses and Opportunistic Infections, a scientific meeting held in Boston this week, Dr. Valdiserri said health-care providers in the U.S. must be more aggressive about early diagnoses, treatment and prevention. He said a number of potential factors could be driving new HIV diagnoses, including complacency stemming from treatment breakthroughs. In addition, recent reports found that a staggering number -- as many as 280,000 people in the U.S. -- are infected and don't know it.
Dr. Valdiserri also said that worries about a possible upturn in HIV incidence are exacerbated by the recent report of the first national increase in syphilis rates since 1990. While the actual increase was slight -- only 124 cases -- he said it adds to public officials' concerns, as the presence of other sexually transmitted diseases can make a person more susceptible to HIV.
In a separate paper presented at the conference Tuesday, researchers found that the Internet also may play a role in HIV transmission. In a survey of 2,934 men who have sex with men and frequent chat rooms on a general interest Web site called gay.com, 82% said they met sex partners online and 60.5% reported they engaged in unprotected anal sex.
Among those who met partners online, HIV-positive men were 1.5 times more likely to report engaging in unprotected sex than HIV-negative men, the study found. "The Internet is a new venue associated with high-risk sexual behavior, as it is a quick and easy way to meet partners," said Sabina Hirschfield, a study author and deputy director of research and evaluation at the nonprofit Medical and Health Research Association of New York City. Researchers compared the Internet with similar high-risk venues of the 1970s and 1980s such as bathhouses.
In another disturbing study released Tuesday, researchers found that many HIV-positive former prison inmates engage in high-risk behavior immediately after release.
The Internet and High-risk Sex among Men Who Have Sex with Men
Abstract from study authors: As HIV transmission among Men Who Have Sex with Men (MSM) resurges, efficient methods of reaching large numbers of high-risk men must be identified and new prevention messages developed. The Internet may be an important venue for these activities. In June-July 2002, 2,934 men recruited through chat room banners on popular gay Web site completed an anonymous, 60-item online questionnaire about sexual, drug- and alcohol- using behaviors during a recent 6-month period. The small number of women and transgendered respondents were excluded from this analysis; the HIV- group included those testing negative and those untested. Statistical differences were assessed using Chi-square tests.
Results: Respondents represented all 50 states in the U.S., roughly in proportion to the population of each state. Most (80%) reported sex only with men, 19% with men and women, and < 1% only with women. By age group, 46% were 18-29, 46% 30-49 and 8% 50+. Most men were white (85%) and had at least some college education (87%); 7.6% (224) were HIV+.
More than 100 lifetime sex partners were reported by 27%, with 6% reporting more than 10 partners in the past 30 days. Most men (84%) met sex partners online and they were more likely to have unprotected anal sex (UAS) than those who met partners in other ways (64% vs 58%, p = 0.02). Most HIV+ men (80%) had HIV- partners and were more likely to report UAS than HIV- men (OR 1.4, p = 0.04). Among those who met partners online, HIV+ men were more likely to report UAS than HIV- men (OR 1.5, p = 0.03).
Of the 10 men diagnosed with syphilis during the 6-month period, 9 met sex partners online and 4 reported being HIV+. Overall, 43% reported any illicit drug use and 34% reported drinking until drunk 1-3 days per wk, with no differences by method of meeting partners.
The authors concluded that the very high risk sexual behavior and the significant association between meeting a sex partner online and UAS, particularly for HIV+ men, found in this study provide additional evidence that the Internet may play a role in HIV transmission. Similar to other high risk venues of the 1970s and 1980s (e.g., bath houses and back rooms), the Internet may be a setting in which to meet new sex partners and potentially transmit HIV. Our success in rapidly recruiting a large number of men reporting very high-risk sexual behavior from a single Internet site suggests that this recruitment method can also be used to provide urgently needed safer sex messages.
Abstract 37, 2003 retrovirus Conference (Boston, MA, Feb 10-14). M. A. Chiasson1, S. Hirshfield*1, M. Humberstone1, J. DiFilippi1, D. Newstein1, B. Koblin2, R. Remien3,4. 1Medical and Health Research Assn of New York City, Inc; 2Lindsley F Kimball Research Inst of the New York Blood Ctr, NY; 3HIV Ctr for Clin and Behavioral Studies, New York State Psychiatric Inst; and 4Columbia Univ, New York, NY
Unsafe Sex is Common Among HIV-Infected Prisoners Shortly After Release