America Living With AIDS

AM E R I C A Living With AIDS

Commission made a telling comparison: "We are essentially asking people
to go on a diet and never cheat for
their entire life. Unlike a diet, cheating may be lethal."
S a m e - iender ra n smisio
Homosexual and bisexual men still
bear much of the burden of HIV disease in the United States across all
racial and ethnic groups. In cities
with large gay communities, such as
San Francisco and New York, a substantial portion of gay men are infected with HIV. The validity of programs
of prevention is dramatically underscored by studies in the last several

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ly large body of
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atten, especially if
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ary 1990

years of white gay men in
urban epicenters of the
HIV epidemic. Sustained
changes in sexual behavior have been accompanied by a marked lowering
of the rate of incidence of
new infections. Interpretation of these trends is
further supported by stable or falling rates of sexually transmitted diseases.
A dramatic change in
peer behavioral norms
among gay men is one of
the heartening stories of
the HIV epidemic. Early
in the epidemic, programs were established to
impart information, to
help motivate change,

and to bolster skills necessary to
change behavior, such as ways to
negotiate safer sex. Many of these
programs came from within the gay
community and relied to a large extent
on volunteers, as many governmental
agencies were not confronting the epidemic. The result of these programs
was that many gay men increased condom use, adopted safer sex practices,
and reduced the number of their sexual partners.
Although many gay men have made
remarkable changes in sexual behavior, these changes should not be taken
as evidence that the job of education
and prevention has been done, but
rather that it can be done. There are
many men who engage in same-gender sex but do not perceive of themselves as being gay or as belonging to
any gay social or political community.
These men are particularly difficult to
reach with gay-specific HIV prevention messages. Targeted messages
about behavior change may have
passed them by. In addition, as the
epidemic matures, sustained efforts
will be necessary to prevent "relapse"
among gay men who have made
changes in their sexual behavior.
More attention to the relationship
between alcohol and drug use and sexual behavior is warranted, as those
who combine sex with alcohol and
other drugs are more likely to engage
in sexual activities that carry a high
risk of HIV transmission.
Gay and bisexual men are the
largest segment of people with AIDS

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