Report on the Global HIV/AIDS epidemic

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Report on the global HIV/AIDS epidemic - June 2000
with casual partners. Among men with no steady partner, three-quarters reported
using a condom the last time they had had anal sex. These rates of protected sex,
on a par with those recorded in countries where the gay community is far less marginalized, constitute a major achievement for HIV prevention.
Brazil, too, has seen an increase in condom use by men who have sex with men.
While a series of studies in Rio de Janeiro showed that between 1989 and 1995 the
proportion of men reporting anal sex in the past six months rose from 67% to 76%,
the proportion of anal sex protected by condoms rose much more dramatically, more
than doubling from 34% to 69%. In the impoverished north-eastern region of Brazil,
however, where there is little in the way of prevention activities, a study in the city of
Fortaleza found very high levels of unprotected anal sex among men having sex with
men, who had an average of 14 sex partners over the previous year. Brazilian men
continue to become infected with HIV through male-male sex at an alarming rate. In
S o Paulo, one study showed that the rate of new HIV infections in this population
group was 2% a year between 1994 and 1997.
Men who have sex with men and women
The Fortaleza study in Brazil raised an issue of some concern: while only 15% of the
men spontaneously identified themselves as bisexual, 23% reported in answer to
questioning that they had had sex with a woman in the previous year, most of it
unprotected. Of those reporting unprotected sex with a woman, two-thirds had also
had unprotected anal sex with a man. This overlap of risk behaviour provides a classic "bridge" for HIV, allowing it to pass from a population with high prevalence rates
to a heterosexual population with typically lower infection rates.
Box 14. Needed: an AIDS vaccine
An AIDS vaccine is urgently needed in a world where over 5 million people are newly
S infected with HIV every year, but it will take time and a concerted international effort
before we have one.
S In the long term, a safe, effective and affordable preventive vaccine against HIV is our
best hope of bringing the global epidemic under control However, it would be a mistake to think that the development of such a vaccine will be quick or easy or to expect
that once a vaccine is available it will replace other preventive measures. Given the complex chain of endeavour involved in vaccine development, it would also be illusory to
belleve that a vaccine will be developed without the active participation of affected
countries and communities, who are an essential link in the chain.
Scientists around the world are working to understand the kind of immunity a vaccine
S. would have to induce in order to protect someone against HIV infection. They are also

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