How to lose the fight against AIDS among gay men

Declare vicotry and leave the field

News from the AIDS front has not been good lately. Data describing the efficacy of biomedical efforts either to cure AIDS or to prevent the disease through use of vaccines are not encouraging. The realisation has been spreading within gay male communities that we are fated to live with the continuing consequences of the AIDS epidemic for the indefinite future, and perhaps for the rest of our lives. The best hope of gay communities for surviving the epidemic in some relatively intact form depends on efforts to support consistent safe sex over indefinite periods of time.

Unfortunately, evidence concerning the efficacy of efforts to support the maintenance of exclusive safe sex among gay men throughout the population over long periods is also disheartening. Studies from several different cities around the world have described widespread patterns of inconsistent safe sex over time (R Gold, second international conference on AIDS impact, Brighton, 7-10 July 1994)¢RF 1-3¢ as well as an increased prevalance of rectal gonorrhoea4 among gay and bisexual men. Perhaps most worryingly, the prevalance of HIV seropositivity among gay men in San Francisco aged 26-29 in 1993 approached that among men aged 26-29 in 1984 - a level reflecting sexual risks taken before the threat of AIDS was recognised (W Winkelstein et al, IX international conference on AIDS, Berlin, 6-11 June 1993).

These findings raise a set of disturbing questions: is the gay male community losing ground against AIDS owing …