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HIV Surge in US Not Seen in Canada
Don't panic over American studies, says specialist

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A Canadian HIV prevention specialist is urging caution in interpreting results of American studies of new HIV infection rates and risky sexual behaviours.

"We don't want to get panicked by what's coming out of the US," says Michael Blair of the AIDS Committee of Ottawa.  "They operate on very different models of public health programming."

Blair heads up Ottawa's Man-2-Man Project and is familiar with Canadian data on new HIV infection rates.  His comments came in the wake of researchers with the US Centres for Disease Control and Prevention reporting today a high prevalence of HIV infection among young gay and bisexual men in seven large US cities.

Dr. Linda A. Valleroy and her colleagues found the HIV infection rate among 3500 such males aged 15 to 22 to be about 7% - higher than average for the whole male gay and bi population.

Alarmingly, the researchers also reported that 41% of the youth said they had had unprotected anal sex in the past 6 months.

The findings were published today in the Journal of the American Medical Association.

In contrast, the study's report explained that the new infection rate had appeared to stabilize by the late 1980s for men who have sex with men.  But those numbers largely reflected HIV among men aged 30 and older.  Younger men, according to research from the 1990s, have had a stubborn prevalence of infection and pattern of risky sexual behaviour.

Dr. Valleroy's team looked at men who either have sex exclusively with men or with both men and women.  They were surveyed on risk behaviour and then given HIV tests.  The researchers found that compared to those who tested negative, HIV-positive men were more likely to have recently had unprotected sex.

Only 18% of infected men knew they were HIV-positive.

The US scientists concluded that the results are "alarming in light of the men's youth and compared with the HIV prevalence for samples of primarily heterosexual youth in the United States."

The team also speculated that many of the HIV-negative men in the study are "likely to become HIV-infected in the near future," in light of their young age and high rate of unsafe sex.

But in Canada, or Ontario anyway, Blair says, current data show that the rate of new infections among gay youth has not seen such an increase.  It's relatively low and stable, he says.

"Clearly the messages have taken here in Ontario," he stated.  "We've had very open and consistent safer sex education in our schools for quite some time."

We need to have more research here in Canada, particularly on men who have sex with men.

  - Michael Blair
 
In fact, the age group of gay men experiencing an increased infection rate in Ontario at this time is 30-45 years, Blair explained, and went on to also say "We do know that there has been a slight increase in the infection rates in Ottawa-Carleton in the last few years in that age range."

The prevention worker speculated that a variety of factors could be contributing to this rise, including condom fatigue and multiple personal losses from the virus impacting self-esteem and social behaviour.  A possible lack of prevention follow-up over the years with this age group may have contributed as well, he said, as prevention efforts shifted to youth.

And although data describing infection rates are available, current documentation of sexual behaviours - including risky ones - are sorely lacking.

"We need to have more research here in Canada, particularly on men who have sex with men," Blair declared, and went on  to state that anecdotal evidence from outreach activities indicates that gay men in the 30-45 age range may be taking risks they weren't taking before.

The only data available describing the extent of risky sexual behaviours are from the 1991 National Men's Survey, although similar studies have been conducted locally in Toronto and Winnipeg.