Number of unprotected Sex in The United States of America

Unprotected sex is a term often used to describe anal or vaginal sex
if a condom is not used.
New York Post
March 19, 2004
THE public health experts - and their amen corner in the media - owe
Helen Gurley Brown an apology.
The legendary Cosmopolitan editor was vilified in 1993 when she
published a piece called "The Myth of Heterosexual AIDS." But she was
right.
Eleven years later, Details is asking: "Whatever Happened to AIDS and
Straight Men?" The article states, "A disease-free man who has
unprotected sex with a drug-free woman stands a one in 5 million
chance of contracting HIV."
The story by Kevin Gray also cites a joke that made the rounds of the
New York City Department of Health as statistics came in showing that
the predicted spread of AIDS to heterosexuals wasn't happening:
"What do you call a man who got HIV from his girlfriend? . . . A
liar." "I feel somewhat vindicated," Brown told PAGE SIX.
Michael Fumento, who wrote the original 1990 book titled "The Myth of
Heterosexual AIDS," said, "I'm not waiting for an apology. It's not
going to happen."
When Basic Books published Fumento's tome, "Distributors refused to
handle it," he says. "Stores refused to carry it. And at many stores
that did have it, clerks left it in the basement."
Celia Farber, who wrote an AIDS column in Spin magazine, was routinely
attacked because she refused to rehash the propaganda put out by AmFAR
and other groups.
"Everybody who was wrong got journalism awards. Everybody who was
right got all but driven from the profession," Farber said.
Farber exposed the conspiracy between profit-hungry drug companies,
researchers who wanted more funding, homosexuals who didn't want the
disease to be known as "the gay plague," and conservatives who wanted
to turn back the sexual revolution. "They believed in what they were
doing, not what they were saying," Fumento said. "They knew it was
lies. They felt the end justified the means."
At a recent editorial meeting at Seed, the new science magazine,
Pulitzer Prize-winning reporter Laurie Garrett supposedly threatened
to quit when a colleague suggested a story about Peter Duesberg, a
leading retrovirologist.
Duesberg lost his funding, his laboratory, and his students when he
announced in 1987 that HIV doesn't cause AIDS. "He lost everything,"
said one insider. Duesberg switched to cancer research, and is now
touted to win a Nobel Prize.
Although men who have sex with men (MSM) comprise an estimated 2% of
the overall U.S. population aged ≥13 years,1 59% of persons with
diagnoses of human immunodeficiency virus (HIV) infection in the
United States in 2009 were MSM, including MSM who inject drugs.2 CDC
recommends HIV testing at least annually for sexually active MSM to
identify HIV infections and prevent ongoing transmission.3 Results of
HIV testing conducted as part of the National HIV Behavioral
Surveillance System (NHBS) in 21 cities indicated that 19% of MSM who
were tested in 2008 were HIV-positive; of these, 44% were unaware that
they were infected.4 To assess whether MSM were tested as recommended
and whether more frequent testing might be indicated, CDC analyzed
NHBS data for 2008. This report describes the results of that
analysis, which indicated that, of 7,271 MSM interviewed and tested
who did not report a previous positive HIV test, 61% had been tested
for HIV infection during the past 12 months; among these, 7% had a
new, positive HIV test result when tested as part of NHBS. Given the
high prevalence of new HIV infection among MSM who had been tested
during the past year, sexually active MSM might benefit from more
frequent HIV testing (e.g., every 3 to 6 months).
NHBS is a behavioral surveillance system used to monitor HIV-related
risk, testing, and prevention behaviors and HIV prevalence among
populations at high risk for acquiring HIV.5 In 2008, NHBS staff
members in 21 metropolitan statistical areas (MSAs) with high
prevalence of acquired immunodeficiency syndrome (AIDS)* collected
cross-sectional behavioral risk data and conducted HIV testing among
MSM.4 MSM were sampled using venue-based sampling methods.6 NHBS staff
members identified venues (e.g., bars, clubs, organizations, and
street locations) and days and times when MSM frequented those
venues.7 Venues and days/times were selected using a computerized
random selection process each month for interviews and supplemented by
up to three nonrandom events (e.g., Gay Pride events) per site per
month. Staff members systematically approached men at each venue,
intercepting potentially eligible men in the order in which they
entered a designated "counting area."6 Men eligible to be interviewed
were aged ≥18 years, residents of the MSAs, and able to complete the
interview in English or Spanish. After participants gave informed
consent, trained interviewers used a handheld computer to administer a
standardized, anonymous questionnaire about sex, drug use, and HIV
testing behaviors. All respondents were offered anonymous HIV testing,
which was performed by collecting blood or oral specimens for either
rapid testing at venues or laboratory-based testing. A nonreactive
rapid test was considered a definitive negative result; a reactive
(preliminary positive) rapid test result was considered a definitive
positive result only when confirmed by Western blot or
immunofluorescence assay. Incentives were offered for participating in
the interview and HIV test.
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This analysis excluded MSM who reported a previous positive HIV test.
CDC determined the proportion of MSM who received an HIV test during
the past 12 months and, of these, the proportion with a positive NHBS
test result, stratifying by demographic and risk characteristics.
Those testing positive were considered to be unaware of their
infection. CDC sexually transmitted disease (STD) treatment guidelines
recommend that MSM who have multiple or anonymous partners, have sex
in conjunction with illicit drug use, use methamphetamine, or whose
sex partners participate in these activities be screened for STDs and
HIV more frequently (every 3 to 6 months) than those without such risk
factors.8 To reflect these guidelines, MSM with high-risk behaviors
were defined as those reporting at least one of the following: more
than one male sex partner during the past 12 months, methamphetamine
use during the past 12 months, sex in conjunction with illicit drug
use at most recent sex, or a most recent male sex partner who
definitely or probably had concurrent sex partners. CDC determined the
proportion of HIV-infected men among MSM who did and did not report
high-risk behaviors.
A multivariable Poisson model was used to create unadjusted and
adjusted prevalence ratios to determine factors associated with being
HIV-infected.9 The adjusted model controlled for various factors:
race/ethnicity, age, annual household income, education, health
insurance status, time since most recent HIV test, unprotected anal
sex, and high-risk behaviors.
Of 28,468 men approached, 12,325 were screened for participation at
626 venues. Of men screened, 11,074 (90%) were eligible for the
survey. Men who were surveyed were excluded from analysis if they did
not complete both the survey (n = 396 [4%]) and the HIV test (n =
1,535 [14%]), did not report sex with a man during the preceding 12
months (n = 1,744 [16%]), had an indeterminate HIV test result (n = 85
[0.8%]), or reported being HIV-positive (n = 1,214 [11%]). These
reasons were not mutually exclusive. Of eligible men, 7,271 (66%) were
included in this analysis.
Of men included in this report, 44% were white, 25% were Hispanic, and
23% were black. Mean age was 34 years (range: 18-85 years); 62% had
less than a college education, 29% reported an annual household income
<$20,000, and 34% had no health insurance (Table 1).
Among the 7,271 MSM, 680 (9%) were HIV-infected. Of these, 16% had
never been tested for HIV, and 29% had been tested during the past 6
months (Figure).
Among the 7,271 MSM, 4,453 (61%) had tested for HIV infection during
the past 12 months and did not receive a positive HIV test result. The
proportion tested was higher among MSM in younger age groups and those
with higher levels of education and income but did not vary by
race/ethnicity (Table 1). Among 5,864 (81%) MSM with high-risk
behaviors, 44% had been tested for HIV infection during the past 6
months.
Among the 4,453 MSM who had not received a diagnosis of HIV infection
previously and were tested for HIV during the past 12 months, 7% (15%
of blacks, 7% of Hispanics, and 3% of whites) were found to be
HIV-infected when tested by NHBS (Table 2). Of 3,672 MSM with
high-risk behaviors who were tested for HIV in the past 12 months and
did not receive a positive HIV test result, 7% were HIV-infected when
tested by NHBS, compared with 8% of those who did not report any
high-risk behaviors. Prevalence of HIV infection among these two
groups remained similar after adjusting for time since most recent HIV
test. After adjusting for risk and testing behaviors, substantial and
significant differences between black, Hispanic, and white MSM
persisted


HIV and sexually transmitted infections (STIs) can be passed on during
unprotected sex. Unprotected penetrative (the insertion of the penis
into the body of another person) anal and vaginal sex carries the
greatest risk of STIs, however, infections can also be transmitted
through oral sex (mouth to genitals), and oral-anal sex (mouth to
anus), also called 'rimming.'

Using condoms (including female condoms) is a very effective method of
preventing HIV and other STIs from being passed on during sex, but
some people with HIV choose to have unprotected sex.

Unprotected sex with HIV-negative and untested people

If you are living with HIV, using condoms during sex with people who
know that they are HIV-negative or are unsure of their HIV status will
protect them against HIV and protect both of you from STIs.

There's a lot of debate about how infectious people with HIV are if
they are taking HIV treatment and have an undetectable viral load.
Most experts agree that when HIV treatment is keeping viral load under
control, the risk of HIV transmission is reduced to a low level, but
that some risk still exists.

The law is also an important consideration. In the UK (and in many
other countries) a number of people have been sent to prison for
passing HIV on to their sexual partners, after failing to tell them
they had HIV. You should also be aware that in some countries you are
legally required to disclose your HIV status to sexual partners. You
can find out more about this subject at www.aidsmap.com/law.

Sometimes, couples who are 'serodiscordant' (one has HIV and one does
not), choose to have unprotected sex because they want to have a baby.
It's a good idea to talk to your doctor about this option, so that you
and your partner can make sure you are as healthy as possible before
trying to conceive.

Sex with other people who have HIV

Many people with HIV have unprotected sex with a partner who also has HIV.

However, If you have HIV and are having sex with another person who
has HIV, there are some important considerations you should be aware
of so you can make an informed decision about sex. These issues
include:

Unprotected vaginal sex can result in pregnancy. There are other
methods of contraception, apart from condoms, but it is important that
you choose the right method for you. Some anti-HIV drugs interact with
hormonal contraceptives, so make sure you discuss your choice of
contraception with your HIV doctor. HIV can be passed on from a woman
to her baby, but with the right treatment and care, the risk of this
happening is very small. Talk to your HIV doctor, or someone else in
your healthcare team if you are considering having a baby.
There have been a small number of cases of so-called 'superinfection'
with a new strain or strains of HIV, which could be resistant to
anti-HIV drugs. This could lead to the failure of treatments that
might otherwise have been effective. This applies to both men and
women. However, the number of recorded cases of superinfection is
small. The cases have almost all involved people who were infected
with HIV for less than four years and either were not on HIV
treatment, or were taking a treatment break.
Unprotected sex puts you at risk of other sexually transmitted
infections. This applies to both men and women.
Bacterial STIs, such as gonorrhoea and chlamydia can be treated just
as easily and successfully in most people with HIV as in people who
are HIV-negative, provided that they are diagnosed and treated
promptly. Some infections, if left untreated, can lead to infertility
and in some cases damage to the internal organs.

There are also viral STIs. Genital herpes and genital warts are not
curable, even in people who are HIV-negative. Although both these
infections will respond to treatment, they can reoccur and can be
harder to control if you have a very weak immune system. Genital
herpes is linked to an increased risk of HIV transmission, especially
when ulcers are present. The viruses hepatitis A and hepatitis B and
(less easily) hepatitis C, can also be passed on sexually and can be
more complicated in people with HIV. Hepatitis can cause liver damage
which can limit HIV treatment options and make you very unwell in its
own right.

There are vaccines for hepatitis A and B (but not C), which should be
available at your HIV treatment centre. Gay men in particular are
advised to be vaccinated against hepatitis A and B. After you have
been vaccinated it is important to have your immunity to hepatitis A
and B checked regularly, as the vaccines do not offer permanent
protection. There's now good evidence that hepatitis C can be passed
on sexually. Some HIV-positive gay men have been infected with
hepatitis C after having unprotected sex.

Having an untreated STI increases the amount of HIV in the genital
fluids, making HIV easier to pass on if you have unprotected sex.

It is recommended that all sexually active people have regular sexual
health check-ups. Many HIV treatment centres have sexual health
clinics attached, which in the UK offer free and confidential testing
and treatment.
Reported by: Alexandra M. Oster, M.D., Isa W. Miles, Sc.D., Binh C.
Le, M.D., Elizabeth A. DiNenno, Ph.D., Ryan E. Wiegand, M.S., James D.
Heffelfinger, M.D., Richard Wolitski, Ph.D., Div of HIV/AIDS
Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB
Prevention, CDC. Corresponding contributor: Alexandra M. Oster, CDC,
aoster@cdc.gov, 404-639-6141.

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