The development of antiretroviral therapy in 1996 led to dramatic decreases in the developed world in the incidence of new AIDS cases and AIDS associated deaths among those who were HIV-infected. But this medical breakthrough, which saved countless lives and, for many, transformed AIDS from a deadly plague into a disease to be managed, had the unintended effect of lessening the pressure to avoid risky sexual behavior.

Rotello believes that 1996 was a missed opportunity to eradicate HIV infection in the U.S. and in other countries where treatment was available, because it sharply reduced the infectivity of HIV. However, the opposite happened. As antiretroviral therapy became more prevalent, people lost their fear of AIDS and returned to high levels of sexual partners and high-risk practices such as condomless anal sex. Instead of ending, or even slowing, HIV infections among gay men continued to infect two to three percent each year––about the same level, or even higher, as before the effective medications were introduced.

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Chapter 11

In 2006, a landmark study by pioneering AIDS epidemiologist Ron Stall demonstrated that among 20-year-old gay men today, about 25% will be HIV infected by age 30, about 40% will be infected by age 40, and more than half will be infected by their fifties. And for African American gay men, the numbers are even worse.

Trends to date are not encouraging. The continuation of high-risk behaviors with multiple partners means that Ron Stall’s predictions that more than 50% of sexually active gay men living in this decade will become HIV-infected by their fifties are likely to be realized.

This pattern is being repeated all over the world..” Instead , the same approach that has failed for more than two decades is being advocated with no mention about reducing sex partners, abstinence, or monogamy.

A 2008 study asked why HIV prevalence among South African youth is two times higher than among youth in Uganda despite a level of condom use that is two times higher than among youth in Uganda and an increase in secondary abstinence among young females. Think about the math, two times higher condom use, two times higher HIV infections!!