June 2, 2000 -- A new CDC report says potent medicines are slowing the progression of AIDS in the U.S. -- even among people whose behavior puts them at the most extreme risk of getting the fatal disease. But whether the treatments are slowing the rate of new HIV infections -- what a CDC spokeswoman calls "the million-dollar question" -- remains unanswered.
Two of the easiest ways to get infected with HIV are to be a man who has unprotected sex with other men and to inject illicit drugs using needles and/or syringes shared by other users. Men who engage in both of these behaviors are more likely than any other group to die of AIDS.
Nevertheless, the CDC's most recent figures show that even these men have seen a dramatic 37% decrease in AIDS cases from 1996 through 1998 -- a period when powerful AIDS drug cocktails became available.
"We know that the decrease that has been observed in AIDS incidence has been tied to AIDS treatment," CDC researcher Pascale Wortley, MD, tells WebMD. "That doesn't necessarily mean anything about who is getting infected with HIV -- it just means people are getting treatment and are staying in this pre-AIDS status. One thing we know for sure is there is ongoing transmission in this group."
The "million-dollar question," Wortley says, is whether these men who have sex with men and are intravenous drug users -- MSM/IDUs, for short -- are less likely to get HIV or to infect others if they are taking AIDS drugs.
It is an important question because the CDC report shows that 43% of MSM/IDUs have sex with women as well as with men. They thus represent a bridge that could let HIV cross more easily between three groups of people: Gay men, heterosexual women, and drug users of both sexes.
Through intensive interviews with 513 of these men, Wortley and co-workers discovered that the size of the group previously may have been underestimated. They now believe that MSM/IDUs make up 7% of U.S. AIDS cases. The study showed that these MSM/IDUs living with AIDS are disproportionately black or Hispanic men; that nearly half are 30 to 39 years old; and that most live in the south or west.
Sheana Bull, PhD, a behavioral scientist at Colorado's Denver Public Health service, has studied MSM/IDUs for several years and performed some of the intensive interviews included in the CDC report. Bull tells WebMD that MSM/IDUs do not fit into either gay or drug-user behavior patterns -- and that they could very well look like the married man next door.
"We see a lot of men who don't identify themselves as gay or who are married and closeted about both their male-sex and drug-use behavior," Bull says. "It's actually quite a mix. Across the board, the majority of men were very well educated -- 40% with some college education. There were also 40% who were employed, and the reason so many were unemployed is that so many are HIV-infected and going on disability. We did have a handful of men recently released from prison, but for the most part there was a high percentage of men in the study who were functioning very well in society."