After more than a decade of decline, the HIV infection rate is creeping back up in many U.S. cities. In Miami, for example, the infection rate jumped 28 percent in the first six months of this year. AIDS researchers blame the trend on complacency about HIV since the advent of anti-viral medications, as well as the so-called "party" lifestyle in some urban areas.
Walk around the southern portion of Miami Beach, called South Beach, at night, and you will pass one dance club after another, often with long lines of young, fashionably-dressed patrons waiting to get in.
Until last year, a 30-year-old who identifies himself as Jeffrey was among the loyal club-goers. Jeffrey says his weekend routine included taking recreational drugs such as ecstasy that seemed to boost his energy level and enhance the club experience.
"When you went out, you could stay up all night, go to the 'after' hours, go to the 'after-after' hours the next day," he said. "So, we are basically talking about staying up from Friday night through Sunday night. That was pretty much a weekend."
Jeffrey, who is gay, says he frequently found himself in the company of men who were HIV-positive yet whose outward appearance suggested perfect health. He says the specter of contracting the HIV virus did not seem terribly ominous at the time.
"Most of the guys that I was attracted to were (HIV) positive, guys that looked like they could be on the cover of a men's fitness magazine," he said. "My ex-boyfriend looked like a Greek god. Everyone I wanted to be with looked like one, coupled with low self-esteem and the drugs, made me ask myself, 'What does it really matter? If I get it, I get it. I'll have to take some pills and everything will be fine.'" University of Miami AIDS researcher Margaret Fischl says Jeffrey's cavalier attitude towards HIV and AIDS is hardly unique. "What has happened with the youth now, is that they do not see patients that are very ill; they do not see patients that are dying." she said. "When you are young, death and dying is not a reality for you.
But Jeffrey's freewheeling days did come to an abrupt end last year, during a visit to a doctor. "I was told that I was (HIV) positive. And I remember the feeling of being alone and looking out of the window in South Beach and thinking that three years earlier someone had told me, 'Either you get the beach or the beach gets you.' It felt like I was in a movie scene," Jeffrey said. "I looked at the container where they put needles and the biohazard sticker. And I took the sticker off and slapped it on my wrist. I thought, 'Now I am a biohazard.'"
Miami Beach AIDS activist Marc Cohen says Jeffrey's story is tragic, yet common. "Miami Beach is a city where every night is New Year's Eve. It has a constant party atmosphere," he said. "It is hedonistic; it is a place where people escape; it is a fantasyland. The party atmosphere itself tends to promote higher-risk behavior. The day is sunny and the beach is hot and the clubs are sultry and the music plays on and on and people are detached from what really is happening inside of this epidemic."
Miami-Dade County has the second highest HIV infection rate in the United States, surpassed only by New York City. In the first half of this year 925 new cases were reported in Miami, nearly 200 more than during the same period last year.
From 1985 to 1995, the United States recorded a dramatic reduction in the HIV infection rate, going from 160,000 to 40,000 new cases reported yearly. But that progress is now in jeopardy as infection rates soar for blacks, Latinos, and young gay men. "When you look at the progress we have made, we have great treatments," said AIDS researcher Margaret Fischl. "AIDS [deaths] are going down. People are surviving. When you look at prevention and intervention, we are not doing very well."
Dr. Fischl says anti-viral medications that emerged in the mid-1990s have proven to be a mixed blessing. On the one hand, they have turned HIV from an automatic death sentence to a manageable, chronic disease. On the other hand, the very success of these medications has lessened the overall fear of AIDS and made some people more willing to engage in unprotected sex.
AIDS activist Marc Cohen points to other factors, as well, including drug abuse and the emergence of Internet chat rooms where people can arrange random sexual encounters in a matter of minutes. Above all, he said, people have not been honest with themselves. "The epidemic has never gone away; it has never been over; it has never stopped eating through our communities," Mr. Cohen said. "But we wanted that moment when we could let our guard down, when we could feel and breathe and be human in our approach to sexuality."
Marc Cohen says there is a "burn-out" factor when it comes to HIV prevention. People have heard safe sex messages for decades and have grown tired of the subject. But, until there is a cure for the virus, prevention is the only viable option. Marc Cohen says the medical and public health community has no choice but to continue to urge safe sex and to find ever more creative and effective ways of doing so.