Love or being used for propaganda ?

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Ronald Stall, M.D., of the University of Pittsburgh School of Public Health, examines the reasons behind the rebounding HIV epidemic among men who have sex with men in the United States — and offers some ideas for how to stop it.  (At  the   The 15th Conference on Retroviruses and Opportunistic Infections  in  2008)

“Turning to the United States model: We looked at just the estimates for the United States. In community-based samples, which were the lowest rate of HIV incidence, compared to HIV alternative test sites or STD [sexually transmitted disease] samples, we calculated a mean incidence rate of about 2.4% per year.

The next thing we did was, we wanted to find out: What does 2.4% mean? What does 2.4%, in particular, mean over long periods of time? So we did a thought experiment, using a closed cohort of young gay men at the age of 18, none of whom were infected at 18, but calculated an incidence rate of infection of 2.4% per year as these men moved from age 20 to age 40. The model that we constructed yielded an estimate that at about age 25, about 15% of the men would be HIV positive; by age 35, about a third; and by age 40, about 41%.

The reason that we used the age of 40 as our cut-point is that AIDS was discovered a quarter of a century ago. These men would have had to have been, by definition, younger than 15 years of age. In addition, because we know that HIV incidence rates were stable from 1995 to the present, the vast majority of their sexual lives would have been in the context of this background incidence rate of about 2.4 or 2.5%.

We were kind of horrified that our model yielded prevalence estimates that high. And accordingly, we went back and looked at the largest samples published by the CDC [U.S. Centers for Disease Control and Prevention] of prevalence rates among men in the United States. The CDC just published, in 2005, a very large study of HIV prevalence rates, by age, in five American cities. What we find is that the model actually fits exactly what’s going on in terms of HIV prevalence among gay men, at least in America’s largest urban centers. This model that we are extrapolating based on the incidence rates, which culminates in an HIV prevalence rate of 40% at age 40, is not a prediction of something that may happen one day. We are describing epidemiological phenomena that are occurring all around us, and will continue to occur among young American men, if we do not find ways to lower HIV incidence rates further.

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