Gone are the red ribbons on every lapel. The AIDS quilt tours amid less fanfare. HIV-positive magazine covers show smiling, healthy faces.
For sure, the face of AIDS has changed as new drug therapies help many HIV-positive individuals prolong and enhance their lives. But medical researchers are concerned that young Americans, who did not come of age in the scary, early days of AIDS, are not taking warnings about the deadly disease to heart.
In a study presented this week at a world AIDS conference in Barcelona, Spain, U.S. researchers said three-quarters of young gay urban men infected with HIV, the virus that causes AIDS, are unaware they are infected. More than half of the men, ages 15 to 29, said they considered their risk of infection to be low, and half had engaged in unprotected sex in the previous six months, said the researchers from the Centers for Disease Control and Prevention.
Despite their risky behavior, most young gay men were able to rattle off safe-sex guidelines as if they authored the pamphlets, said Douglas Shehan, a research scientist at the University of Texas' Southwestern Medical Center who headed the CDC study in Dallas.
"The problem isn't knowledge," Shehan said. "It's translating knowledge into behavior change."
Many factors, including level of intimacy, connection, trust and whether the relationship was long-term or a fling, seem to contribute to risky behavior among young gay men, Shehan said. Many young men think only older guys have HIV, he said.
"A decision whether to have safe sex doesn't happen in a vacuum," Shehan said.
Do Real Men Wear Condoms?
Risky behavior is not unique to young gay men, of course. Young women comprise 58 percent of new HIV infections among teens.
People under 25, gay and straight, are estimated to make up half of all new HIV infections in the United States, and many infected teens do not know it, according to the Kaiser Family Foundation. While many teens take precautions, one out of three admits to not using a condom "all of the time."
"There's a certain degree of invincibility among adolescents, the idea that 'I won't catch it,' " said Syracuse University Professor Alejandro Garcia, co-editor of the book HIV Affected and Vulnerable Youth: Prevention Issues and Approaches. "My concern is that when our hormones are running wild, particularly in that age group, the first thing you think about is not precaution."
Especially when drugs and alcohol are involved, he said, young people are more interested in spontaneity than their own protection.
Ignorance about AIDS and resistance to safe-sex techniques likely have gender and culturally specific factors, too, Garcia said. Latino and black families are often more conservative, he said, and so their teens may be less likely to discuss how to avoid sexually transmitted diseases.
Young women may be afraid to ask their partners to wear a condom, and young men may think they are more macho if they engage in risky sexual behavior. "Sometimes there's a kind of thinking that real men don't wear a condom," Garcia said.
Urgency of Epidemic Deflated
The development of new drug therapies has deflated some of the urgency of the AIDS threat, particularly among young people, experts say.
While most sexually active young adults probably don't think about drug cocktails before jumping into bed, they are also not bombarded with reminders of AIDS' deadly consequences.
"AIDS is not scary the way it was 20 years ago. The people in my generation, our behaviors were impacted by the gruesome imagery you saw of AIDS," said Jonathan Alexander, 34, a University of Cincinnati professor and AIDS educator. "Now, AIDS seems just like a treatable disease."
The latest drug therapies hardly comprise a cure, experts point out, despite the apparent health of high-profile HIV-positive individuals like basketball star Magic Johnson.
In reality, many individuals cannot tolerate the harsh medications used to keep viral levels down or have developed resistance to anti-AIDS drugs.
Turning On the Safe-Sex Messages
Experts say messages need to be tailored to youth, whether gay or straight, that they can relate to in places where they spend time and are likely to fall into risky behavior.
College students say they are not "turned on" by the safe sex messages they hear, Alexander said.
"Our culture has a difficulty talking about sexual issues, especially talking about pleasure," he said. "This translates to students as a lack of interest. It's not 'real' for them, that's one of the things I am hearing frequently."
Health professionals should also develop strategies to intervene on social and environmental levels, Shehan said. Posters hung above urinals at popular bars could advertise safe sex and point out that condoms are available at the bar, for example.
From there, parents, schools, employers and churches — any institution that is part of a social support network — should all convey safety messages.
While safe-sex behaviors are important, Shehan said convincing teens and young adults to get tested for HIV, even just once a year, could go a long way toward preventing infected, unaware young people from spreading the disease.