HIV strikes the next generation

Tim Steeves stood in the State Capitol rotunda last Wednesday and, in a shaky voice, told his story to the small crowd of activists and the much larger crowd of unemployed construction workers who just happened to be on hand.

"I was homeless, a college dropout with no job and no hope," he said. "I hated myself for being gay."

He was also just 18 and had no idea that he was at the eye of a public health storm -- a new generation of young gay and bisexual men who are once again at risk for a disease that had almost been forgotten.

Last month the Minnesota Department of Health reported the biggest jump in HIV infections in 17 years -- with cases almost doubling among young gay men -- a development that has shocked state health officials into starting work on a new statewide AIDS prevention strategy.

In other parts of the country rates have climbed far higher. In New York and Washington D.C., for example, rates among gay men and blacks rival those of some African countries. Last week, for the first time since the virus was first identified, the U.S. Centers for Disease Control and Prevention reported just how common it is among gay and bisexual men nationally. About 4 percent of the male population has sex with other men, the report estimated, and they are 44 times more likely than heterosexual men to be infected with HIV.

Steeves, who spoke last week at an AIDS rally in St. Paul, is one of 77 young men in Minnesota who were diagnosed with HIV last year, almost certainly an underestimate of the true total. His story helps explain how and why the virus has returned with such force.

Steeves, now 20, entered adolescence during a time of dangerous complacency about AIDS, experts say. After two decades of work in the gay community and by public health agencies to promote safe sex, new infections were low -- as was public concern. At the same time, thanks to new anti-viral medications, HIV had evolved into a treatable disease.

No idea of the risks

He told his parents he was gay when he was about 15. They asked him to try being straight. For a while he pretended.

HIV was a fear, but it lived in the back of his mind. It would emerge sometimes after he had unprotected sex with another man. He didn't ask about their HIV status, and they didn't ask about his.

Steeves had no idea what the risks were -- something that remains true for many gay men his age, he said. Young gay men of his generation often don't get any messages about how to protect themselves, Steeves said, and as a result "unsafe sex is really hot right now," he said.

The CDC's data underscore the point: One in five people who carry the virus doesn't know it.

At first he was shocked when test came back positive. But in a way it felt inevitable. "I remember being really at peace," Steeves said. "I was such a miserable kid -- now it was justified."

That, too, is a common reaction, say public health experts -- many gay men see infection as their destiny.

Steeves said his diagnosis was the low point of his life, but it also inspired him to grow up and take responsibility. "It made me into a man," he said. Now he takes anti-viral medications that keep the virus under control. He got treatment for his drinking. Thanks to social services he found through AIDS support groups, he now lives now with a stable gay couple in St. Louis Park -- they have dinner together almost every night.

He's attending the Minneapolis Community and Technical College with plans to become a social worker. He's part of a corps of volunteers at the Minnesota AIDS Project (MAP), the state's leading AIDS advocacy group, who are spreading out to form social groups at colleges as a way to change the culture of silence around HIV.

A difficult conversation

"We need more facts," he said. "And less fear."

But starting that sort of conversation is hard.

Joshua Tomashek, 20, a sophomore at Macalester College, this year helped create a new group called Homo@mac focused on sexual health. But he has found that some gay students don't want to be associated with it because they don't want to be perceived "as that kind of gay."

"People don't want to know the risks," Tomashek said.

Their conversations with other young men are more complex than, "Safe sex, use a condom." But then, so is their audience. Today the Internet is the social scene of choice for young gay men, just as it is for many young adults. But for gay and bisexual men, the ease of finding sexual partners online also increases the number of unsafe sexual contacts.

"They need a depth of information nowadays that they are not going to get," said Dr. Gary Remafedi, an expert in HIV/AIDS at the University of Minnesota. "The condom use message does not go far enough."

Steeves knows, for example, that as long as he takes his meds, his chances of infecting someone else are low, but not zero, and that a lot depends on what kind of sex he has.

He also knows now what he didn't know when he became infected: There is a sort of morning-after pill for HIV, a course of antivirals called PEP that if taken immediately after sex may eliminate infection altogether. Steeves' doctor told him about it at the same time he told him he was positive. But it was too late.

Most important, he said, individuals have to take control of their risks by asking about others' HIV status. The problem, he said, is that many don't want to know the answer to that question.

The man who raped him, for one, still identifies himself as HIV negative on his Web profile, Steeves said.