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What does the rise in unprotected gay sex mean for the fight against AIDS?

President Obama's call for an AIDS-free generation might face a serious obstacle

To commemorate World AIDS Day, President Obama said today that he believes an "AIDS-free generation is within our reach." But a seemingly worrisome impediment to this goal has recently come to the fore: A significant spike in gay men engaging in unprotected anal sex.

Last week, the Centers for Disease Control and Prevention reported a 20 percent increase in gay men engaging in unprotected sex from 2005 to 2011. In a further cause for worry, unprotected sex was twice as common among men who were unaware of their HIV status.

Similar spikes in unprotected sex have also been seen in Canada, Britain, the Netherlands, France, and Australia, "heightening concerns among public health officials worldwide," writes Donald G. McNeil Jr. at the New York Times.

Their fears are far from unfounded. It’s no secret that unprotected sex is one of the prime ways to transmit HIV, especially among gay men, a group still considered to be at a higher risk for HIV.

Dr. Thomas R. Frieden of the CDC tells the Times, "Unprotected anal intercourse is in a league of its own as far as risk is concerned."

Michael Specter at The New Yorker went so far as to say, "If unprotected anal intercourse is rising among gay men, the rates of HIV infection will surely follow."

Specter attributes the increase in barebacking (unprotected anal sex) to the fact that millennial gay men have not witnessed firsthand the ravages of AIDS, and thus are less fearful of contracting it. "For a while, in the nineties, gay men were scared, and the statistics showed it. They used condoms regularly, and tested themselves," he writes. He acknowledges that "many still do," but that more men than before have "wearied of the sexual and emotional straightjacket."

But it's not just that. Thanks to advances in medicine, HIV is no longer a death sentence. "HIV has become a chronic disease," Alex Carballo-Diéguez, a researcher at Columbia University, tells the Times. "Everyone knows some behaviors are bad for you like smoking and trans fat. But in the moment, they’re going to do what they enjoy."

That someone in the medical community could compare the risk of HIV contraction to unhealthy eating exemplifies how much more manageable HIV has become.

It also shows why the scare tactics Specter alluded to are no longer working. "For decades, we’ve been trying to shame, guilt, and terrify men into using condoms," writes Mark Joseph Stern at Slate. "The nightmare of the ‘80s doesn’t reflect the reality of HIV today; condom scolds have seen their most effective weapon fear-defanged."

Furthermore, Stern isn’t convinced that the rise in barebacking is cause for panic. Referring to "an era of marriage equality and gay monogamy," he argues that more men may be having unprotected sex because they’re sleeping with only one person. He points out that the fear of unprotected sex is often rooted in the "myth that all gay men are promiscuous."

But Stern’s explanation, even if accurate, doesn’t provide perfect justification for condom-less sex. For one, people may cheat. But the bigger issue is that people may not always know their most accurate and recent HIV status. The Times reported that 10 percent of gay men who thought they were HIV negative were actually positive.

This is a problem that stretches beyond the gay community. In November, the CDC reported that fewer teens in general were using condoms than they were in the 1990s. A lack of fear of HIV is also cited as part of the reason for the drop. And unfortunately, the effects of this behavior is already manifest in this demographic: People in their early twenties have the highest reported cases of HIV.

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