Survival time has increased substantially for adult Brazilian AIDS patients. The timing of these gains and analysis of the predictors of survival both indicate antiretroviral treatment as the cause. These findings demonstrate that universal access to antiretroviral treatment in a developing country can produce benefits on the same scale as in richer countries.

Two decades of experience and research provide new insights into the role of condoms for AIDS prevention in the developing world. This literature review and synthesis is based on computerized searches of the scientific literature and review of conference presentations, publications of national and international organizations, and popular media. Condoms are about 90 percent effective for preventing HIV transmission, and their use has grown rapidly in many countries. Condoms have produced substantial benefit in countries like Thailand, where both transmission and condom promotion are concentrated in the area of commercial sex. The public health benefit of condom promotion in settings with widespread heterosexual transmission, however, remains unestablished. In countries like Uganda that have curbed generalized epidemics, reducing the number of individuals' sex partners appears to have been more important than promoting the use of condoms. Other countries continue to have high rates of HIV transmission despite high reported rates of condom use among the sexually active. The impact of condoms may be limited by inconsistent use, low use among those at highest risk, and negative interactions with other strategies. Recommendations include increased condom promotion for groups at high risk, more rigorous measurement of the impact of condom promotion, and more research on how best to integrate condom promotion with other prevention strategies.

The largest investments in AIDS prevention targeted to the general population are being made in interventions where the evidence for large-scale impact is uncertain.

OBJECTIVES. Little is known about the human immunodeficiency virus (HIV) high-risk sexual practices of gay and bisexual African-American men. These data are needed so that better interventions can be developed and implemented in this population. METHODS. The frequency and correlates of unprotected anal intercourse were examined among 250 gay and bisexual African-American men in the San Francisco Bay Area. The cohort was recruited in 1990 from bars, bathhouses, and erotic bookstores, and through African-American gay organizations, street outreach, advertisements in gay mainstream and African-American newspapers, health clinics, and personal referral from other participants. RESULTS. More than 50% of the men in our sample reported having unprotected anal intercourse in the past 6 months, a considerably higher percentage than that among gay White men in San Francisco through 1988 and 1989. Men who practiced unprotected anal intercourse were more likely to be poor, to have been paid for sex, or to have used injection drugs; to have a higher perceived risk of HIV infection; and to report less social support for concerns about risky sexual behavior. Condom norms, condom efficacy, and negative expectations about using condoms predicted these men's failure to use them. CONCLUSION. In the second decade of the acquired immunodeficiency syndrome epidemic, risk reduction programs are still needed for gay and bisexual African-American men.

A national probability survey of human immunodeficiency virus (HIV)-related risk factors among the general heterosexual population, the National AIDS (acquired immunodeficiency syndrome) Behavioral Surveys, has obtained data from 10,630 respondents. Data are presented on the prevalence of HIV-related risks in the general heterosexual population, on the distribution of the three largest risk groups across social strata, and on the prevalence and distribution of condom use among heterosexuals reporting a risk factor. Between 15 and 31 percent of heterosexuals nationally and 20 and 41 percent in cities with a high prevalence of AIDS reported an HIV risk factor. Condom use was relatively low. Only 17 percent of those with multiple sexual partners, 12.6 percent of those with risky sexual partners, and 10.8 percent of untested transfusion recipients used condoms all the time. Overall, the results suggest that current HIV prevention programs have, to a very limited extent, reached those heterosexuals with multiple sexual partners but have failed to reach many other groups of the heterosexual population at risk for HIV. New public health strategies may be needed for these specific risk groups.

To study the effect of military service during the Vietnam era on subsequent mortality, we analyzed a randomized natural experiment, the military draft lottery of 1970 to 1972. Between 1974 and 1983, there were 14,145 deaths among California and Pennsylvania men whose dates of birth were in the years for which the draft lottery was held. The group of men with birth dates that made them eligible for the draft had a higher mortality rate than the group with birth dates that exempted them from the draft: suicide was increased by 13 percent (P = 0.005 by two-tailed test), death from motor-vehicle accidents by 8 percent (P = 0.03), and total mortality by 4 percent (P = 0.03). Only 26 percent of the men who were eligible for the draft actually entered the military. If military service (rather than draft eligibility) was the actual risk factor, suicide and death from motor-vehicle accidents would have to have been increased by 86 percent and 53 percent among men who served in the military, to produce the increased risk that we observed among all draft-eligible men. A separate analysis that compared the causes of death in veterans and nonveterans yielded similar estimates: veterans were 65 percent and 49 percent more likely to die from suicide and motor-vehicle accidents, respectively. We conclude that the most likely explanation for these findings is that military service during the Vietnam War caused an increase in subsequent deaths from suicide and motor-vehicle accidents.

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OBJETIVO: Identificar aspectos da masculinidade relacionados à vulnerabilidade dos homens à infecção pelo HIV. MÉTODOS: Pesquisa qualitativa realizada com homens motoristas de ônibus e integrantes de uma Comissão Interna de Prevenção de Acidentes (Cipa) em uma empresa de transportes coletivos na cidade de São Paulo, SP. Foram gravadas e transcritas dez entrevistas individuais e quatro oficinas de sexo seguro. Seu conteúdo foi disposto e discutido em blocos temáticos relacionados à sexualidade, à infidelidade, ao preservativo, às doenças sexualmente transmissíveis e à Aids. RESULTADOS: São aspectos que tornam os homens mais vulneráveis: sentir-se forte, imune a doenças; ser impetuoso, correr riscos; ser incapaz de recusar uma mulher; considerar que o homem tem mais necessidade de sexo do que a mulher e de que esse desejo é incontrolável. A infidelidade masculina é considerada natural; a feminina é atribuída a deficiências do parceiro. A decisão por usar ou não camisinha é feita pelo homem; a mulher só pode solicitá-la para evitar gravidez. A não-utilização da camisinha é atribuída a: estética, alto custo, medo de perder a ereção, perda de sensibilidade no homem e na mulher. Os entrevistados não se consideram vulneráveis ao HIV nem a doenças sexualmente transmissíveis (DST) e confundem suas formas de transmissão. CONCLUSÕES: A idéia de que ser homem é ser um bom provedor para a família e ter responsabilidade pode constituir um aspecto que favoreça a prevenção, já que pode levá-los a usar camisinha como contraceptivo e para não trazer doenças para casa. É importante conhecer e intervir sobre as concepções de masculinidade, não só porque elas podem contribuir para aumento da vulnerabilidade ao HIV, mas também porque podem apontar caminhos mais efetivos para a prevenção.