Homosexual transmission of AIDS predominated in Europe, North America and parts of Latin America during the 1980s. HIV infection among homosexual males then fell in the 1990s and in general AIDS infections have become less common among gay men since the height of the epidemic in the 1980s. For instance, in New York, just over half of all gay men of all ages who were tested at venereal disease clinics in 1988 were infected, compared with 20 percent in 1997.
However, in the USA the burden of HIV has increasingly shifted from white homosexuals to to blacks. The most recent study (reported in 2001) found that among young, gay men living in large US cities, 3 percent of Asians, 7 percent of whites, 15 percent of Hispanics and 30 percent of blacks are infected with the virus. (An earlier study by the same group looked at AIDS infections among gay 15- to 22-year-olds. It found that 14 percent of blacks were infected.) HIV infections were disturbingly common among gay men of all races in their 20s, especially considering that they grew up knowing how AIDS spreads. Less than one-third of those in the survey who had HIV knew about their infection. Almost half of the men surveyed admitted they had had unprotected anal sex during the previous six months.
In 2001, just over half of the estimated 40,000 new HIV infections annually in the USA occur among blacks. This is half of a 12% infection rate. Among infected women, blacks outnumber whites almost 4 to 1.
Homosexual exposure accounted for 54% (14,890 of the total 27,180 known infections) of HIV-positive British people in 1991. The incidence of AIDS in gay men was expected to peak in the UK in 1993 or 1994.
A study reported by the US Centers for Disease Control and Prevention found that oral sex accounted for a larger than expected number of new HIV infections among gay men in San Francisco in the three years from June 1996 through June 1999. Of the 102 participants in the study, 85 percent said they did not use condoms for oral sex because they believed that it represented either no or minimal risk in transmitting HIV.
Homosexual men have grown complacent about catching HIV because effective treatments can hold the disease in check. Gay men are now more likely to have risky sex, such as anal intercourse without condoms.
The disease largely affects populations on the edges of the mainstream, including gay men and poor blacks. In African-Americans, there is a much greater stigma about being homosexual than there is among whites. That makes them even more marginalized.