HIV infection is on the rise among gay and bisexual men in Rhode Island, even as it is declining for other populations: injection drug users, who are considered particularly at risk, and heterosexuals.

There were 45 newly reported cases for gay and bisexual men in 2005. There were 54 last year. That's a 20 percent increase.

The jump comes amid a resurgence of syphilis in the state, and across the country, that is particularly pronounced among men who have sex with men (see "The sudden return of an old killer: syphilis," 4.20.11).

Public health officials can't say, definitively, what is to blame. But they suggest easy access to anonymous sex through the Internet has had an impact. And they say improvements in HIV treatment have contributed to increasingly lax attitudes about unprotected sex.

Thomas Bertrand, executive director of the AIDS Project Rhode Island, says he is alarmed by the trends and convinced that the state must do more to target gay and bisexual men. We caught up with him for a Q&A via email.

YOU'RE OUT ON THE FRONT LINES. HOW HAVE ATTITUDES ABOUT SAFER SEX SHIFTED AMONG GAY AND BISEXUAL MEN IN RHODE ISLAND AS HIV TREATMENTS HAVE GROWN MORE EFFECTIVE? I think we were all fearful early in the HIV epidemic that as effective HIV treatments emerged, attitudes towards safer sex might shift towards complacency. Where we once saw pictures in the media of sick men, like Rock Hudson, helplessly dying of HIV/AIDS, we now see pictures in magazines of healthy-looking men on hikes touting the benefits of HIV medications. Gone are the days in the '80s and '90s when men carried around their most recent HIV test results in their wallets.

I am an HIV test counselor, so I frequently talk with men about safe sex. Although some men approach it seriously, there are others who are willing to take some risks because they hear HIV is no longer a "death sentence." This is unfortunate because to stay healthy, people who get HIV will likely need to take daily medication, deal with potential social stigmas and HIV disclosure issues, and confront health care costs of about $650,000 over their lifetimes. Changing safe-sex behavioral attitudes and norms through education is one of my top priorities — but it is a big challenge in an era of advancing HIV therapies.

HOW WORRIED ARE YOU ABOUT THE GROWTH IN HIV CASES IN THIS POPULATION? I'm very concerned about the rates of HIV among gay and bisexual men in Rhode Island, which have been slowly climbing in recent years — especially in comparison to Massachusetts which has seen a significant drop in cases. Due to media coverage of national trends, many Rhode Islanders don't know that HIV rates in Rhode Island have only been rising among gay and bisexual men, while other groups, like heterosexuals and injecting-drug users, have seen encouraging declines. We need to get the word out that gay and bisexual men represent up to 75 percent of new HIV infections in Rhode Island each year.

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