Although AIDS first took root in gay communities, it soon moved on to users of injected drugs. Now, more than half of new infections in Philadelphia are passed through heterosexual contact, a third are the result of men having sex with men, and just 13 percent arise from drug addicts sharing dirty needles, the new federal analysis shows.
"The HIV epidemic is caused by poverty and despair," said Jane Shull, executive director of Philadelphia FIGHT, an AIDS service group.
An estimated 1,400 Philadelphians are newly infected each year - on top of the more than 16,000 who are living with HIV or AIDS - and those who do not realize they have been infected are believed responsible for an outsized portion of new cases.
So public-health workers are testing far more people in far more places, trying to get past cultural barriers that contribute to strikingly high numbers of infections among African American men and fast-increasing rates among black and Hispanic women.
Nationwide, rates of HIV, the virus that causes AIDS, are highest in black communities. Philadelphia has the second-highest percentage of black residents of the 10 most populous cities - 43.2 percent, according to the 2000 census.
Overall, experts said, the local picture is of a disease that is transmitted largely by people who do not think of themselves as being at high risk and have not until recently been primary targets for prevention efforts.
'A tough guy'
Lester Faison, 50, says he never has had sex with men (including while in prison) or used intravenous drugs (he was addicted to crack cocaine). He never discussed using a condom with either of his last two girlfriends.
"They would think that I was messing around or that I had something already," he said. Plus, "we felt we were true to each other. I did, anyway."
