Not likely, says Gayle. The heterosexual epidemic in Africa results largely from conditions that do not exist in industrialized countries. These include large-scale population shifts, little information about AIDS prevention, many migrant workers, widespread prostitution, deep reluctance to use condoms and frequent, untreated sexually transmitted diseases. Still, heterosexual transmission is slowly increasing in the United States, largely to low-income black and Hispanic women. Fears that the highly effective AIDS drugs would quickly lose their punch have not come true.
Most patients continue to do well, although long-term side effects are the biggest worry.
Side effects that make some people quit treatment include an abnormal redistribution of body fat that leaves them with buffalo humps and skinny faces and extremities, along with a variety of metabolic complications, such as high blood sugar and cholesterol. Thinning bones are the latest anxiety. Eventually some run out of options. Nevertheless, they often stay healthy if they remain on treatment. The virus in their bodies is so weakened by its drug-resisting mutations that it does relatively little damage.