5. Including those who inject drugs, the numbers fell from 65 percent in 1981 to 44 percent in 1996. Centers for Disease Control, Atlanta, Ga., March 1996.

6. Interview with Gary Remafedi, director of the University of Minnesota/Minneapolis Youth and AIDS Project, 1998.

7. "Rate of AIDS Has Slowed," New York Times, April 25, 1998, A9. African Americans make up half of new HIV infections and 40 percent of full-blown AIDS cases. Doug Ireland, "Silence Kills Blacks," Nation (April 20, 1998): 6. Poor neighborhoods, where almost everybody knows somebody with the disease, are being ravaged. In the South Bronx, for instance, AIDS is the leading cause of death in children (interview with GMHC spokesman, 1999).

8. Altman, "Study in 6 Cities Finds HIV in 30% of Young Black Gays."

9. Cherrie B. Boyer and Susan M. Kegeles, "AIDS Risk and Prevention among Adolescents," Social Science Medicine 33, no. 1 (1991): 11-23.

10. New York City Health Department, phone interview, April 1999.

11. Barbara Crossette, "In India and Africa, Women's Low Status Worsens Their Risk of AIDS," New York Times, February 26, 2001.

12. B. R. Simon Rossner, "New Directions in HIV Prevention," SIECUS Report 26 (December 1997/January 1998): 6.

13. Governments of developing countries have won some concessions from the major pharmaceutical companies, but many observers believe these are too little, too late.

14. The following remarks from people in the Twin Cities came from interviews that I conducted during my visit there in 1998.

15. District 202 Youth Survey (Minneapolis, 1997).

16. District 202 Youth Survey.

17. Marsha S. Sturdevant and Gary Remafedi, "Special Health Needs of Homosexual Youth," in Adolescent Medicine: State of the Art Reviews (Philadelphia: Hanley and Belfus, 1992), 364. The authors cite a study of male prostitutes and other delinquent young men that found that 70 percent of the former group considered themselves gay or bisexual compared with only 4 percent of the latter. D. Boyer, "Male Prostitution and Homosexual Identity," Journal of Homosexuality 15 (1989): 151.

18. R. Stall and J. Wiley, "A Comparison of Alcohol and Drug Use Patterns of Homosexual and Heterosexual Men: The San Francisco Men's Health study," Drug and Alcohol Dependence 22 (1988): 63-73.

19. "Although there is a significant relationship between substance use and high risk sexual activity, substance use does not cause sexual risk taking," according to a compilation of research by Advocates for Youth. "At-risk teens tend to engage in several inter-related high risk behaviors at once." Marina McNamara, "Adolescent Behavior: II. Socio-Psychological Factors," Advocates for Youth fact sheet, Washington, D.C., September 1997.

20. Studies suggest that as many as 35 percent of young gay males and 30 percent of lesbians have considered or tried suicide. Alan Bell and Martin Weinberg, Homosexualities (New York: Simon and Schuster, 1978). As for kids who succeed in self-annihilation, the 1989 U.S. Department of Health and Human Services Task Force on Youth Suicide reported that 30 percent may be gay.

21. Gary Remafedi, Michael Resnick, Robert Blum, and Linda Harris, "Demography of Sexual Orientation in Adolescents," Pediatrics 89, no. 4 (April 1992).

22. Patton, Fatal Advice.

23. U.S. Conference of Mayors, "Safer Sex Relapse: A Contemporary Challenge," AIDS Information Exchange 11, no. 4 (1994): 1-8.

24. Altman, "Study in 6 Cities."

25. D. Boyer, "Male Prostitution and Homosexual Identity," Journal of Homosexuality 9 (1984): 105.

26. In one study of New York kids selling sex on the street, only 36 percent of respondents had failed to protect themselves in the last encounter. S. L. Bailey et al., "Substance Use and Risky Sexual Behavior among Homeless and Runaway Youth," Journal of Adolescent Health 23 (December 1998): 378-88.

27. Amy Bracken, "STDs Discriminate," Youth Today (March 2001): 7-8.

28. Minnesota's Youth without Homes (St. Paul: Wilder Research Center, 1997), 5.

29. Ine Vanwesenbeeck, "The Context of Women's Power(lessness) in Heterosexual Interactions," in New Sexual Agendas, ed. Lynne Segal (New York: New York University Press, 1997), 173. A 1998 study of homeless youth, however, found that only 36 percent of respondents, who were mostly female, did not use a condom with a casual partner, and the less-well-known a partner was, the more likely they were to use a condom. S. L. Bailey et al., "Substance Use and Risky Sexual Behavior."

30. Author interview, New York, 1999.

31. E. Matinka-Tyndale, "Sexual Scripts and AIDS Prevention: Variations in Adherence to Safer Sex Guidelines in Heterosexual Adolescents," Journal of Sex Research 28 (1991): 45-66; S. J. Misovich, J. D. Fisher, and W. A. Fisher, "The Perceived AIDS-Preventive Utility of Knowing One's Partner Well: A Public Health Dictum and Individuals' Risky Sexual Behaviour," Canadian Journal of Human Sexuality 5 (1996): 83-90; Linda Feldman, Philippa Holowaty, et al., "A Comparison of the Demographic, Lifestyle, and Sexual Behaviour Characteristics of Virgin and Non-Virgin Adolescents," Canadian Journal of Human Sexuality 6, no 3. (fall 1997): 197-209.