877: new infections diagnosed in Tennessee in 2011
2,037: new infections diagnosed in Georgia in 2010
50,000: Average number of new infections diagnosed per year nationally in last decade
1.1 million: people living with HIV/AIDS in the U.S.
641,976: AIDS deaths nationally since the epidemic began
18: the percentage of people who are infected nationally and don't know it
50: the percentage of infected who are not in regular care
Source: Kaiser Family Foundation, Tennessee Department of Health, Georgia Department of Health
• Estimates show that gay and bisexual men comprise 2 percent of the population but account for 61 percent of new infections.
• Young gay and bisexual men (age 13 to 29) are at risk. This group accounts for 27 percent of all new HIV infections.
• Young gay and bisexual men are the only group for whom new HIV infections increased since 2006, specifically because of the rise in infections among young black men.
Source: Kaiser Family Foundation
Of the 877 new HIV cases in Tennessee last year, most were the result of viral accidents. A condom broke. A partner didn't know he or she was infected. Drugs or alcohol clouded judgment.
But a handful, a small percentage of those with HIV, knew they had it and passed it on anyway.
In those cases, national researchers and local prevention workers call those with the virus "gift givers." Those who pursue the virus are labeled "bug chasers."
For almost a decade, they have advertised online in large metropolitan areas like Nashville and Atlanta. But now a subgroup is popping up in suburbia, too. On popular gay dating sites like Manhunt and Adam4Adam you can find them listed in and around Chattanooga.
Just an hour or more down the interstate you can attend a bug chasing party, online personals show. And while passing on the virus to a partner without his or her knowledge is illegal, spreading the disease between willing partners isn't, according to officials with the Tennessee Department of Health.
"It is naive to think that it is not going on," said Vic Sorrell, community educator with the Vanderbilt HIV Vaccine Program.
Those who purposely contract the HIV virus are condom fatigued, looking for acceptance through the illness or tired of fearing testing every six months, he said. Often, they are mentally ill or drug dependent, experts say.
"Bug chasers are people trying to reach for the highest high," said Donald J. Alcendor, an HIV researcher at Meharry Medical College and a Vanderbilt faculty member. "Couples sometimes want to maintain their relationship. [Others] are promiscuous and don't want to stop."
Most who study the HIV/AIDS epidemic downplay the practice as so small as to be of little significance.
And indeed, overall new HIV/AIDS diagnoses have stabilized or even fallen in Tennessee, Georgia and across the U.S. In 2008, new diagnoses reached 1,000 in Tennessee, a high for recent years. By 2011, new diagnoses had declined by 12 percent.
Bug chasing, on the other hand, while still rare -- no one knows the exact extent of the phenomenon -- has become more common, to the point that researchers are noticing it and getting concerned.
Experts say the aberration is important because it may point to a larger problem for efforts to prevent HIV/AIDS. A younger generation is more lax about the disease. Unlike earlier days, when an infection was an automatic death sentence, drug cocktails can keep the infected living a normal life span.
It takes just one pill a day for $1,500 a month, a cost covered by TennCare, Medicare, private insurance or the federal Ryan White CARE act.
In some cases, anti-retrovirals can lower the viral load in the body to undetectable levels, making it less likely to spread the virus to sexual partners, even without a condom.
And in the last couple of years, a new drug entered the market that could keep those without HIV from ever catching it. The pre-exposure prophylaxis, Truvada, would be taken once daily. The U.S. Food and Drug Administration approved it last May.
The pill will be marketed to high-risk populations, gay men, drug users and prostitutes and could discourage condom use, critics say.
On World Aids Day in December, 2.5 million men on Manhunt, a dating site, received promotions calling the drug "a choice when condoms are in the way or not enough."
Paired with an Internet culture of anonymous sex, risky behavior multiplies, experts say. While overall cases of HIV are down significantly, new cases among young men are up, especially men who have sex with men, and especially minority men who have sex with other men.
In East Tennessee, new cases jumped from 80 to 106 from 2010 to 2011. Of the 106, 75 percent were men who have sex with men, according to data from the Tennessee Department of Health. Data in Georgia mirrors Tennessee. Most new infections are in men who have sex with men, data from the Georgia Department of Health show.
"We have people who come in and are nonchalant. [They say] 'It doesn't matter to me.' They are looking at it as a one-pill-a-day regime ... They haven't lived with HIV," said Jerry Evans, prevention education program manager at Chattanooga CARES.
Gay bars were once hubs of prevention. In the bathrooms there would be signs about getting tested, wearing protection. A bowl of condoms would sometimes sit on the counter.
But now sexual pairings happen more commonly on the Internet. People afraid of coming out can set up meetings unafraid. There is even an iPhone app that locates gay men nearby looking for a hookup.
The state notifies people who may have had sex with someone who is HIV positive. But sometimes the HIV-positive person doesn't know the real names of their recent sexual partners and state workers can only go off the nicknames listed on online profiles.
"They don't even know the name. The only way to track them is online. Traditionally, we can't sit in a government website and go on these websites," said Tim Jones, state epidemiologist for the Tennessee Department of Health.
Some Tennessee and Georgia agencies do go to online cruising and dating sites to promote prevention. Chattanooga CARES no longer does, said Evans. The organization doesn't have the money or manpower. Websites like Manhunt, which used to allow prevention agencies to advertise for free, now charge $500, he said.
Prevention dollars to pay those types of costs are shrinking. The state has a pool of $4 million through the U.S. Centers for Disease Control and Prevention, and Chattanooga Cares, which is the primary facility for care and prevention of HIV/AIDS, gets just $84,000, said Evans.
"Social attitudes and what is popular behavior are constantly trying to change our tactics," Jones said. "You can't write a policy for that."
The psychological reasons for pursuing HIV seem unfathomable. There is still a stigma associated with the disease. Some strains of the virus are drug resistant and can mutate to kill. The side-effects can range from dementia to bone breakage. The pill that can keep the worst symptoms at bay has been linked to cancer, said Perry N. Halkitis, professor of applied psychology, public heath and population health at New York University's Steinhardt School of Culture, Education and Human Development.
Bug chasing is in some cases sexual defiance or sexual addiction. Other times, it is a product of self hate, especially in the South. The families of homosexuals may reject them. Their church may reject them. Even the gay community may reject them for one reason or another. But HIV forces someone to care, said Halkitis.
A healthy fear of HIV swept the gay community in the '80s and '90s because gay men were dying. Before drugs, HIV meant vomiting, weight loss, pneumonia, pain and death.
"Ask [HIV] positive men who are 50 and older. They are the most interesting guys because they can't understand why anyone is having unsafe sex," Halkitis said. "They are very unsympathetic to the young guys. They would say, 'How dare you? We didn't know what was going on. How can you be so stupid!'"