Bill Weintraub

AIDS Cases on the Rise in United States

8-3-2003

AIDS Cases on the Rise in United States

Sun Aug 3, 2003

By DANIEL YEE, Associated Press Writer

ATLANTA - Americans became complacent about safe sex. Revolutionary new drugs allowed HIV -infected people to live longer. A new generation of gay men entered their 20s without the memory of the early days of AIDS devastation.

Health officials saw the signs and warned that AIDS - after declining for a decade - could make a comeback in this country.

Last week, new figures showed the predictions were right - AIDS diagnoses increased for the first time in 10 years.

Many Americans felt that AIDS had become an African epidemic, that the disease was under control here. That complacency is one of the main reasons that new HIV infections have been creeping up lately, especially among gay men in large cities.

"There needs to be a lot more attention paid to the HIV epidemic in the United States," said Dr. Jim Curran, dean of Emory University's Rollins School of Public Health, and a former AIDS director with the Centers for Disease Control and Prevention (news - web sites). "People need to realize there's still no cure and no vaccine. Our greatest enemy in HIV prevention is ... complacency about our epidemic here."

Last year, 42,136 new AIDS cases were diagnosed in the United States, up 2.2 percent from the previous year. The number of gay and bisexual men infected with HIV, the virus that causes AIDS, was up for the third year in a row after a decade of declining numbers.

Health officials say prevention efforts have stalled, and they are changing their strategy from one of preventing new cases to counseling those who already have HIV in an attempt to get them to stop spreading it.

The CDC estimates 850,000 to 950,000 Americans are living with HIV, and nearly 385,000 of those have full-blown AIDS.

"I don't think we're losing the war, but we're certainly not finished with the war," said Dr. Ronald Valdiserri, a CDC deputy director.

Since 1990, the U.S. HIV infection rate has been constant at 40,000 cases a year. The country is in danger of failing to meet its goal of cutting that number in half by 2005. Not meeting the goal will result in 130,000 more people infected with HIV by 2010 and a health care cost of $18 billion, researchers estimate.

New threats have emerged: Up to 15 percent of new HIV cases in the country are believed to have drug-resistant strains of the virus.

Other statistics have indicated an increase of risky sexual behavior. Syphilis outbreaks have erupted in recent years among gay men in America's largest cities.

The problem, and the answer, health officials say, lies in prevention. The new generation of sexually active Americans do not remember the devastation of the AIDS epidemic. AIDS-era veterans have suffered burnout from years of good-health messages and safe-sex practices. There's also a lack of concern because of life-extending drugs. Some gay men use the term "pill fatigue" to describe what happens when someone tires of taking HIV medication for many years.

"Part of it is complacency, part of it is indifference - people may know it and they just don't care," said Terje Anderson of the National Alliance of People with AIDS. "Part of it is fatigue -- guys have been trying to stay safe for 20 years, how do you keep doing it? At a certain point people are losing their ability to do that and it's very troubling."

At the Outwrite Bookstore and Coffeehouse in Atlanta's Midtown district, customers ponder the changes in the AIDS epidemic.

"It's not something people want to talk about - it's not in people's faces all the time as 20 years ago," says the bookstore owner, Philip Rafshoon, 42, who has lost friends to the disease. "People want to have sex and it's hard to always remember to have safe sex and it's hard to stop yourself from pushing the limits."

Those interviewed said unsafe sex still was being practiced and prevention messages don't target the restaurants, clubs or bars frequented by gays. Some said there hasn't been nearly enough outreach for young people who are becoming sexually active.

"Nowadays, people cheat - no matter how long you have a partner, always use a condom," said Kenneth Royster, 34.

Demond Campbell, 29, said he tries to be careful but admits there have been one or two times in the past five years when a condom wasn't available.

"(HIV) could be in the back of people's minds until it happens to them," Campbell said. "I think that it's still serious, but since medication, it's a little bit better but still scary."

Both men, who are black, said that there isn't enough emphasis on prevention in the black gay community. Royster said there seem to be more prevention messages during high-profile events, such as Atlanta's gay festivals.

Others say they've been faced with unsafe sex.

"I've had many occasions where I've had people who did not want to (use a condom) and I get rather upset," said Tom, 25, who did not want to give his last name. "It's unnerving seeing how many unprotected casual relationships are out here."

In April, CDC director Dr. Julie Gerberding, noticing current efforts had stalled, announced a change in the country's HIV prevention strategy. The new focus is on stopping HIV patients from transmitting the virus to others.

That plan also aims to reduce the number of mother-to-child HIV transmissions and to take advantage of a new rapid test for screenings in homeless shelters, drug treatment centers, jails and other non-medical settings.

A new antibody test the CDC will distribute next year will be able to tell if someone has been infected in the last six months. Experts hope it will enable them to pinpoint infection hotspots to control new HIV outbreaks.

The country's previous strategy focused on addressing potentially risky behavior in uninfected people.

"We haven't put as much emphasis on HIV-infected people as we should," Gerberding said then. "It's very important to know who their partners are and to make sure they have access to prevention (and) treatment."

But the strategy has been criticized by AIDS activists, who worry that it focuses too much on people who already have the virus and not enough on people at risk. AIDS groups also are worried they will lose vital funding to pay for the new effort.

Overall, the CDC initiative is a good approach, but prevention campaigns cannot neglect the power of small-group and community-level interventions, Anderson said.

"You've got to recognize the social environment risk happens in," Anderson said. "There's a shared responsibility for prevention and the recognition that (HIV) positives and negatives need a whole range of services. We need an approach that adds to both, not takes away from one."