Sharp Drops in AIDS May Be Over

By CHARLES ORNSTEIN from the Los Angeles Times


The sharp declines in the number of new AIDS cases and deaths in the United States appear to be ending, stoking fears of a possible resurgence of the disease, federal health officials said Monday.

Driving the trend are a rise in risky behavior among young gay and bisexual men and growing resistance to powerful drug cocktails introduced in 1996.

"For the last two to three years, we have seen signs that have suggested that there really could be a resurgence," said Dr. Helene Gayle, director of the National Center for HIV, STD and TB Prevention at the Centers for Disease Control and Prevention in Atlanta. "Increasingly, the drumbeat is louder and louder . . . that there is cause for real concern." Gayle announced the new data at the second National HIV Prevention Conference in Atlanta.

Although researchers have predicted that their success in slowing the disease would end, Monday's announcement by the CDC marked the first official recognition of a steady trend in that direction.

According to data released by the government, the number of new AIDS cases stayed constant at about 10,000 per quarter between mid-1998 and mid-2000. AIDS deaths also remained steady, at about 4,000 per quarter. At the peak of the epidemic during the first half of the 1990s, more than 15,000 AIDS cases and more than 10,000 deaths were reported each quarter.

The prevailing mood at this week's conference is frustration.

Counselors and advocates have already reached out to people who are willing to change their behavior, said Lee Klosinski, director of education for AIDS Project Los Angeles.

"All of the easy education has been done," said Klosinski, who is at the Atlanta conference. "People who are getting infected today are getting infected for reasons that are much harder to deal with, such as addiction, poverty, mental illness and racism."

Another frustration is that the nation is nowhere close to conquering AIDS 20 years after the first reported cases. Today, researchers acknowledge that they are not close to finding a vaccine, and people whose lives have been prolonged by drugs are now beginning to die.

Gayle and her colleagues cited a number of reasons for the stabilization in AIDS cases and deaths:

Many people who are infected with the human immunodeficiency virus, or HIV, which causes AIDS, don't get tested until the disease has reached an advanced stage. And between the time they are infected and they are tested, those people have infected others.

Infected people have experienced side effects associated with the life-extending protease inhibitor drugs and have interrupted or discontinued their use. Others have found that the drugs stop working after several years.

Some people, especially if uninsured, have had difficulty obtaining treatment.

Many young gay and bisexual men, as well as heterosexual African American women, are engaging in unsafe sex, without condoms and with multiple partners.

A survey of 250 low-income black women in Atlanta showed 45% did not use a condom during any sexual encounter in the previous two months and 60% did not know their partners' HIV status.

According to a separate study by the CDC in six major U.S. cities, more than 1 in 10 young gay or bisexual men tested positive for HIV. The proportion climbed to 3 in 10 among African Americans.

The CDC researchers interviewed more than 2,400 gay and bisexual men ages 23 to 29 in Los Angeles, Baltimore, Dallas, Miami, New York City and Seattle.

Overall, 12.3% of the men were found to be HIV-positive, with the rate ranging from 4.7% in Seattle to 18% in Dallas. Los Angeles was near the middle, at 9.7%.

From the early 1980s to December 2000, nearly 775,000 Americans had been reported to have developed AIDS and 448,000 of those had died, according to the CDC.

While drug therapies are important, Gayle said, prevention efforts should be redoubled. "With this epidemic, just like so many, relying on treatment only is not going to be the answer," she said.

At this week's conference, however, HIV researchers found some positive signs. For example, AIDS cases among infants have continued to decline, and are now at the lowest level in nearly a decade. In 1999, only 156 infants contracted the disease from their mothers, compared to 901 in 1992.

CDC officials attribute the decline to increased HIV testing of pregnant women. If a woman tests positive, she is now given drugs that reduce the risk of transmission to her child.

"We [had] only one case last year in L.A. County," Klosinski said.

Another success has been the decrease in HIV infections among intravenous drug users in New York City. The proportion of users there who are HIV-positive has fallen by more than half since 1990, researchers said, from 50% that year to 20% in 2000, according to Don Des Jarlais of the Beth Israel Medical Center.

Syringe exchange programs, combined with counseling and testing, contributed to the decline, Jarlais said.

While researchers and advocates would like to see further drops in AIDS cases and deaths, they are mindful that AIDS is spiraling out of control in other parts of the world.

In that context, just keeping the numbers from rising is an achievement, Klosinski said.

Times medical writer Thomas H. Maugh II and the Washington Post contributed to this report.