Number of AIDS Cases, Deaths Remained Stable from 1998 to 2000, Ending Era of Decline, CDC Reports

According to data released yesterday by the CDC at the National HIV Prevention Conference in Atlanta, AIDS cases and AIDS-related deaths have remained stable over the last two years, signalling that the "era of dramatic declines" in the mid-1990s might be over, the Washington Post reports. Figures through December 2000 show that 774,467 Americans were reported to have AIDS, and 448,060 died of complications related to the disease. Each quarter from July 1998 through June 2000, nearly 10,000 new AIDS cases were diagnosed and 4,000 AIDS-related deaths were reported, compared to 15,000 new cases and 10,000 deaths a quarter at the epidemic's "peak" during the early 1990s. The data is considered "preliminary" because information for 2000 is not yet complete, but it "indicate[s] that our progress in fighting the disease is in serious jeopardy," Dr. Helene Gayle, director of the CDC's National Center for HIV, STD and TB Prevention, said.

The Changing Face of the Epidemic
The new numbers come amid reports that show HIV infections are on the rise in some populations. The annual number of new infections has remained stable at 40,000, but the demographics of the new infections are changing. HIV is "reaching younger people, it's reaching more women, it's reaching more communities of color," Gayle said (Okie, Washington Post, 8/13). Gay men account for 42% of new infections, with heterosexuals infected through sexual intercourse accounting for 33% of new cases and intravenous drug users accounting for a quarter. Nearly half of all new cases are in blacks, while whites and Latinos account for 30% and 20% of new cases, respectively (Heredia, San Francisco Chronicle, 8/14). A recent CDC survey found that HIV infections were increasing particularly among young gay black men, with 14.7% becoming infected each year, compared to 2.5% of white men. The CDC reported that the numbers are somewhat puzzling because black men were actually "somewhat less likely" to report engaging in risky sexual behavior than other gay men. The high rate of infection in the population may be attributable to the "relatively small" number of gay black men seeking partners among the same population. Gayle said that the rise in HIV infections among gay men is "particularly troubling" because the gay community's activism was a "major reason" for the decline in infection rates in the late 1980s and early 1990s (Washington Post, 8/13). Another study of gay men in the Seattle area found that the rate of unprotected sex had increased 20% since 1994, with the number of men who reported having six or more partners in the last 12 months rising nearly 30% (Sternberg, USA Today, 8/14). A different study of 250 low-income African-American women in Atlanta found that nearly half did not use a condom the last time they had sex and 60% were unaware of their partner's HIV status (McKenna, Atlanta Journal-Constitution, 8/14).

The Next Step
Increasing awareness, redoubling prevention efforts, "expanding access to quality care" and developing new treatment for those who have developed resistance to HIV medications must now be the focus of the AIDS battle in the United States, Gayle said (AP/New York Times, 8/14). "We must work to ensure the plateaus we have reached in AIDS cases and AIDS deaths and in HIV do not remain plateaus -- or worse, given some of the trends we are seeing, do not evolve into a newly expanding epidemic," Gayle said (Atlanta Journal-Constitution, 8/14). Lee Klosinski, director of education for AIDS Project Los Angeles, said that task will be different, because "[a]ll of the easy education has already been done. 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" (Ornstein, Los Angeles Times, 8/14). Public health officials must increase efforts to get people tested for the virus because "[a]round one-third of people whom we estimate to be HIV-infected are not getting tested and getting into early care," decreasing their chances of prolonging their lives, Gayle said. The leveling off of AIDS cases and deaths implies that the antiretroviral treatments that were largely responsible for the decline have "already reached most Americans who know they are infected and who have good access to medical care," she said. She added, "If treatment failures become more of a serious problem, if resistance becomes more of a problem, we could see increases in deaths as well as in AIDS cases" (Washington Post, 8/13). However, "[w]ith this epidemic, just like so many, relying on treatment only is not going to be the answer," Gayle added (Los Angeles Times, 8/14). "We have come too far in fighting this epidemic, and we have made too much progress in fighting the epidemic and learning what works to turn our back on prevention, which is still the best way to fight this epidemic," she said (Hitt, Reuters Health, 8/13).

The Good News
While the stabilization of AIDS cases and deaths was troubling, success was reported in reducing HIV infections among IV drug users and in reducing vertical transmission. The HIV infection rate among IV drug users in New York City fell to 20% in 2000 from 50% in 1990 (Washington Post, 8/13). Dr. Don Des Jarlais, an AIDS researcher at Beth Israel Medical Center in New York City, today will present findings that show needle-exchange programs, drug counseling and testing programs are largely responsible for the "sharp drop" in infections among city IV drug users (Winslow, Wall Street Journal, 8/14). In 1999, there were only 156 cases of mother-to-child HIV transmission, compared to 901 cases in 1992. Increased HIV testing of pregnant women led to the decline, according to CDC officials. Testing allows doctors to identify HIV-positive women and administer antiretroviral drugs that reduce the chance that they will pass the virus on to their infant (Los Angeles Times, 8/14).