The Bay Area Reporter - September 10, 1999
Liz Highleyman

Researchers from the Centers for Disease Control and Prevention (CDC) reported that the number of AIDS deaths decreased by 20 percent from 1997 to 1998, nearly half the 42 percent rate of decline from 1997 to 1996. There were 17,047 U.S. deaths due to AIDS in 1998 compared to 21,222 in 1997 and 36,792 in 1996. Health officials also estimated that the rate of new HIV infections is holding steady at approximately 40,000 per year.

The earlier dramatic decline in AIDS deaths was attributed in part to the widespread use of combination anti-HIV therapy including protease inhibitor drugs. The new lower rate suggests that the drugs may not be as effective as previously hoped over the long term or for the majority of those with HIV disease. According to Dr. Helene Gayle of the National Center for HIV, STD, and TB Prevention at the CDC, "In a period of only two years, new combination therapies cut the annual level of death in half -- But for the time being, it appears that much of the benefit of these new therapies has been realized." HIV often develops resistance to antiviral drugs, and many people experience adverse side effects from the medications or find it difficult to adhere to the drugs' complex and strict schedules. Steven Fisher of AIDS Action emphasized that "AIDS drugs don't work for everyone, and they aren't a cure for anyone."

In his August 31 report to the city's Health Commission, San Francisco Department of Public Health (DPH) Director Dr. Mitch Katz said he believed that media reports of the slowing decline in AIDS deaths "exaggerated the significance" of the change. In San Francisco there were 304 deaths due to AIDS in 1998 compared to 360 in 1997 and 1,118 in 1996. As was the case nationally, there was a much greater decline from 1996 to 1997 than from 1997 to 1998. Katz said it would be "highly improbable" to see continued decreases in AIDS deaths of 68 percent (the rate of decline from 1996 to 1997). According to Katz, the fact that deaths due to AIDS continued to decrease û albeit at a slower rate û "should give us increased motivation to make sure that everyone benefits from antiretroviral drug combinations by increasing the number of people who are HIV-positive who know they are positive [through increased voluntary HIV testing] and increasing programs that address access and adherence to treatments."

The Atlanta conference, the first of its kind, was sponsored by the CDC and brought together over 2,000 researchers, public health officials, members of AIDS service organizations, and advocates for people with HIV and AIDS.

Among the other prevention news from the conference, the CDC's Gayle reported that in 1998 the number of AIDS deaths as a proportion of population was 10 times higher among African Americans than among whites, as was the rate of new AIDS cases. Overall, the relative proportion of U.S. AIDS cases in populations other than white gay men has increased. U.S. Surgeon General David Satcher reported that in 1997-98, 45 percent of new AIDS cases were among African Americans (who make up 13 percent of the U.S. population), compared to 25 percent a decade and a half ago. The relative proportion for Latinos in 1997-98 was 22 percent (up from 14 percent in the mid-1980s), and just over 23 percent of 1997-98 AIDS cases were in women (compared to 8 percent in the mid-1980s). Relative proportions of deaths due to AIDS were similar, with 49 percent among African Americans, 32 percent among whites, and 18 percent among Latinos. According to Satcher, "One of the major concerns we have about the AIDS epidemic is that increasingly it is affecting communities that tend to be left out of the health care and public health system à We know that in order to be successful we have to find a new way to reach these communities."

Researchers also presented results from a study conducted by the National Commission on Correctional Health Care that indicated that AIDS rates are high in the nation's prison system. There were approximately 8,900 incarcerated persons with AIDS in 1997, five times higher than in the rate in the unincarcerated population. Rates of HIV infection are estimated to be up to 10 times higher among prisoners. Recently released ex-prisoners may account for up to 17 percent of U.S. AIDS cases, and they also have high rates of hepatitis C infection, tuberculosis, and sexually transmitted diseases.

Health officials at the conference frequently sounded the alarm about what they called increased complacency in regards to HIV disease and AIDS. Many expressed concern that advances in antiviral drug treatments have given some people a false sense of security that may make them less interested in prevention. According to Gayle, "Despite a growing complacency about the need for HIV prevention, HIV remains a serious disease that is still very much with us, and there is a greater need for HIV prevention today more than ever."
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