InterPress News Service (IPS); Monday, 3 March 1997
Farhan Haq

The good news, confirmed last Thursday by the Centres for Disease Control (CDC), was that the number of reported AIDS deaths for the first six months of 1996 fell to 22,000 nationwide -- a 12 percent drop compared to the first six months of 1995. Every region of the United States, and every racial and ethnic group, experienced a significant drop between early 1995 and early 1996.

"This new evidence indicates that people with AIDS are living longer, as physicians capitalise on new and improved ways to manage the disease," says Michael Isbell, associate executive director of Gay Men's Health Crisis, the largest U.S. AIDS organisation.

But Isbell cautions that the decline in deaths doesn't mean that many AIDS-affected populations in the United States are still in extreme risk. "Unfortunately, mortality related to HIV (human immunodeficiency virus) continues to grow in certain populations, particularly women and racial and ethnic minorities," he says.

Although AIDS cases for men declined sharply, falling by 15 percent, the number of AIDS deaths among women actually rose by 3 percent between early 1995 and early 1996. The CDC also estimates that the rate of progression from HIV infection to AIDS is seven times higher for African Americans, and three times higher for Latinos, than it is for whites.

"Homeless people, poor people of colour -- these people are going to die" if they are infected by HIV, says Keith Cylar, co- executive director of Housing Works, a New York group that supports AIDS patients who are homeless or poor. "We still have a major epidemic on our hands that is going to grow. This disease is still 100 percent fatal."

That is the central dilemma, AIDS activists say: New medical treatments may allow AIDS patients to live longer and healthier lives, but they do not reverse HIV infection or cure the disease.

Many of the latest AIDS-treatment medicines, including protease inhibitors -- which block the HIV virus as it seeks to replicate its genetic structure and, ultimately, to attack the body's immune system -- are also too expensive for all of the roughly 600,000 to 900,000 estimated U.S. AIDS patients to afford.

That in turn means that, as a growing population of people face the challenge of living longer with AIDS than previously expected, health officials will have to decide how to make the latest treatments available to everyone who needs them.

"As the population of people living with serious HIV illness grows, the need for health care and supportive services will grow, as well," says Isbell. "America's ability to sustain this good news will depend on its willingness to invest in programmes to ensure health care access for HIV-infected individuals."

Ultimately, as the numbers of poor, black and Latino HIV- infected people swells, Cylar says, the question can be put bluntly: "Where do we draw the line?" He worries about the possibility that poorer HIV-infected groups could be left behind if more expensive treatments sharply reduce AIDS deaths among the richest.

New Yorkers so far have been spared that fate: In New York City, AIDS deaths dropped by 30 percent over the past year, a decline shared by many large cities with extensive AIDS programmes. Cylar says that part of the reason for the drop is that New York state provides access to the costly AIDS treatments even to patients unable to pay for it. "We have better infrastructure (against AIDS) than many places in this country," he says.

Not all of the improvement can be traced to treatments, many of which -- including protease inhibitors -- have only become more available in recent months, after the period covered in the CDC estimates.

Some of the drop in deaths, says one New York health expert who spoke to IPS on condition of anonymity, stem from earlier testing in several at-risk populations, including among African Americans and Latinos, who have suffered high rates of HIV infection.

"A lot of minorities are getting education about HIV and the risk infection in their lives," she says. "That gets them testing (for HIV) sooner than they would," at a time when their immune systems are stronger and thus when doctors can do more to help them live longer, she adds.

In particular, she contends, cities like New York have made major efforts to reach the lowest-income groups and test for HIV infection as early as possible. Twenty-six of the 50 U.S. states now report HIV infection in adults and children, helping to track down patients before they become sick with full-blown AIDS.

Imrpoved education, testing and treatment have not succeeded at reducing all types of AIDS transmission, however. AIDS deaths remain high, and increasing, among people who become HIV-positive through heterosexual contact or through intravenous drug use. Women in fact suffer from AIDS more than ever in the United States, with the CDC data showing women now comprising 20 percent of all AIDS deaths.

Worse, AIDS deaths worldwide rose to their highest level last year, with 1.5 million people -- one-quarter of the total number of AIDS deaths -- dying worldwide from AIDS in 1996 alone.

Still, for President Bill Clinton, the lesson for the United States is that AIDS "is beginning to yield to our sustained national public health investment in AIDS research, prevention and care." But he added, "It is also clear the AIDS epidemic is not over." (end/ips/fah/yjc/97)

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