Los Angeles Times - August 15 2001
Charles Ornstein, Times Health Writer

A day after health officials acknowledged that sharp declines in AIDS cases have ended, the studies highlighted systematic failures to adapt to the changing epidemic and reach large numbers of people at risk.

"It is a chilling portrait. It's not a good picture," said Phill Wilson, executive director of the African American AIDS Policy and Training Institute in Los Angeles. "At least it provides a blueprint of what we need to do."

A huge concern is that, despite the addition of HIV testing venues, 41 percent of people learn of their HIV-positive status a year or less before being diagnosed with full-blown AIDS.

These findings, released Tuesday by the Centers for Disease Control and Prevention, are based on comprehensive data from 25 states and take into account all patients diagnosed with HIV or AIDS between 1994 and 1999.

They are disturbing to researchers because HIV takes a median 10 years to reach full-blown AIDS. Untested people are unwittingly passing the virus along to their sexual partners. At the same time, they are missing out on early drug interventions, which would likely extend their lives.

Dr. Ronald Valdiserri, the CDC's deputy director of HIV, STD and TB programs, said he was dismayed that "in 2001, we still have a situation...where four out of 10 people are not testing until very late in the course of infection, often when they present with symptoms of AIDS."

Other findings from the second National HIV Prevention Conference in Atlanta:

-- Forty percent of patients diagnosed with HIV in 1998 showed symptoms of the disease or had risk factors noted in their medical records at least one year before the diagnosis, according to a study by Group Health Cooperative in Washington state and seven Kaiser Permanente regions.

As a result, Kaiser has implemented new guidelines to help doctors more quickly identify patients who should be tested, and the HMO has streamlined procedures for patients to get tested and find out their results.

-- Physicians rarely discuss strategies with HIV-positive patients to reduce transmission of the disease to others, say University of Washington researchers whose study was based in Seattle. Only 36 percent of the 273 men studied received counseling during a three-year period, and only 11 percent during the previous year.

"Physicians really have a difficult time talking to their clients about any sexual matter, and HIV is probably the most deadly," said Lee Klosinski, director of education for AIDS Project Los Angeles.

-- More than half of gay and bisexual men who sought care for rectal gonorrhea already had HIV, according to the San Francisco Department of Public Health. Such men were more likely to find sexual partners in bathhouses or over the Internet.

The study did not indicate whether the men knew of their HIV status.

Prevention groups say people delay HIV testing for two main reasons: They're afraid of the results or they don't think they are at risk.

Valdiserri acknowledged that delays in diagnosis are prevalent in other diseases, notably cancer. But because HIV is a highly infectious, transmissible disease, delays can be deadly not only for patients but also their sexual partners.

For years, the CDC and public health agencies nationwide have focused their attention on non-infected people. But the data released at the conference and other studies argue for curbing risky behavior among the 800,000 to 900,000 people who already have HIV and AIDS.

Part of the prevention effort for HIV and AIDS patients is ensuring that they have a stable living environment. In some cases, Klosinski said, infected people would offer sex for money in order to pay their bills.

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