Los Angeles Times - July 29, 2003
Allison M. Heinrichs, Times Staff Writer

For the first time in a decade, the number of new AIDS cases in the U.S. has increased - an unsettling sign that efforts to combat the deadly disease have stalled, the national Centers for Disease Control and Prevention reported Monday.

The number of reported AIDS cases last year rose 2.2%, to 42,136, over the previous year, the CDC announced at the 2003 National HIV Prevention Conference in Atlanta.

The most disturbing trend was a 7.1% increase in new HIV infections among homosexual and bisexual men - the third year in a row that the number has risen, said Dr. Harold Jaffe, head of the CDC's prevention efforts. "These findings add to the growing concern that we are facing a potential resurgence of HIV among gay and bisexual men," he said in a statement.

New HIV infections among intravenous drug users and heterosexuals showed small, but noticeable, increases as well, according to the CDC.

The report compiled statistics from 25 states that have monitored HIV, the virus that causes AIDS, for a long period of time. California was not included because it only recently began tracking HIV cases.

Edwin Bayrd, executive director of the UCLA AIDS Institute, said the increases in HIV and AIDS were a sign of a dangerous sense of complacency, partly due to the success of AIDS therapies. "A lot of people feel that they don't have to worry about being exposed to HIV because they feel that they just have to take a pill and they'll be fine," he said. "It's very important for the public to understand that the treatment of HIV infection is problematic, hugely expensive, meets with only limited success and cannot yet cure anybody."

Jaffe said the rise in AIDS and HIV cases had probably stemmed from many causes, including more comprehensive HIV testing and the difficulty that many HIV patients have in following the complicated treatment regimens, which may foster the development of full-blown AIDS.

Treatment includes a cocktail of drugs and weekly checkups, a strict routine that can be difficult for many patients to keep up with, said Gail Wyatt, a professor of behavioral sciences at the UCLA AIDS Institute.

The 2002 results were part of a growing stream of evidence that the great strides made in the mid-1990s in reducing infection rates have since stumbled.

One positive finding in the report was the continuing decline in the United States of AIDS-related deaths, which fell 5.9% last year. But health officials note that the numbers are no longer declining at the rapid rate of the mid- to late 1990s.

"The deaths related to AIDS continue to decline, but what we've seen over time is a slowing in that decline," said Ron Valdiserri, deputy director of the CDC's National Center for HIV, Sexually Transmitted Diseases and Tuberculosis Prevention.

In 2001, the CDC began a five-year campaign to cut by half the number of individuals at high risk of HIV. The new statistics seem to indicate that the CDC faces an uphill battle.

Lee Klosinski, director of programs at AIDS Project Los Angeles, said that while the plan had not yet failed, the statistics should be "a wake-up call to the urgency of the work" necessary to achieve those goals. "I think that most people who are involved think that cutting the HIV infection rate in half in five years is simply unattainable," he said. "I hope they're wrong."

Because HIV takes many years, sometimes even decades, to manifest into full-blown AIDS, it is extremely difficult for health officials to paint a clear picture of the domestic HIV epidemic.

The current statistics do not differentiate between someone infected recently or many years ago, Valdiserri said.

To sharpen its grasp of the situation, the CDC also announced at the conference a new nationwide system for tracking HIV infections that it said would allow it to determine whether someone was infected within six months before the test.

The new Serologic Testing Algorithm for Recent HIV Seroconversion will help the CDC target prevention measures to the communities that need it most.

Monitoring HIV infections will also improve with the use of a rapid test, OraQuick. This test, approved last year, provides results in 15 to 20 minutes, whereas old tests took days or weeks.

Los Angeles is one of the first cities to bring the tests directly to local bathhouses and other venues, and the results have been staggering, said Ged Kenslea, spokesman for the AIDS Healthcare Foundation.

"The increase in [HIV cases among] gay and bisexual men is being borne out by our testing initiatives," he said.

Before the rapid testing procedure, only about 65% of the people who tested positive would actually come back to get their results, he said.

"We're trying to, in a sense, get people to think of their sexual hygiene in the way they would think of their dental hygiene," Kenslea said. "Hopefully, we can encourage people to get tested on a yearly basis."

The CDC has recently begun to change its HIV strategy by focusing less on prevention and more on testing and treatment of those at greatest risk.

The more difficult problem in controlling the AIDS epidemic is grappling with the increasing complacency toward the disease, which seems to have contributed to an increase in risky sexual behavior, Valdiserri said.

Kenslea said some ads for protease inhibitors and other medications gave the impression that the disease was not that severe. The ads have been largely discontinued, but the impression remains, he said.

The popularity of certain recreational drugs, such as crystal methamphetamine, has also fostered risky sexual behavior, especially among gay and bisexual men, said Bayrd of the UCLA AIDS Institute.

Crystal methamphetamine "produces a heightened euphoria and that leads people to take risks they might not otherwise take, both in terms of having unprotected sex and having it with multiple partners," he said.

Times staff writer Jesus Sanchez contributed to this report.

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