The Miami Herald, Inc.; Friday, 19 September 1997.
Stephen Smith, Herald Health Writer

The enemy remains wily as ever, Sandra L. Thurman said in Miami Beach. The epidemic marches on. Only the faces are different, now increasingly black, Hispanic and female.

"There is every reason to believe that the misperception that we have a cure is leading many into a false sense of security," Thurman told her audience, 2,500 people from the front lines gathered at the Fontainebleau Hilton Resort & Towers for the U.S. Conference on AIDS. "We must find new and improved ways to shout from the mountain tops that, `It ain't over till it's over.' "

That is especially true in the nation's African-American and Hispanic communities.

Just a few hours after Thurman's address, the U.S. Centers for Disease Control and Prevention released statistics showing that for the first time since the start of the epidemic, the number of AIDS diagnoses declined in 1996. There were 6 percent fewer AIDS cases overall compared with the previous year.

The credit for the drop is given to the new drug regimens and to prevention campaigns.

But the reduction was not universal, in part because education efforts don't touch everyone and the high price of the new drugs puts them beyond the reach of many. Disease trackers reported significant increases in AIDS cases among heterosexual African-American and Hispanic men: 19 percent and 13 percent, respectively.

And the epidemic's assault on women continued: There was a 7 percent increase last year in women infected through sexual contact.

It is a story lived every day by Miguel Milanes. He's a top AIDS expert with the Florida Department of Health in Dade County. And he has witnessed the virus march into the Hispanic community with unabated fury. Between 1990 and '95, the rate of infection increased 444 percent among Hispanic women in Dade.

`I feel your anger'

"I know you're angry and I feel your anger because our community is being infected and affected by this virus at disproportionate numbers," Milanes told participants at the conference sponsored by the National Minority AIDS Council. "And our systems continue to plan and deliver services the way we did 10 years ago, 15 years ago."

Instead, those systems should be tailoring services and treatment for the varied communities attacked by the virus, said the CDC's top AIDS doctor. And that means understanding that it's not enough, for instance, to preach to women that the only kind of acceptable sex is totally risk-free sex.

That, Dr. Helene Gayle said, is not reality.

"We have to decide," said Gayle, chief of the CDC's AIDS division, "can you give people a range of different information that will give them a wider range of options for reducing transmission?"

And the latest spate of statistics reflects AIDS cases, not the number of people newly infected with the virus that causes the disease. Thus, Gayle and other AIDS experts are calling for improved monitoring of the virus' spread.

Complacency easy

Thurman, director of the White House Office of National AIDS Policy, was calling for something else: a reinvigorated fight against the virus. Complacency, she said, would be easy now -- there are those powerful drug combinations and, 17 years after the dawn of the epidemic, it's understandable that the intensity of the battle might wane.

But it mustn't, Thurman said. There's a generation of Americans becoming sexually active who need to hear the AIDS message for the first time.

She pledged that the Clinton administration will continue to increase spending on AIDS treatment and research, especially stoking the efforts to find a vaccine. Opponents in Congress, though, hamper the effort to do more, Thurman said after her address.

There are, she said, "some really conservative, backward members of Congress who don't seem to understand the realities of America today. They're still looking for Leave It to Beaver."

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