Miami Herald - July 8, 2002
Fred Tasker, ftasker@herald.com

The disturbing new trend was revealed at the 14th International AIDS Conference by Dr. Ronald Valdiserri, deputy director of the National Center for HIV, STD and TB Prevention of the U.S. Centers for Disease Control and Prevention.

More than 15,000 people from around the world have gathered here for the weeklong conference that opened Sunday. Participants are looking for solutions to an epidemic in which 40 million people have been infected worldwide.

Valdiserri cited new trends for the human immunodeficiency virus from the 25 U.S. states that keep such statistics and new CDC studies in six major U.S. cities, including Miami.

"New HIV diagnoses in these states remained stable," he said.

"But by risk group, it seems that heterosexuals are increasing slowly but steadily in the 25 states. And mostly in African-American communities, particularly African-American women."

The 25 states studied exclude California, New York and Florida and account for only a quarter of the HIV infections nationwide, he said. Hispanics accounted for a low proportion of HIV cases in the 25 states studied.

RATE OF INCREASE

In the 25 states, HIV, the virus that causes acquired immune deficiency syndrome, increased among U.S. heterosexuals by 10 percent from 1998 to 2000, continuing a slow, steady trend since 1993, Valdiserri said. Black women accounted for almost half the new cases, he said. Among gay and bisexual men, white men were 52 percent of new cases and black men were 40 percent.

"Taken together, these data point to the urgent need to stem the spread of HIV among gay and bisexual men and heterosexuals in many areas of the country, especially in those African-American communities most dramatically impacted," he said.

The level rate of new infections since 1998 contrasts with sharp declines that took place between 1993, when powerful antiretroviral drugs were introduced, and 1998, Valdiserri said. He blamed the lack of continued progress on:

ò The fact that nearly half of the 900,000 or so Americans who are HIV-positive are either unaware of it or are aware but still not getting treatment.

ò Treatment failures, when the virus becomes resistant to the new drugs.

ò The difficulty patients have in adhering to complex drug regimens often requiring a dozen or more pills a day.

Valdiserri also said that with powerful new drugs holding AIDS at bay, the number of people living with HIV is soaring. A new multi-state CDC study shows that such infected people are sexually active but not always responsible, he said.

That study says 67 percent of HIV-positive people in those cities are sexually active but that only 57 to 75 percent of them use condoms.

Condom use ranged from 57 percent for women with steady partners to 75 percent for heterosexual men with non-steady partners.

UNAWARE OF INFECTION

In the study, he said, "a new analysis from the CDC showed that a substantial majority of HIV-positive gay and bisexual men in six major cities didn't know they were infected, and may have unknowingly transmitted it to their partners."

The six cities studied were Miami, New York City, Baltimore, Dallas, Los Angeles and Seattle.

In fact, a third CDC study, which also included Miami, concluded that more than three-quarters of young gay and bisexual men infected with HIV were not aware of it; 91 percent of the infected black men, 70 percent of the infected Hispanics and 60 percent of infected white non-Hispanics were unaware.

"They didn't believe they were at high risk, even though they were engaging in high-risk behavior. African-American men were the least likely to know they were infected. This explains in part the high levels of infection in this population," Valdiserri said.

The increasing AIDS rates fall mostly on poor and disfranchised people, Valdiserri said.

"We need to get back to the level of collaboration, commitment and concern that we saw in the first decade of the epidemic. We need to realize that we have to develop new solutions, because this is a very different epidemic from the one we've seen in the first two decades."

And yet another CDC study concluded that young gay and bisexual men are far more likely to engage in high-risk sexual behavior, and to become infected with HIV, if they suffer from any of four major psychosocial health problems.

The four problems are multiple drug use, partner violence, a history of childhood sexual abuse and depression.

The study surveyed 2,881 men in New York City, Chicago, Los Angeles and San Francisco.

The percentages of men showing high-risk sexual behavior ranged from 7.1 percent for those with none of the psychosocial problems to 33.3 percent for those with all four. HIV-positive status varied from 13 percent for those with none of the problems to 25 percent for those with all four.

"These findings point to the need for a more comprehensive approach to gay men's health, which addresses the multiple health and social issues influencing HIV risk," Valdiserri said.

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