Newsdays -May 29, 2001
Laurie Garrett and Richard Dalton, Staff Writers

The survey finds that 26 percent of respondents named AIDS as the most important health problem facing the nation, compared with 44 percent six years earlier.

That comes as the disease is shifting from a largely white population to poorer communities of color, and the virus that causes AIDS is rapidly evolving.

At Los Alamos National Laboratory in New Mexico, scientist Bette Korber manages the world's largest computer data bank on HIV's strains. Korber says the widest variety of types of HIV in the world can be found in the Congo, where the epidemic is quite old and HIVs have had plenty of time to evolve and diversify.

"The global diversity is mirrored in New York City almost to Congo's scale, but not because of the age of the New York epidemic, but due to travel to and from Africa and other parts of the world," Korber says.

Whatever evolutionary course HIV is taking will find New York its ground zero. Bizarre mutant forms of the virus, representing mixes of pieces of HIV from two different continents, can be found today in Gotham's melting pot.

And the complexion and complexity of the American epidemic has shifted dramatically from that which confronted the nation 20 years ago.

A Newsday analysis of the Centers for Disease Control and Prevention AIDS database reveals that throughout the first decade of the U.S. epidemic, AIDS cases rose steadily for whites, blacks and Hispanics, but most sharply for white, gay males. But in 1991, the numbers of new cases identified in white, gay men began to plummet, and by 1995, more African-Americans than whites were diagnosed annually with AIDS.

The shift from whites to blacks was accompanied by an increase in heterosexually acquired infection. By 1999, more African-American women were diagnosed with AIDS than gay, white men.

By 2000, for the first time, the numbers of white, heterosexual men diagnosed with AIDS exceeded the total of gay, white men. Today, for every AIDS case diagnosed among gay or bisexual men in America, two are diagnosed among heterosexual men or women.

By 1999, heterosexuals accounted for seven of every 10 new AIDS diagnoses in America. About 60 percent were IV drug users who may have acquired HIV through the sharing of non-sterile needles. But nearly one in nine of the heterosexual men report getting their infection sexually, from HIV-positive women.

The geographic distribution of HIV/AIDS has also changed over time. While New York, San Francisco and some other cities remain hotbeds of HIV, infection and AIDS diagnoses continue to soar in poor areas of America, particularly in inner-city and rural parts of the country.

Declining death rates are seen throughout middle class and suburban populations, dropping sharply about four years before introduction in 1996 of drug treatment cocktails. That initial decline has been attributed to aggressive treatment aimed at preventing opportunistic infection, which had hastened the course of illness and death.

That downturn has been evident in New York's suburbs, where Long Island has seen a sharp downturn since 1990 in both newly diagnosed AIDS cases and deaths. In 1999, largely due to improvements in HIV treatment, only 36 Long Islanders died of the disease-a striking decline from the 1994 peak of 463 deaths.

New York City saw a sharp increase in HIV incidence from 1996 to 2000, with a third of all young, gay African-American men in the city becoming HIV positive by last September.

HIV rates among IV drug users have plummeted since 1990 and have remained low for a decade, presumably the result of needle distribution and drug rehabilitation programs.

The CDC estimates 75 percent of all new HIV infections this year will occur among African-Americans and Latinos, and about a third of all newly infected Americans will be females.

The CDC's reporting is based on physician reporting of diagnosed AIDS cases, which is legally required. There is no tracking mechanism for cases of HIV infection, so pre-AIDS infection rates are based on very rough estimates.

Nationally, AIDS diagnoses have plummeted since 1996 due to the use of prophylactic medicines to prevent opportunistic infections and the new anti-HIV drugs.

The CDC database, experts say, now reflects two trends: access to care and actual HIV distribution.

African-Americans, Latinos, rural residents and inner-city poor are far less likely to have health insurance and steady access to medical care, and are more likely to go undiagnosed during early stages of HIV infection. As a result, they are likely to develop AIDS as rapidly as the original group of 1980's patients.

Since the database is based on actual AIDS diagnoses, white, middle-class HIV patients are underestimated; they are far more likely to be receiving treatments that are forestalling their descent into AIDS. And experts say that is undoubtedly the case in wealthy suburban areas such as Long Island.

But the ethnic and sexual-orientation shifts in AIDS cases probably does reflect genuine changes in who is becoming infected in America. Numerous CDC and local health department surveys, based on blood tests done on targeted populations, show that African- Americans are now bearing the brunt of the U.S. epidemic.

Increases in new HIV infection rates also have been noted over the last year in the population that was at greatest risk 20 years ago- white, gay men. San Francisco, Denver, Chicago, Los Angeles and New York City health officials all have reported recent outbreaks of sexually transmitted diseases in that population, as well as evidence of declining habitual use of condoms.

Yet a new national survey conducted by the Henry J. Kaiser Family Foundation finds that Americans are less concerned, by and large, about AIDS than they were just a few years ago. In 2001, only 26 percent felt that level of concern, and most Americans placed cancer ahead of AIDS.

The exceptions were African-Americans and Hispanics, 70 percent and 64 percent of whom, respectively, said they were more concerned about HIV/AIDS today than they were in 1995. And that ethnic difference in concern mirrors the U.S. epidemic.

"While African-Americans and Latinos represent 12 percent and 13 percent of the U.S. population, they represent 47 percent and 19 percent of the reported cases, respectively," states the Kaiser survey report, released last week.

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