The San Francisco Chronicle - Tuesday, August 31, 1999
Carl T. Hall, Chronicle Science Writer

At the same time, HIV, the virus that causes AIDS, seems to be gaining ground again in San Francisco and in minority communities at highest risk.

Disease trackers at the Centers for Disease Control and Prevention counted 17,047 deaths from AIDS last year, down 20 percent from the national AIDS death toll in 1997.

Although that was, by all accounts, a substantial decline, it was less than half the 42 percent drop in deaths recorded from 1996 to 1997. It was the smallest improvement since the advent of protease inhibitors and combination drug therapies in the mid-'90s. And virtually all of the 20 percent improvement in 1998 came during the first half of the year.

Deaths from AIDS had plunged from nearly 50,000 in 1995 to 21,000 just two years later. Few were expecting such dramatic gains to continue beyond the initial rollout of the new treatment options.

Helene Gayle, director of the CDC's National Center for Prevention of HIV, Sexually Transmitted Diseases and Tuberculosis, reviewed the latest statistics yesterday at the opening of the National HIV Prevention Conference in Atlanta.

Besides the more modest improvements in the death toll from AIDS, she noted that new AIDS cases declined only 11 percent in 1998 compared with an 18 percent decline in 1997.

"We're now seeing the first signs of the slowing of this trend," Gayle said, adding that in terms of the U.S. population as a whole, "most of the benefits of the new treatments have been realized."

"We have gotten the drugs out to the people that know they're infected," she said. "I think now we've got to do a better job to be sure we get access to treatment for people who don't know they're infected, which means getting more people tested."

40,000 HIV CASES A YEAR

The CDC also estimated that new infections with HIV are holding steady at 40,000 a year in the United States. That marks a huge drop from the worst years of the 1980s, when up to 150,000 people were being infected with HIV each year.

At the same time, studies of the AIDS virus in San Francisco showed a disturbing possibility that HIV may be on the rise.

William McFarland of the University of California at San Francisco presented new data showing that HIV was found in only 1 percent of gay men who sought anonymous testing in San Francisco during the second half of 1997.

By the first half of 1999, the infection rate among gay men seeking an HIV test in San Francisco had risen to 2.8 percent.

He blamed the increase on more high-risk sexual activity and the spread of gonorrhea and other sexually transmitted diseases linked to HIV infection. As many experts had feared, success on the AIDS treatment front may be translating into complacency at the leading edge of the epidemic.

"After years of progress in preventing HIV, transmission may be increasing in the San Francisco Bay Area," McFarland said. "These findings are particularly worrisome in light of recent increases in gonorrhea and high-risk sexual behavior from other studies in the city."

IMPACT ON AFRICAN AMERICANS

The national AIDS/HIV statistics also confirm the changing demographic nature of the AIDS epidemic. About half the AIDS deaths last year were among African Americans, who make up just 13 percent of the total population.

Officials were somewhat surprised to find that heterosexual activity is now about as significant a factor in the spread of HIV as is injection-drug use and the sharing of contaminated needles.

Virus trackers said the apparent increase in heterosexual transmission is most likely due to the virus spreading first from male injection drug users to their female partners, who then spread HIV to other sex partners.

Younger gay men and heterosexual women account for a growing number of new HIV infections in African American populations, officials said.

About 70 percent of all new infections in 1998 were in men, among whom gay or bisexual contact was blamed in about 6 of every 10 cases. Intravenous drug use was cited in 25 percent of the new infections in men, while 15 percent were due to heterosexual contact.

Among women newly infected with HIV, 75 percent of the infections were due to heterosexual contact with an infected male and 25 percent from intravenous drug use. Among newly infected women, approximately 64 percent were African American women, 18 percent white and 19 percent Latino. Half of the newly infected men were African Americans, 30 percent white and 20 percent Latino.

The statistics set a sobering tone yesterday for the opening sessions of the Atlanta conference. About 2,000 scientists and disease prevention specialists are attending the event, which ends tomorrow.

Many of the researchers came to discuss ways to stem the epidemic in minority populations often neglected in the past. Also, because so many people with HIV and AIDS are living longer, the total number of those infected is increasing, further complicating efforts to halt the spread of the virus.

"We are entering a new era in HIV prevention," said CDC director Jeffrey Koplan. "Prevention efforts must aggressively target a wider range of communities at risk, as well as an increasing population of HIV-infected individuals."
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