Important note: Information in this article was accurate in 2003. The state of the art may have changed since the publication date.
San Francisco Chronicle - Tuesday, July 29, 2003
Christopher Heredia, Chronicle Staff Writer
The number of AIDS cases nationally rose 2.2 percent from 41,227 in 2001 to 42,136 in 2002, according to preliminary data released Monday by the Centers for Disease Control and Prevention. AIDS cases nationwide had been on the decline since they peaked with 80,010 cases in 1993.
"We continue to sound this warning note to communities and state and local health departments that we need to redouble our (prevention) efforts," Dr. Ronald Valdiserri, deputy director of the CDC's National Center for HIV, STD and TB Prevention, said from the National HIV Prevention Conference in Atlanta.
Also at the conference, top AIDS experts said a shift in the allocation of scarce prevention resources is needed. Most resources, they said, should be directed at people who already have the virus in an effort to stop the spread of the disease, instead of focusing on people who hadn't yet contracted the disease. The experts highlighted several new programs designed to get people tested so they know their HIV status and getting those who test positive into counseling and treatment.
Valdiserri attributed the rise in AIDS cases to the failure of patients to adhere to complicated drug regimens, delayed HIV diagnoses and treatment and the fact that some medications just don't work for some people. He also pointed to a worrisome increase in the number of newly diagnosed HIV infections.
In a study of 25 states, the number of newly diagnosed HIV infections among gay and bisexual men increased last year by 7.1 percent, the third year in a row an increase. Experts said the trend is consistent with studies of gay and bisexual men indicating "AIDS complacency" may be causing this high-risk group to abandon safer sex practices.
The data did not include results from California, New York or Florida, which have been hard hit by the AIDS epidemic. Experts cautioned that the increase in diagnoses may be a result of more people being tested, as well as possible rise in new infections.
"This new data suggest that the dramatic progress we made in the fight against AIDS after the advent of antiviral treatment in the mid-90s is beginning to plateau," Valdiserri said.
"We're not finished with the war," Valdiserri said. "Clearly, there have been improvements in medical treatment (for AIDS), which is why we have seen a decline in AIDS deaths. People are living longer, but the fact that AIDS cases are (leveling out) means we don't have a curative treatment. . . . The rising number of HIV diagnoses is telling us we have a concern among some populations that we might be seeing a resurgence in HIV transmission."
AIDS deaths, meanwhile, continued to decline, with 5.9 percent fewer people dying from the disease. This phenomenon reflects the benefits but also the limitations of antiviral treatment for the blood-borne illness, which can be transmitted through sexual activity, or from mother to fetus or by sharing infected needles.
In San Francisco, experts say studies indicate HIV infections are on the rise among gay and bisexual men, but AIDS cases continue to decline.
In 2002, there were 438 AIDS cases in San Francisco, down from 535 in 2001.
Dr. Mitch Katz, the city's director of public health, attributed the local decline to the wide availability of treatments for HIV-positive people.
"Access to treatment in San Francisco is higher than in other places," Katz said. "By providing effective treatment, we may be preventing people who have HIV from developing AIDS. It's true that (the antiviral medication) does prevent the development of AIDS.
"We don't think new (HIV) infections are low, however," Katz said. "That's due to many things, including the increasing use of methamphetamines, Viagra and people recognizing that AIDS is no longer a death sentence."
E-mail Christopher Heredia at cheredia@sfchronicle.com.
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