San Francisco Chronicle - July 16, 2004
Marshall Kilduff, mkilduff@sfchronicle.com.

Left unnoticed is the first prominent AIDS stage: the gay ghettos of America such as San Francisco. At this week's gathering of 18,000 scientists and policy-makers, hardly a word is spoken about this starting point. It's the same back home.

Call it complacency or weariness, AIDS simply doesn't stack up as a public-health peril in the United States. When was the last march or stormy takeover of a government official's office? The impression left is that the danger and death have vanished. There are few new infections and early-day survivors are kept alive by a medicine chest of drugs.

But AIDS has dug a solid beachhead in the United States. No drug regimen, needle-replacement or condom-giveaway program can eradicate its grip. Why the indifference? One answer is the changed nature of the disease: It has found a new, powerless group to victimize.

The disease was first noticed and categorized in the 1980s by American scientists who responded to complaints of a strange and fatal sickness among homosexuals. When AIDS finally was identified, white middle-class gays mobilized powerfully, and over time their efforts drove down infection rates in San Francisco's Castro district, which approached 50 percent of males there. "There was this gray cloud" over gay neighborhoods across the country, said Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, who conducted the early studies of AIDS.

But the virus wouldn't stay still. Infection rates flattened, but didn't go down. A total of 40,000 Americans are infected every year, but the new victims have a different face. "It is young adults and women, mainly black or Hispanic," Fauci said during a daylong round of speeches and panels at the Bangkok conference. "We still have a significant problem in the U.S."

For Phil Wilson, director of the Black AIDS Institute, it's a buried crisis that few want to confront, even those in his community. "We're 12 percent of the population, but we have 54 percent of the new infections," he said. The numbers get worse: among women, 73 percent of new AIDS cases are black or Hispanic, and 80 percent of adolescents infected are from the two minority groups. A third of all those infected don't know their status because they fear testing or don't recognize their symptoms, Wilson said.

There are powerful reasons for the continued grip of AIDS. The stigma of an incurable disease leads many to dodge testing. Ignorance plays a role, too. Wilson tried to set up a temporary testing site at a nonprofit center, which then voiced worries about AIDS-tainted blood in its building. New tests don't require blood samples, Wilson explained to his nervous hosts.

There are other problems. Black leaders "are tired of negative images in the media such as a man in handcuffs" and don't want to underline another problem in their ranks. In addition, money remains tight for a disease that decision-makers think is curbed.

These arguments are lost in the long halls of Bangkok's convention center. African delegations in swirling robes and Indian women in glittering saris fill the lecture sessions. Drugmakers set up house-sized pavilions in nearby exhibit areas to advertise new treatments. The worried talk -- as it should be -- is about the future: What drugs can be found to tame AIDS, what are the chances for a vaccine, and debates over spending money. The heavy heat and diplomatic pace of the conference is a world away from San Francisco's windy streets and decades-old confrontations over closing bathhouses and expanding AIDS wards.

The plague has moved on in the United States, just as it has in the rest of the world. Its first wave of targets bravely fought back, and AIDS found a new crop of victims in America as it swept across the globe.

More tellingly, no one seems to care as AIDS settles in to its new neighborhoods in San Francisco's Tenderloin, the Oakland flatlands and the edges of Richmond.

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