San Francisco Chronicle - Thursday, June 16, 2005

We're not winning this war.

The number is tempered by the fact that more people with AIDS or the virus that causes it are living longer, thanks to new drugs. But there's a flip side to this shiny coin: The rate of new cases is holding steady at 40, 000 per year.

No amount of prevention leaflets, benefit concerts or bus-shelter ads is denting this dismal number. In 2001, federal policy aimed to cut this yearly rate in half, to 20,000. That has not come true, and experts worry that the infection rate may actually be climbing toward 60,000 people per year.

What is happening is that this country has become very good at treating the sick. But doctors and health-care experts aren't nearly as good at preventing infection.

Medically, there is no vaccine, and there won't be one for years. The fast-mutating AIDS virus has eluded scientists trying to design an inoculation.

AIDS experts have long acknowledged this and turned to work on more immediate problems. Sustaining life via anti-retroviral drugs is a major triumph, especially now with costs dropping and treatment simplified. President Bush and the heads of five African countries announced this week that 200,000 people in the sub-Saharan region now are getting these life- extending drugs, as the United States rolls out its major AIDS program overseas.

But lethal roadblocks remain here at home, as the new numbers show. The AIDS problem has fractured in many directions.

Within the gay community, which first felt AIDS and marshaled its forces to combat it, the problem is crystal meth, an illegal party drug that incites frequent sex. Also, younger gays have shrugged off the safe-sex message that an older generation took to heart.

African Americans make up the second front. Nearly half of the 1 million living with AIDS are black, with a surge in numbers in poor areas of the South and Northeast.

Taming the epidemic will be hard. Both state and federal budgets are pinched financially. There is little political will for new programs that take years to pay off.

But this indifference is what feeds the epidemic. There are proven steps that need more support. Condoms must be freely available. Clean needles should be available for drug users. Testing for the AIDS virus should remain a priority in controlling its spread.

This is a war of small battles. San Francisco has had success. The city once had the highest per-capita rate of AIDS infection. Now, it has dropped to third, behind New York and Miami. Awareness, the city's compact size, and public-health messages all played a role.

It's time to find methods that will show results elsewhere in ending AIDS.
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