United Press International - Monday, 13 August 2001
Ed Susman, UPI Science News

The plateau achieved in the U.S. epidemic is no reason for complacency, however, said Dr. Helene Gayle, director of the National Center for HIV, STD and TB Prevention of the Centers for Disease Control and Prevention, Atlanta.

"I believe the United States is at a critical juncture in the battle against HIV (human immunodeficiency virus)," Gayle said at the gathering of 2,500 scientists, doctors, public health specialists and AIDS activists. "The type of progress made to date is in jeopardy if efforts are not intensified and in fact accelerated."

Gayle said with the new data, which cover the epidemic through December 2000, there has been a total 765,559 cases of AIDS counted in the United States since the disease was first reported in 1981. Of that number, 442,882 people have died of AIDS.

In addition, about 600,000 people in the United States are infected with HIV -- the virus which, untreated, progresses to AIDS. At one point as many as 150,000 new HIV infections occurred on a yearly basis, but that number has remained constant at about 40,000 infections since 1998, Gayle said. She said that the number of AIDS cases in which patients show symptoms of the disease has also leveled off at 10,000 cases every three months, or 40,000 a year, about half the number of cases reported at the peak of the epidemic in the United States in 1993.

Deaths from AIDS, which peaked at 40,000 a year in 1995, have now fallen to around 16,000 a year. The dramatic drop in AIDS cases and deaths coincided with the introduction of combination cocktails of potent antiretroviral medications.

The CDC has announced a program designed to reduce the number of new infections by 50 percent within the next five years. "At a time when advocacy for prevention at the local level has never been greater," Gayle said, "the sense of urgency in the United States seems to have vanished for most."

While citing progress in fighting the disease, Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said, "we are in the midst of a still accelerating epidemic. It is not time to congratulate ourselves on some of our advances but to look at some of the challenges that remain."

Gayle said that new studies indicate that the gains made in prevention may be eroding in certain high-risk groups, particularly among African-American women and in young men who have sex with other men. She said that 54 percent of new HIV infections occur in African Americans, 26 percent in whites and 19 percent in Latinos. In the US, the leading risk group continues to be men who have sex with men -- 42 percent of new infections. She said 33 percent of new infections occur in heterosexuals and 25 percent of new infections are found in injecting drug users. In one study, Ellen Yancey of the Morehouse School of Medicine, Atlanta, and colleagues interviewed more than 400 African-American women in Atlanta to identify types and prevalence of risk behavior among the sexually active women aged 17 to 44.

Nearly half the women reported that they did not know if their partner had been tested for HIV infection, yet 65 percent of the women said they did not use a condom for prevention of sexually-transmitted diseases (STDs) such as HIV often or at all when engaging in sexual intercourse. About 70 percent of the women said they perceived no risk or very little risk for contracting HIV.

Gayle that that study was particularly disturbing because other research has found that 17 percent of men who have sex with men also have sex with women.

Other studies to be presented at the meeting, Gayle said, underscore other factors that make it difficult to control the spread of the disease:

-- A study by Kaiser Permanente researchers in Oakland, Calif., found that 40 percent of infected individuals, most of whom were men who have sex with men, did not get tested for HIV until they were already ill with infections that are the hallmarks of AIDS.

-- Increases in STDs have been reported across the country among men who have sex with men.

-- HIV infection rates of 4 percent among young gay men-rates, Gayle said, that are comparable to what was seen in some gay men in the 1980s.

-- HIV infection rates of 15 percent among African-American men who have sex with men. "Those rates are similar to what has occurred in countries now faced with a devastating HIV epidemic," Gayle said.

-- In the studies of young gay men, she said that 50 percent reported unprotected anal intercourse; one-third of the men reported having five or more sexual partners in the previous six years. One great success has been the decline in transmission of HIV from an infected mother to her newborn.

Gayle said that in the first half of 2000, there were 47 infected babies born across the US, which would translate to a yearly rate of less than 100 infections-compared to a high of 900 a year in the 1980s.
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