Washington Blade - August 17, 2001
Eric Erickson

Their message was clear: New studies show the decline of full-blown AIDS cases has stagnated and prevention programs aren't reaching new minority groups as quickly as the disease.

Health experts spent the four-day conference sounding an alarm to keep the new trends from evolving into a new epidemic.

"Scientific evidence suggests there's a resurgence [of HIV] among men who have sex with men," said Linda Valleroy, a Centers for Disease Control & Prevention epidemiologist who has conducted extensive research on men who have sex with men and spoke at the conference.

"My take on that is perhaps there is [a resurgence], but it doesn't almost matter because the important thing is how many people are getting infected right now," she added. "Please don't misinterpret me-people are just trying to figure out whether there's a resurgence, but to me, do I have to wait for there to be a resurgence, because we have such a bad situation now?"

The conference highlighted two emerging trends: The declines in the number of people contracting AIDS and those dying of the disease are leveling off, and more than 40 percent of HIV-positive Americans don't know they are infected until just before developing full-blown AIDS, sometimes missing out on a decade or more of critical treatment.

Both studies, researchers said, demonstrate that Americans are becoming more complacent about the disease.

Since 1993, the number of new AIDS cases reported fell each quarter, dropping from a total of 20,000 eight years ago to 10,000 in 1998, according to the CDC. In 1994, the CDC reported 12,000 deaths each quarter. That number continued to drop to about 4,000 deaths each quarter in 1998.

In the last three years, the numbers have stabilized, worrying AIDS educators and experts who fear a complacency surrounding the disease could lead to an increase in the number of new cases.

At the same time, new HIV cases among ethnic minorities have been on the rise. Overall, new HIV infections have leveled off at about 40,000 a year.

"We really are at a very critical point in this epidemic," said Dr. Helene Gayle, the CDC's AIDS chief, according to Associated Press. "We must work to ensure that the plateaus that we've reached will not remain plateaus - or worse, given some of the trends that we're seeing, evolve into a newly expanding epidemic."

The statistics suggest that the next wave of progress in fighting AIDS lies in expanding HIV testing, improving access to quality care and finding new treatments for patients in whom the virus resists drugs, Gayle said, according to AP.

Meeting highlights new concerns

The National HIV Prevention Conference takes place every other year, alternating with the International AIDS conference. As startling statistics show HIV infections touching people in every corner of the country, many AIDS educators said this week that they want to see continued, even increased emphasis on prevention efforts.

"Twenty years into the epidemic, prevention interventions need to help all men who are having sex with men [to] think through decision-making and risk-taking, including those marching in Gay Pride marches and those who never will," said Phill Wilson, executive director of the African American AIDS Policy & Training Institute in Los Angeles.

During a passionate speech Tuesday, Wilson reminded conference attendees that AIDS prevention efforts could no longer be tailored to a specific segment of society.

"If messages are only designed for people who are white or for people who are out or people who live in the north, those of us who do not have that experience won't understand those messages simply because of the stigma of HIV," Wilson said. "It is absolutely imperative and essential that message resonates from those who you are trying to reach."

Several speakers during the conference outlined a host of demographic groups, other than white gay men, who need to be the focus of heightened prevention efforts.

Cynthia Gomez, assistant professor for the Center for AIDS Prevention Studies at the University of California-San Francisco, asked attendees if they are surprised at the groups of people seeing an increase in the number of AIDS cases.

"Youth. Is this a surprise since we've been unable to speak to youth openly about sex and about sexuality and about condom use?" Gomez said. "Young gay men. Is this a surprise? Again, [it's] individuals who have not been allowed to embrace their sexuality.

"Have we been able to help young, gay, lesbian, bisexual, transgender, questioning, queer youth?" she added. "Not very easily. Has someone said, 'Here's somebody to help these kids'?"

Women and black gay men also need better prevention programs targeted at them, Gomez said. Wilson echoed that plea.

"When gay, white men thought AIDS was primarily a white, gay disease, they wanted everyone to pay attention," Wilson said. "Unfortunately, a very few, very expensive, very toxic drugs that work for some people, some of the time, does not a cure make."

Wilson also spoke about a CDC study released earlier this year that outlined a dramatic increase in the number of black men who have sex with other men and contracted HIV. Because the number of black men with HIV is increasing, Wilson said many people assumed black men are engaging in higher risk behavior than white men.

"I knew that the information in the study suggested that was not true," Wilson said. "The black men in the study were less risky than the white men in the study. We need to ask the question, 'If the black men are being safer than the white men, why is the incidence and the prevalence higher in the black men?'"

Focus on minority groups

Two other groups identified as needing prevention efforts geared to them were Latino men and Asian and Pacific Islander men.

New York City has 17 percent of the nation's AIDS cases; 30 percent of those cases are among Latino men. During his presentation at the conference, Daniel Castellanos, an official with Gay Men's Health Crisis in New York, said there are few interventions that effectively address the specific cultural issues of being a Latino gay man in New York City.

Gay Asian and Pacific Islander men in the United States are getting infected with HIV at a younger age compared to white gay men, according to a report presented by Kyung-Hee Choi of the Center for AIDS Prevention Studies in San Francisco.

That was the cornerstone of the conference: looking at rates of infection and talking about how to get the prevention message out to varying all segments of society.

"Sometimes it feels like prevention gets lost in the shuffle," Valleroy said. "The CDC decided that there was a really big need and that they should support this National HIV Prevention Conference."

The event brought together AIDS educators from across the country, allowing them to hear how AIDS services organizations and governmental institutions are promoting a prevention message.

Gomez also discussed the importance of including HIV-positive people in prevention programs.

"HIV-positive people who are now healthy and feeling better are also aware that they play an important role in the prevention of HIV," Gomez said. "The most effective research and intervention has been the one that has started from the ground and has worked from the beginning in communities in developing them, in thinking about them, in testing and implementing them. It is only that kind of marriage, with all of these together, that we create effective intervention."

Late diagnosis

A study presented at the conference suggested many people who have AIDS are missing out on several years of critical treatment due to late diagnosis.

More than 40 percent of HIV-positive Americans don't know they are infected until just before developing full-blown AIDS, the government study says.

Of about 19,000 AIDS patients studied, about two in five first tested positive for HIV within the year before being diagnosed with AIDS. The disease usually develops 10 to 11 years after HIV infection.

"Significant numbers of people with HIV are only finding out about their infection when they feel sick," said Dr. Ronald Valdiserri, the CDC's deputy director of HIV prevention. "We must reach these individuals at an earlier stage of infection for their own health and to prevent transmission to others."

Valleroy suggested that it may be hard to get that message out simply because many people may no longer see AIDS as a serious health concern.

"People feel well and they think that it's not a death sentence and perhaps they resume some of the social activities that they had before, which would include risky behavior," Valleroy said.

About four times as many men as women were surveyed. But the rate of individuals who tested late for HIV was nearly identical across gender and race, and heterosexuals were more likely to test late than gay men, according to the study.

A similar survey completed in 1992 - when health officials knew much less about HIV/AIDS and how to treat it - found that about half of HIV-positive people had learned their HIV status within a year before being diagnosed with AIDS, according to the Associated Press.

No memory of 'death toll'

Gomez, the UCSF assistant professor, suggested another reason for a growing complacency surrounding the AIDS epidemic: the lack of exposure many people have to the disease.

"Many young gay men have not seen the death toll that other gay men witnessed in the early fight of this epidemic," Gomez said as the conference opened Monday.

"There's something about that that never leaves. You and I know many of you are here because it has never left you and you are surrounded by the memory of many friends and loved ones and it drives you to make a difference.

"Young gay men have not had that experience and probably, hopefully, will never have that experience," Gomez added. "And so it means that our prevention efforts now have to be different. It's the new generation, a new way of thinking. We have to catch up with that."

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