A "Chilling Portrait" of Failure to Prevent AIDS

A day after health officials acknowledged that sharp declines in AIDS cases and death have ended, studies presented at the Second National HIV Prevention Conference in Atlanta highlighted failures to adapt to a changing epidemic. "It is a chilling portrait. It's not a good picture," said Phill Wilson, executive director of the African American AIDS Policy and Training Institute in Los Angeles. "At least it provides a blueprint of what we need to do."

Of huge concern is that 41 percent of people learn of their HIV-positive status a year or less before they find that they have full-blown AIDS. The news is disturbing to researchers because HIV takes a median of ten years to reach full-blown AIDS. Untested people are unwittingly passing the virus along to their sexual partners and missing out on early drug interventions that could extend their lives.

Dr. Ronald Valdiserri, the CDC's deputy director of HIV, STD and TB Prevention, said he is dismayed that "In 2001, we still have a situation . . . where four out of 10 people are not testing until very late in the course of infection, often when they present with symptoms of AIDS."

For years, the CDC and public health agencies have focused their attention on uninfected people. But the new data argue for curbing risky behaviors among the 800,000 to 900,000 people who already have HIV and AIDS. Many of those are dangerously outside the reach of the health system, according to Dr. Tom Coates, director of the Center for AIDS Prevention Studies at the University of California-San Francisco. "These [people] are the marginalized of the marginalized," Coates said. "These are people who use substances, have problems with alcohol, have difficult childhoods. They have trouble forming intimate relationships . . . and they are more likely to have one-night stands."

Part of prevention for hard-to-reach populations is ensuring that they have a stable living environment. Los Angeles County and San Francisco have received grants from the CDC to develop new outreach services, particularly for racial and ethnic minorities.

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