Era of Decline of US AIDS Cases May Be Over

The dramatic decline in the number of Americans developing AIDS and dying from the disease may be coming to an end, federal health officials from the CDC announced today.

After dropping sharply in the mid-1990s, the number of US AIDS cases and deaths reported quarterly remained stable between mid-1998 and mid-2000, according to new government figures released at the 2001 National HIV Prevention Conference, which opened today in Atlanta. Health officials expressed concern about the leveling-off, as well as about new findings that indicate high rates of risky behavior and HIV infection in some population groups, notably young gay men and low-income African-American women.

"The latest data suggest that the era of dramatic declines is over," said Helene Gayle, director of the National Center for HIV, STD and TB Prevention at the CDC. "There are a number of signs indicating that our progress in fighting the disease is in serious jeopardy," she said. "If treatment failures become more of a problem, if resistance becomes more of a problem, we could see increases in deaths as well as in AIDS cases."

Some encouraging trends were also evident from the data reported. Thanks to vigorous efforts to expand HIV testing and treatment to pregnant women, only 156 cases of transmission from infected mothers to newborn infants were reported nationally in 1999, a record low since the start of the epidemic and an 84 percent decrease since 1992. In addition, HIV rates have declined in injecting drug users in areas where testing has been done, Gayle said. In New York City, the proportion of drug users who were infected fell from 50 percent in 1990 to 20 percent in 2000.

The stability in overall numbers of Americans who become newly infected with HIV each year (about 40,000 annually) does not necessarily explain the leveling-off of AIDS cases and deaths from the progress made in the 1990s. Health officials believe the plateau reflects the fact that that most people who know they are infected and who have access to health care are now getting treatment that includes highly active drugs against the virus. Health care workers need to expand HIV testing, improve access to treatment and focus on the care of patients who can't tolerate the drugs, fail to follow their medication schedule, or stop responding to the medicines, Gayle said.

The populations that are encompassed in the 40,000 new infections are different, Gayle said. HIV "is reaching younger people, it's reaching more women, it's reaching more communities of color." Forty-two percent of new infections are occurring in gay men, 33 percent in heterosexuals infected during sex, and 25 percent in injecting drug users, she said. Infections in heterosexual women are increasing more rapidly than any other group. A recent CDC study of young gay men in six cities found that 4.4 percent are becoming infected annually with the rate especially high (14.7 percent annually) among African-Americans, compared to 3.5 percent among Hispanics and 2.5 percent among whites. The striking racial disparity in infection rates does not appear to be explained by differences in frequency of risky sexual behavior, according to researchers at the CDC today.

African-American gay men were actually somewhat less likely than other groups to report having unprotected sex or having multiple partners. Gayle said the high rate of new infections among African-American gays may be occurring because such men are seeking sexual partners among a relatively small groups of people where the frequency of HIV infections and STDs is already high.

The new findings on infection rates in gay men are particularly troubling because efforts by gays to reduce HIV transmission were major reasons for a dramatic, nationwide decline in infection rates in the 1980s.

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