Despite the U.S. government's promise to "break the back" of the AIDS epidemic by 2005, about 40,000 Americans test positive for HIV infection every year--the same number as a decade ago. The figure is double the annual goal of 20,000 new HIV cases laid out by the Centers for Disease Control and Prevention nearly four years ago. Nearly a million people in the United States are now HIV-positive, according to a report released Wednesday by the CDC.
"We have a ways to go before we reach the mark of reducing new infections by half in the United States," said Ronald Valdiserri, who heads the CDC's HIV and AIDS prevention program. Still, Valdiserri described the HIV infection rate as "relatively stable." "Clearly we want to continue, and are continuing, to fund programs to reach out to people who are high-risk and are not infected," he added.
In 2001 the CDC's campaign focused on outwardly healthy people who did not realize they had HIV--about a fourth of those infected. Officials then said targeting them was key, because if they knew they were infected, they would be more likely to take steps not to spread the virus. Such an effort "could possibly break the back of the epidemic in the United States," the CDC's Robert Janssen said then. But the agency found that just targeting people who didn't know they had the AIDS virus was not enough. So last year the CDC shifted gears, focusing on counseling those who knew they had HIV in an attempt to get them not to spread the virus.
Some advocacy groups say that effort fails to focus on drug users or very sexually active young men. "It just doesn't seem like much is really happening," said Terje Anderson, executive director of the Washington-based National Association of People Living With AIDS. "There just is a lack of imagination or spark in terms of the kinds of programs they support. I think they are politically afraid."
One AIDS expert said it's difficult for health officials to measure exactly how many new HIV infections there are each year. "Forty thousand is an estimate that is averaged over time. The changes can't be tracked easily from year to year," said James Curran, dean of Emory University's Rollins School of Public Health and the CDC's former AIDS chief during the epidemic's peak in the 1980s.
Valdiserri said the CDC is working on how to accurately determine how many people are infected with HIV each year but the system is still under development. Despite that, more attention needs to be paid to AIDS, Curran said. "What has concerned many of us in the United States is the lack of attention to the domestic AIDS problem and complacency on behalf of high-risk groups," Curran said, adding that more counseling, testing, and education are needed in the country to prevent HIV.
The CDC believes up to 950,000 people in the United States are infected with HIV and up to 280,000 of them don't know it, Valdiserri said. The rate of HIV diagnoses in the United States increased slightly--by 1%--between 2000 and 2003, from 19.5 people per 100,000 population to 19.7 per 100,000 in the 32 states surveyed by the CDC. But the increase in diagnoses was substantially greater for gay and bisexual men --an 11% rise between 2000 and 2003. The increase in HIV diagnoses, along with recent outbreaks of syphilis among that group in major U.S. cities, has concerned health officials, who fear that gay and bisexual men may be growing weary of sexually transmitted disease prevention messages and are abandoning safer-sex practices.
Advocacy groups blame a lack of federal money for part of the failure to make a dent in the HIV rate. "The reality is, to cut the number of infections, we need to do more--you can't always do more with less. We desperately need more resources," Anderson said. (AP)