For the first
time since the height of the AIDS epidemic in the 1980s,
more than a million Americans are believed to be living with
the virus that causes AIDS, the government said Monday. The
latest estimate is both good and bad news--reflecting the
success of drugs that keep more people alive and the failure
of the government to "break the back" of the AIDS epidemic
by its stated goal of 2005.
The Centers for Disease Control and Prevention said
that between 1,039,000 and 1,185,000 people in the United
States were living with HIV in December 2003. The previous
estimate from 2002 showed that between 850,000 and 950,000
people had the AIDS virus. The jump reflects the role of
medicines that have allowed people infected with the virus
to live longer, said Ronald Valdiserri, deputy director of
the CDC's National Center for HIV, STD, and TB Prevention.
"While treatment advances have been an obvious
godsend to those living with the disease, it presents new
challenges for prevention," Valdiserri said.
The challenges include overcoming a failure by the
government to meet its 2005 goal of cutting in half the
estimated 40,000 new HIV infections that have occurred every
year since the 1990s. Then, Robert Janssen of the CDC
pledged the government campaign would "break the back" of
CDC officials previously have said the country's HIV
infection rate has been "relatively stable" and without
change. As the National HIV Prevention Conference was set to
begin this week, Valdiserri said no new infection data will
be available until next year. However, recent outbreaks of
HIV and sexually transmitted diseases in major cities around
the country offer a hint that new infections may be as high
as 60,000 cases a year, rather than the government estimate
of 40,000, said Carlos del Rio, an Emory University
professor of medicine.
"The U.S. has had a clear failure in HIV prevention.
I think the increase in prevalence is a reflection of that,
of the poor job we do in HIV prevention," Del Rio said. He
added that the higher number is not as surprising as why the
country has not been able to curb new infections. He said
the CDC hasn't been given adequate resources to tackle HIV
prevention and that experts have focused too much on whether
it's better to promote abstinence or condom use to stop the
spread of the virus. "We're debating too much what to do and
are not doing enough," he said.
At the same time, reaching the 1 million mark is "a
sign of both victory and failure," said Terje Anderson,
executive director of the National Association of People
Living With AIDS. "Part of the reason the number is so big
is we're not dying as before," he said. "But the other
problem is we have not made a significant dent in new infections."
Estimating the number of Americans with HIV has
always been a difficult task for health officials, but this
year's figures are believed to be the most accurate ever
thanks to wider case reporting. In the 1990s the CDC and
other agencies generally agreed that between 600,000 and
900,000 people had the virus, according to the University of
California, San Francisco's Center for HIV Information.
Previous estimates--as high as 1.5 million people--from the
1980s were later determined to be too high. For example, the
CDC estimated in 1986 that between 1 million and 1.5 million
people had HIV. In 1987, that was revised to 945,000 to 1.4
million and was refined in 1990 to 800,000 to 1.2 million.
The CDC's latest estimates indicate that blacks
account for 47% of HIV cases. Gay and bisexual men make up
45% of those living with the virus that causes AIDS, the
health agency believes.
In 2003, the rates of AIDS cases were 58 per 100,000
in the black population, 10 per 100,000 Hispanics, 6 per
100,000 whites, 8 per 100,000 in the American Indian/Alaska
native population, and 4 per 100,000 Asian/Pacific Islanders.
The CDC also warned that those demographics may soon
change because heterosexual blacks, women, and others
infected after having high-risk sex (such as with someone
with HIV, an injection-drug user, or a man who has sex with
other men) now account for a larger proportion of those
living with HIV than those who are living with full-blown