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The number of Americans infected with HIV has surpassed 1 million, boosted by skyrocketing crystal use among sexually active gay men--and by decreasing mortality from AIDS.

At the Los Angeles Gay and Lesbian Center during the past few years, the staff has become more and more used to gay men who test positive for HIV after admitting to a crystal meth addiction. "If you had asked any of our counselors, anecdotally, they would have said that 90% of new HIV cases were linked to meth," says Quentin O'Brien, the center's director of health and mental health services.

It's not quite that high, but still alarming.

In June the center released startling findings: Nearly one in three gay and bisexual men who tested positive at the clinic in 2004 admitted to using meth. That rate is nearly three times greater than the proportion of HIV-positive men who admitted using the highly addictive drug in 2001. In addition, more than 10% of all men who have sex with men tested at the center in 2004 said they had used meth, almost double the rate from 2001.

"There's evidence we're still on an upward trend, and it's not abating," O'Brien tells The Advocate. "For gay men it's linked to sexuality. It is so strong that many people who say that once they have sex on crystal, there's no going back. We need to let them know that things that are often appealing have a consequence."

The Los Angeles Gay and Lesbian Center's data was released at a national HIV prevention conference, as was another unsettling piece of news: The number of Americans now living with HIV has passed the 1 million mark.

Officials call that news a mixture of good and bad. On one hand, it means that a greater number of people are living longer on anti-HIV drugs that were not around when the virus ravaged gay men in the 1980s.

"While treatment advances have been an obvious godsend to those living with the disease, it presents new challenges for prevention," Ronald Valdiserri, deputy director of the Centers for Disease Control and Prevention's National Center for HIV, STD, and TB Prevention, told attendees. He renewed a call for health officials to reach the estimated 25% of Americans who have contracted HIV but do not know it.

The new estimates indicate that African-Americans account for 47% of HIV cases, and gay and bisexual men make up 45% of those living with the virus that causes AIDS, the CDC believes.

Yet the new figures also mean that the CDC has failed on a pledge made in 2001, when the agency set a goal of cutting in half the 40,000 new HIV infections that have occurred annually since the 1990s. "It is clear that we have not achieved that goal. We have not halved the rates of new infections," Valdiserri told the conference. "But we do think we are making progress."

Some health officials believe that the number of new annual infections is closer to 60,000. "We're seeing more infections, that's the bad news. But the good news is that many of us are living longer," says Terje Anderson, who was diagnosed with HIV eight years ago and with AIDS four years ago. He now serves as executive director of the National Association of People With AIDS. "It just points out how far we still have to go in really dealing effectively with this in this country. Maybe passing the million mark will drive home that this thing is getting bigger and it's not going away."

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