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U.S. reaches disappointing milestone in AIDS epidemic

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ATLANTA (AP) – The United States has reached an AIDS milestone, but not the one the government intended. This was to be the year that federal health officials slashed the country’s annual rate of 40,000 new HIV infections in half.

Instead, the government said Monday the infection rate has remained the same and that for the first time since the height of the epidemic in the 1980s there are 1 million Americans living with HIV.

In part, it’s a testament to the powerful medicines keeping so many people alive. After nearly a quarter-century of battling AIDS, much more is known about the disease than ever before – and how to treat it.

But U.S. health officials face problems similar to the early days of the epidemic, including a new generation of Americans who engage in risky, unprotected sex and the inability of a government to curb the spread of the virus.

“In the earlier days of the AIDS epidemic, we didn’t know how to get AIDS under control. I think now we do, but we’re watching a textbook case of not implementing a good plan,” said Julie Davids, spokeswoman for the Community HIV/AIDS Mobilization Project.

Advocacy groups like Davids’ say there’s not enough federal money behind public awareness campaigns and other prevention programs. They accuse the government of politically motivated efforts that emphasize abstinence over condom use.

Health officials say HIV and sexually transmitted diseases have recently spread through outbreaks in major cities as many gay and bisexual men have let down their guard after enduring years of safe-sex messages.

The new estimates indicate that, as in recent years, blacks still account for a disproportionately high share of the cases – about 47 percent.

“We have not halved the rates of new infections. But we do think we are making progress,” said Dr. Ronald Valdiserri, deputy director of the CDC’s National Center for HIV, STD and TB Prevention as the National HIV Prevention Conference got under way.

It was Dr. Robert Janssen of the Centers for Disease Control and Prevention who announced a campaign in 2001 to “break the back” of the epidemic by reducing the rate of new HIV infections to 20,000 a year by 2005.

Today experts believe the government’s campaign was such a failure that instead of chopping in half the number of new HIV infections, it has increased to 60,000 new cases per year.

“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,” said Dr. Carlos del Rio of Emory University.

But the government says what the country faces now is not failure but a challenge. Having more than 1 million Americans living with HIV means that more people are living longer.

To Valdiserri, that means working with those who have HIV to make sure they know not to pass the virus to others. The CDC also wants to focus on the nearly 300,000 people who have the virus but don’t know it.

More than a quarter of the people living with HIV have not been diagnosed, the CDC estimated, and some apparently don’t want to know. Valdiserri noted that nearly a third of those who tested positive at CDC-sponsored sites around the country did not return for the test results.

An upcoming scientific paper from CDC officials says the majority of new infections have been transmitted by those with HIV who don’t know they are infected, Valdiserri said.

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. The number in the mid-1980s was probably around 1.2 million, experts believe.

The latest numbers, from 2003, indicate gay and bisexual men make up 45 percent of those living with HIV. The racial breakdown indicates 58 per 100,000 in the black population, 10 per 100,000 Hispanics, 6 per 100,000 whites, 8 per 100,000 American Indian/Alaska native population, and 4 per 100,000 Asian/Pacific Islanders.

The CDC also warned 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 AIDS.

“We’re seeing more infections, that’s the bad news. But the good news is many of us are living longer,” said Terje Anderson, who was diagnosed with HIV eight years ago and AIDS four years ago. He now serves as executive director of the National Association of People Living 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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On the Net:

CDC: http://www.cdc.gov

University of California-San Francisco Center for HIV Information: http://hivinsite.ucsf.edu

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