More than a million in US live with HIV
(Agencies)
Updated: 2005-06-14 10:48

ATLANTA - More than a million Americans are believed to be living with the virus that causes AIDS, the government said Monday in a report that reflects both a victory and a failure at combatting the disease.

While better medicines are keeping more people with HIV alive, government health officials have failed to "break the back" of the AIDS epidemic by their stated goal of 2005. This is believed to be the first time the 1 million mark has been passed since the height of the epidemic in the 1980s.

New medicines that weren't around in 1981 have allowed people infected with the virus to live longer, said Dr. 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," he said as the National HIV Prevention Conference got under way. Among the challenges is reaching an estimated 25 percent of those with HIV who don't even know they have it.

That in part is why the CDC has been unable to fulfill the 2001 pledge made by the agency's Dr. Robert Janssen to "break the back" of the epidemic by cutting in half the estimated 40,000 new HIV infections that have occurred every year since the 1990s.

"It is clear that we have not achieved that goal. We have not halved the rates of new infections," Valdiserri said. "But we do think we are making progress."

However, some critics think the number of new annual infections could be even higher than 40,000.

"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."

Health officials say the prevention failure in part has come from an abandonment of safe sex practices by gay and bisexual men — who account for almost half of HIV cases. Experts think they may be weary of STD prevention messages. The majority of the others infected are high-risk heterosexuals and injection drug users.

Advocacy groups also say there's not enough federal money behind public awareness campaigns and other programs.

"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.

Valdiserri said the CDC still is committed to cutting the new infection rate. One difficulty is that despite increases in routine HIV testing — including wide use of rapid test kits that provide results in minutes — many people have not been tested.

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 to learn their 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.

Recent outbreaks of HIV and other sexually transmitted diseases in major cities offer a hint that new infections may be as high as 60,000 cases a year, said Dr. Carlos del Rio, an Emory University professor of medicine.

"The U.S. has had a clear failure in HIV prevention," del Rio said. The CDC hasn't been given adequate resources to tackle HIV prevention, he said, and 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," said del Rio.

Estimating the number of Americans with HIV has always been difficult 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 new estimates indicate blacks account for 47 percent of HIV cases; gay and bisexual men make up 45 percent 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 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.