| Rob
Stein, Washington Post July 29, 2003- The
number of new U.S. AIDS cases appears to have begun to rise again for the first time in 10
years, health officials reported Monday.
The number of Americans who have had
AIDS diagnosed increased 2.2 percent in 2002, the first time incidence of the disease has
risen since 1993, according to preliminary data from the federal Centers for Disease
Control and Prevention in Atlanta.
"If we let down our guard even
a little bit, this is the kind of thing that can happen," said Dr. Ronald Valdiserri,
a CDC deputy director.
If confirmed in the final analysis
of the national data collected annually by the CDC, the increase could mark a disturbing
turning point.
The AIDS epidemic in the United
States had appeared to be stabilizing because of decades of intensive safe-sex campaigns
and the introduction of powerful new antiviral drugs.
The overall increase could be driven
by a rise in new infections of the HIV virus among gay men. There have been disturbing
indications in the past few years that risky sexual behavior has been increasing among gay
men, particularly younger ones, causing the number of new HIV infections to begin to rise
again. That could have begun to translate into a jump in new AIDS cases.
"Our biggest concern is what
appears to be a resurgent epidemic in gay men," said Harold Jaffe, director of the
CDC's National Center for HIV, STD and TB Prevention.
Data from 25 states show that the
number of new HIV diagnoses among gay and bisexual men increased 7.1 percent from 2001 to
2002, marking the third consecutive year that infections have risen in that high-risk
group. HIV diagnoses among gay and bisexual men have increased by 17.7 percent since an
all-time low in 1999.
"We continue to sound this
warning note to communities and state and local health departments that we need to
redouble our efforts," Valdiserri said.
In Minnesota, the number of new HIV
cases rose 6 percent in 2002. That was driven largely by new infections among African
immigrants. There were 65 new cases among African-born people, compared with 46 in 2001,
according to Minnesota Health Department data.
The trend among white gay men in
Minnesota has been more reassuring. After a spike of 130 new cases in 2001, the number of
new cases in 2002 dropped 7 percent, according to state data. But health experts warn that
the decline could be temporary. A syphilis outbreak among members of the gay community
last year might be a harbinger of a coming increase in HIV, health officials said, a
pattern that has emerged in other cities.
In Minnesota there were 82 new cases
of syphilis in 2002, compared with 49 the previous year. Half of those with new syphilis
infections were HIV-positive, raising concerns that some might be engaging in unsafe
sexual practices.
"I don't think there is any one
explanation" for the rising numbers, Jaffe said. "Some of it may be related to
treatment optimism: 'So what if you get infected? You can get treated.' Some of it may be
related to the belief that if you are in treatment, you may not transmit the virus. Some
may be epidemic fatigue -- being tired of hearing about it.
"I think the most compelling
reason is that people aren't scared anymore. If you were a gay man in the 1980s, you were
scared. You had a lot of friends who were sick and dying. If you are a gay man today, you
don't have a lot of sick peers," Jaffe said.
No parallel increase in HIV
infections has been detected in any other groups, Jaffe said. But according to the
preliminary analysis of the incidence of new cases of AIDS, the number increased from
41,227 cases in 2001 to 42,136 cases in 2002 -- a 2.2 percent increase. The AIDS incidence
numbers increased steadily through the 1980s and into the 1990s, reaching a peak of 80,010
cases in 1993. The numbers had declined every year since.
Researchers will have to do
additional analysis to confirm the increase and to determine whether the new cases are
occurring largely among gay men, Jaffe said.
On the positive side, the number of
deaths from AIDS continued to decline in 2002, dropping 5.9 percent, said Jaffe, who
presented the new data at the National HIV Prevention Conference in Atlanta. But that
decrease represents a slight slowdown in the decline in deaths, which dropped dramatically
because of the introduction of powerful new treatments in the mid-1990s.
More prevention efforts need to be
aimed at gay and bisexual men, said David Ernesto Munar of the AIDS Foundation of Chicago.
The CDC plans to provide money to
community groups in large cities that have had outbreaks of sexually transmitted diseases
such as syphilis and AIDS, Valdiserri said. |
