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H.I.V. Infections Continue Rise, Study Says
  NY Times
November 27, 2003

The number of new H.I.V. cases diagnosed in the United States is continuing to climb, and the most significant rise has been among Hispanics and gay and bisexual men, according to the Centers for Disease Control and Prevention.
The study by the centers, which appeared in its Morbidity and Mortality Weekly Report, looked at data from 29 states that included a confidential system that was started in 1999. The picture of H.I.V., the virus that causes AIDS, might even be much worse than the data indicate because states with the highest populations and possibly the highest rates of infection, like New York and California, were not included in the four-year study.
From 1999 through 2002, the number of new H.I.V. cases soared by 26 percent among Hispanics and by 17 percent among men who have sex with men, while the increase in new cases over all for that period was 5.1 percent, according to the study.
"Because more effective treatments are available, there seems to be a perception particularly in the gay community that H.I.V. is a manageable disease," said Dr. Robert Janssen, director of the division of H.I.V. and AIDS prevention at the centers. "Most of the increase in the Latino community is due to men having sex with men. I think the disease just doesn't have the fear that it once carried."
Several other groups also showed increases in the rate of diagnosis. African-Americans still make up the largest portion of new cases, at 55 percent, while whites accounted for 8 percent of the new cases, the study found. The numbers for men in general went up 7 percent.
The number of new cases in other groups remained stable. Injection drug use accounts for 17 percent of HIV in the USA; heterosexual contact accounts for 35 percent of HIV cases in the USA. Hispanics account for 11 percent of HIV in the USA. Women account for 29 percent of cases of HIV in the USA.
Whether the study's findings reflect higher rates of H.I.V. infection is difficult to say because some cases are not diagnosed immediately.
But if that was a factor, Dr. Janssen said, the study would have detected more cases that had progressed to AIDS. Instead, he said, rates of testing have stayed about the same and many of the recently detected H.I.V. infections were caught in the earlier stages.
"We're seeing an increase in people with H.I.V. but not necessarily an increase in simultaneous diagnoses of H.I.V. and AIDS," he said.
The new findings reinforce the notion that there is a growing sense of complacency among groups at the highest risk for contracting the disease. Advances in AIDS treatments in recent years, some experts are saying, could be undermining efforts to promote safe sex. The latest figures, in that case, might reflect a more widespread willingness to engage in risky behaviors.
Earlier this week, for example, the centers released figures showing that rates of syphilis infections had risen sharply in 2002 for the second consecutive year. Gay and bisexual men accounted for a disproportionate number of those cases, Dr. Janssen said, and in most cities more than half the men involved in the outbreak also had H.I.V.
Dr. Jeffrey Laurence, program consultant for the American Foundation for AIDS Research in New York, said: "Even among populations targeted for outreach, it's as if people think they can become infected because there's a pill to take care of them. There needs to be a stronger message that it's not a picnic to be on these drugs and that even when you're being treated you can still transmit this disease."
Efforts to promote AIDS prevention and convey the gravity of the disease have not reached Hispanics and other minorities, experts say. Too often, Dr. Laurence said, AIDS education programs rely on blanket messages that are too weak to combat the widespread images of healthy, resilient AIDS patients in drug advertisements.
"There's such a striking disparity among Hispanics and blacks that we're obviously not doing a good enough job of targeting them and conveying the right idea," he said. "Here's a population that is not responding to the messages we're sending. Perhaps it is because that message is getting stale."
More than 850,000 Americans are infected with H.I.V., the greatest number since the AIDS epidemic started in the early 1980's. According to the centers, about 40,000 people in the United States are infected with H.I.V. every year.
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