"By now you'd think people would know a lot about HIV, but they don't. I would never tell someone I was not close to. Even when I do feel close enough to someone to tell them, I wonder. Are they going to say, 'Get away from me! Don't touch me!' The truth is that people really do look at you differently when they know you are HIV positive. ... It is hard. But I know people's ignorance is not going to go away. I still think people are going to hate me or not want to be my friend when they learn I have HIV."
-- 18-year-old U.S. woman, HIV infected since birth, name withheld by request.

AIDS isn't in U.S. headlines any more. Yet more Americans are living with the AIDS virus than ever before.

AIDS in America used to mean patients wasting away before our eyes. Unable to fight off infections, many of them suffered terribly from awful lung, eye, brain, and skin diseases.

You don't need a vivid imagination to know what it was like. Step outside the developed world - into sub-Saharan Africa, for example, or South and Southeast Asia, or Eastern Europe, or the Caribbean - and you'll see it today.

What makes the U.S. and Western Europe different? One word: access. Access to drugs that -- despite their power and astonishingly high cost -- don't cure HIV infection. What they can do is keep the wily and deadly AIDS virus at bay.

When highly active antiretroviral therapy (HAART) became available in the mid-1990s, U.S. AIDS death rates fell sharply. Now, with a steady rate of about 40,000 new infections each year, the number of Americans living with HIV is steadily rising. This means trouble, says Carlos del Rio, MD, chief of medicine at Atlanta's Grady Memorial Hospital.

"What people need to hear is that HIV still is a very significant, severe disease," del Rio tells WebMD. "People do not take it seriously enough. It is a major threat. It is something we are not doing enough about. Forty thousand new infections a year is unacceptably high. We have the highest number of new infections of any developed nation. People say, 'Oh, there are therapies, I can have unsafe sex.' We need to get people out of that mode of thinking."

Who are these fellow citizens? What is it like to live with HIV in 2004? To find out, WebMD spoke with patients and with doctors on the front line of the U.S. AIDS epidemic.

HIV: The New Reality

"It was very traumatic to learn I had HIV. Waking up, it was the first thing on your mind, and going to sleep it was the last thing on your mind. You forget for a second, then it hits you in the stomach like a ton of bricks."
-- Joseph Wolfe, age 28.