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World AIDS Day: HIV Pandemic Surging

Despite Advances, Record Numbers Dying of AIDS

U.S.: Sick Patients Fill City AIDS Wards continued...

Other inner-city hospitals see the same thing. Michael Kolber, MD, PhD, is director of adult HIV services in the University of Miami department of medicine. The vast majority of patients he sees are poor. And most are black Americans.

"I am not optimistic," Kolber says of the U.S. AIDS epidemic. "The HIV infection rate keeps rising without an infusion of new money. We've had the same dollars for four or five years being spread out among increasing numbers of individuals. Our outreach program has diminished. And the population we treat has other social needs -- housing, child care, mental health, food. HIV -- when they have it -- they don't worry about it because of all these other things."

The irony, del Rio says, is that he's optimistic about the world AIDS situation but pessimistic about AIDS in America.

"The news about U.S. AIDS may be more negative than positive," he says. "More people are living with HIV than ever before. The number of new infections has not decreased. It has stayed about the same -- 40,000 a year. Maybe that is where it is always going to be, but to me that is an unacceptable level. More needs to be done."

The central problem, del Rio and Kolber agree, is twofold. Prevention messages somehow must find their way to the most disenfranchised people in the nation. And people who already have limited access to health care must somehow get tested for HIV, and, if infected, get treated.

"In the US, the cost of AIDS drugs is on the order of $15,000 a year," Kolber says. "They are still very expensive. I understand the need for paying these companies for their research and development. But this cost is a dramatic cost, and in parts of the U.S., people are not getting medications they need."

Forward, Step by Step

It's easy to get discouraged by the huge numbers needed to describe the global AIDS situation. It's discouraging that AIDS appears ready to boil over in populous places such as Pakistan and Indonesia. It's scary to think about what might happen if AIDS expands its foothold in China. And it's horrible to count the number of AIDS deaths that cannot be avoided in the coming years.

Yet progress is being made, even if it's of the one-step-forward variety.

Thanks to a huge five-year effort, 1 million of the world's 6 million desperately ill people now get lifesaving treatments. True, the World Health Organization's plan to treat 3 million people by 2005 fell 2 million people short. But this year there were 300,000 fewer AIDS deaths than there would have been. And next year the impact should be even greater.

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