AIDS Could Rise Again in the U.S., Statistics Show

Medically Reviewed by Charlotte E. Grayson Mathis, MD
From the WebMD Archives

July 8, 2000 (Durban, South Africa) -- The head of the U.S. government agency that tracks HIV/AIDS infections said Saturday she's scared that new trends indicate an increase in the deadly disease that is believed to currently infect more than 850,000 Americans. She reported her findings here at a special media briefing hosted by the American Medical Association on the eve of the 13th International AIDS Conference in Durban, South Africa.

"These new figures do paint a picture of a real potential for resurgence [in the numbers of people with HIV infection]," says Helene D. Gayle, MD, MPH, director of the National Center for HIV, STD, and TB Prevention at the CDC in Atlanta.

Gayle tells WebMD that she is concerned about trends that indicate AIDS rates could rise again after years of steady decline or stability -- especially due to risky behavior among young men and women. Gayle adds that as many as 5 million Americans are at risk of AIDS due to risky behavior.

The concerns are based on the latest CDC surveillance data on AIDS cases, deaths, and HIV diagnoses through June of 1999. Gayle also reported new risk behavior data and the preliminary results of the first wide-scale analysis of studies on HIV incidence conducted between 1978 and 1999.

Among the findings:

  • A leveling-off of the incidence of HIV infection and AIDS cases among people 13-24 years of age since 1996 -- at about 2,000 cases a year -- in 25 states.
  • Data indicating that just over 2% of the population engage in risky behavior: unprotected sex or drug-related risks.
  • Less than half of unmarried adults used condoms the last time they engaged in sexual intercourse.
  • Less than one-fourth of drug abusers used condoms the last time they had sex.
  • Twenty percent of drug users continue to share needles.

In addition, last week the San Francisco Department of Public Health reported a striking increase in new HIV infections between 1997 and 1999. The data show increases in infection of about 8% in 1998, the highest levels since 1991.

Other recent CDC data show a marked increase in infections from gonorrhea and other sexually transmitted diseases.

"I am scared by the trends we are seeing," Gayle says. "I'm scared when we see increases in rates of sexually transmitted diseases. I'm scared when I see rates for gonorrhea among gay men increasing. I'm scared when I see the rates of AIDS cases in San Francisco -- which have been declining for six years -- rise again."

Currently, about 40,000 Americans contract HIV each year, down from the 100,000 new infections annually during the mid-1980s. The improvement is largely attributed to safer sex habits and drug users avoiding dirty needles.

However, Gayle says that increases seen in recent years in high-risk activities -- unprotected sex and injecting drugs -- are leading to increased rates of sexually transmitted diseases and an increase in HIV infection.

Gayle worries that a deadly combination of complacency over getting AIDS and the availability of the highly effective HIV treatments is behind a return to risky behaviors. She cites new surveys showing that young men who have sex with men are engaging in unprotected sex, believing that new drugs will reduce the risk of dying from AIDS.

"We should not have to have another generation of gay men suffer though HIV infection as a right of passage," Gayle says. "Despite the dramatic benefits new treatments have had in extending the lives of individuals with HIV, the overall shortfalls of AIDS treatments are becoming increasingly apparent, and HIV infection and risky behaviors continue at levels far too high. Now more than ever, it is critical that we expand successful HIV prevention programs to bring infection rates down."

Just as worrisome, she says, is the plateau in the numbers of new cases of AIDS and deaths from the disease. Gayle says that since July 1998, the number of AIDS deaths and new cases of the disease have remained steady at about 12,000 deaths and 40,000 new cases a year. Before then, deaths had steadily declined since 1993; cases of AIDS had been declining since 1995 as combination therapy for HIV infection became the standard of treatment for the disease.

"Stable means that some rates are going up and others are decreasing. [For example,] I'm concerned that the AIDS cases among young women are increasing," she says.

She says that the lack of progress in further reducing AIDS statistics is likely caused by treatment failures, by the fact that most people who would benefit from treatment are already being served, by the lack of early testing and treatment for some infected individuals, and by some patients' difficulty in adhering to new treatment regimens.

"We estimate that we need $300 million a year more in AIDS prevention programs in order to reduce new cases of AIDS by 2005, our new national goal," Gayle says. "In the scheme of things, that is not a lot of money and the cost of inaction is great."

By contrast, Peter Piot, MD, executive director of the Joint United Nations Programme on HIV/AIDS, says that in order to get a handle on the out-of-control epidemic in Africa -- where 25 million people live with HIV -- would cost $3 billion. "That's what is needed for basic care and prevention," Piot says. "Before we even consider the issue of combination [drug] therapy [to treat those already infected]." He adds that African nations currently spend just one-tenth of that amount.

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