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Jun. 15--FORT LAUDERDALE, Fla. -- In a sign of both success and failure in combating the nation's AIDS crisis, federal officials said Monday that for the first time more than one million Americans are now living with the HIV/AIDS virus.
Drug cocktails that became available a decade ago have helped HIV patients survive longer than ever before. But the number of new infections has stubbornly refused to fall despite years of efforts to prevent new cases and contain the outbreak, the U.S. Centers for Disease Control and Prevention reported.
"It is good news in a way, because it means the medications are working," said Manuel Rodriguez, education director at the Fort Lauderdale agency Community Health Care Center One. "But it poses a huge challenge in prevention, because there are more people with the virus."
Across the nation, money to take care of people infected with HIV is waning. South Florida this year received $49 million in federal "Ryan White" grants to care for the uninsured among the area's 41,541 living HIV/AIDS patients. That's a 6 percent cut from 2003 and about the same as in 2001 when the number of patients here was about 30,000.
"There are more patients coming into system and the dollar levels are staying the same," said David Begley, chairman of the Palm Beach County HIV Care Council. "I think it's unconscionable to say we have to put all these people into the system and not put in the money to back it up."
At an HIV prevention conference in Atlanta, the CDC reported that as of the end of 2003, at least 1.04 million Americans were living with HIV or had developed AIDS from the virus. A year ago, the estimate was up to 950,000.
A big factor in the surge during recent years is increased success of several classes of medications that beat back the virus and allow people to live mostly symptom-free for years. The drugs have been refined so patients take a few pills a day instead of one or two dozen, as in the late 1990s.
"It's easy to be compliant. I only have to take [four pills] once in the morning and once in the evening," said Richard, a Boca Raton professional in his late 50s who has been HIV-positive since 1987. He spoke on the condition he would not be identified by his full name.
But the main group of groundbreaking drugs, protease inhibitors, often produce side effects, including severe diarrhea, elevated cholesterol and are possibly linked to heart disease.
Even so, the image of AIDS patients dying horrible deaths has faded as the disease has become more manageable.
Despite a CDC desire to cut the number of new HIV infections in half by this year, it has held steady at 40,000 per year since the 1990s.
The face of the epidemic has changed in recent years, with half of all new infections reported in the black community. Also, complacency and unsafe sex practices among some young gay men, partly fueled by use of drugs like crystal methamphetamines, in some cases, has led to more infections.
"Prevention is not a one-shot deal. Each generation must be reached as they come of age," said Ron Valdiserri, deputy director of HIV prevention programs at the CDC.
About one-quarter of infected people do not know they have HIV, the CDC said, and risk spreading the disease. A survey of 1,767 men who have sex with men in five cities, including Miami, found that 67 percent of the black gay men did not know whether they had the virus, he said.
Locally, targeted prevention programs have led to fewer new infections in some of the neighborhoods with the biggest HIV outbreaks, said Dr. Mitchell Durant, HIV/AIDS coordinator at the Palm Beach County Health Department. But prevention budgets have been shrinking, officials said.
By Bob LaMendola and Nancy McVicar
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