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DURBAN, SOUTH AFRICAWith passion rare for a scientific meeting, the head of the AIDS program for the Centers for Disease Control warned of "unacceptably high" rates of new HIV infections in the United States and said that efforts to control the epidemic were hampered by apathy and inadequate funding.
Speaking at a press conference on the eve of the XIII International AIDS Conference, which opened here on Sunday, Helene Gayle contrasted efforts in the United States with those in Africa, where public health officials struggle to wring the most out of the little they have. America, said Gayle, knows how to control the epidemic, but noting that prevention efforts receive only one-tenth the funding given to treating AIDS, she said, "Our failure to invest adequately is totally unacceptable."
Gayle also revealed "worrisome" data showing that the decline in AIDS death rates had stabilized, and that there was a slight rise in new cases of full-blown AIDS. Researchers have been worried whether deaths will begin to rise as viral resistance renders anti-HIV drugs less effective.
The fact that there is no cure for AIDS, and that the drugs are costly and cause severe side effects, makes it crucial to prevent people from contracting the virus. CDC researchers reviewed 83 studies from 1978 through 1998. They found that as soon as prevention education began in the early 1980s, the rate of new HIV infections plummeted and that it has remained relatively stable, at about 40,000 new infections a year.
But that relatively small total number masks the impact on specific groups, such as gay men and African Americans. In a seven-city study published today in the Journal of the American Medical Association (JAMA), CDC researchers found that 7 percent of gay men aged 15 to 22 were infected with HIV. Among African Americans, the rate was fully twice that: 14 percent.
"Optimism about treatment has led to complacency," Gayle said, and "that could signal a real resurgence in HIV among gay men." Indeed, another multi-city study, which looked at HIV-positive gay men from 1993 to 1998, found that their rates of gonorrhea had doubleda strong indicator that these infected men were having unsafe sex, and so possibly spreading HIV. A recent highly publicized study from San Francisco found that the number of new infections, which had been holding steady for six years, rose sharply from 1997 to 1999.
"We simply cannot allow each generation of gay men to suffer HIV infection as a rite of passage," said Gayle.
Among injection-drug users, the rate of new infections seems to be holding steady, but a full fifth of drug users do not have access to clean needles. Congress and the president have banned federal funding of needle exchange programs, despite clear evidence that they reduce HIV transmission. Thirty percent of new HIV infections are attributed to heterosexual contact but, Gayle noted, many heterosexuals who have gotten infected believed that they were not at risk. "People interpret low risk as no risk," she said. Overall, the CDC estimates that between 4 million and 5 million Americans are at high risk for acquiring HIV.
Asked if there was enough money for prevention, Gayle answered, "In a word, no." She argued that the United States needed to appropriate new money, saying, "It scares me that we're still playing a game of not increasing the pie, but rather continuing to rob Peter to pay Paul."
Gayle was also questioned about two Americans who were infected through the blood supply. There has always been a "window period" after a person gets infected before he produces antibodies to HIV. To eliminate this risk, blood banks screen blood by using both an antibody test and one that looks for the virus itself. But in the case of the two infected peoplereported in today's Journal of the American Medical Associationthe original donor had so little HIV in his blood that it didn't register.
Does this suggest the potential for a larger problem? Studies consistently show that the American blood supply "is very, very, very safe," Gayle replied, adding, "We have zero tolerance around blood and so much tolerance around ways most people are actually getting infected." Referring to transmission through sex and needles, she said, "The levels of infection we continue to allow are unacceptable."
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