It hasn't gone away...

[NRSKarenRN, BSN, RN]

Rising HIV infection rates are causing worries about a resurgence of AIDS amid public complacency.

By Jeannine Stein

Times Staff Writer

August 18, 2003

http://www.latimes.com/news/printedition/health/la-he-hiv18aug18,1,1276574,print.story?coll=la-headlines-pe-health

Marco Correa's wake-up call came last spring when a friend was diagnosed with AIDS. "He was this very cheerful person, and then all of a sudden he started getting sick," said the 27-year-old Los Angeles businessman. "They diagnosed him, and that opened my eyes."

Before that, Correa lived like many of his young peers, usually practicing safe sex but sometimes not. And like many of his friends, he felt invincible. "After my friend was diagnosed I went from one-night stands to no one-night stands," he says. "It's sad that I had to see it this way."

Federal health officials reported last month that the number of new AIDS cases was up for the first time in a decade. Along with a continued rise in new cases of HIV infection, the numbers are raising concerns that AIDS may be making a resurgence after years of progress had been made in battling it. Health experts are concerned that the statistics reflect a growing sense of public complacency about the disease, especially among homosexual and bisexual men. New HIV infection rates rose an alarming 7.1% among that group last year.

For years HIV cases were waning, a sign that prevention and education programs were getting through to the public. During that period there was also a dramatic reduction in AIDS deaths, which continued to drop last year despite the rise in HIV infection. But officials at the national Centers for Disease Control and Prevention fear that the HIV numbers may portend a rise in AIDS-related deaths years from now.

CDC officials say the increase in HIV cases cannot be attributed to a single group. However, officials are particularly concerned about younger Americans because regional data show that people in their 20s account for a sizable number of new diagnoses. Moreover, data show rising incidences of other sexually transmitted diseases in younger Americans, further suggesting that they are not heeding advice about condom use and the hazards of unprotected sex.

Experts said other possible reasons for the rise in HIV cases include the fact that more people are being tested, and an increase in substance abuse.

'People are still dying'

Many Americans in their late teens and 20s did not witness firsthand the devastation caused by AIDS in the 1980s and early 1990s. "They are not seeing in such a visible way the consequences of HIV and AIDS," said Darrel Cummings, 46, chief operations officer for the Los Angeles Gay & Lesbian Center. "One of the messages we need to make clear is the fact that people are still dying in huge numbers, and living with the disease can be a horrible experience."

None of this is news to Kent Dobbs, a 40-year-old former L.A. medical office worker who tested positive for HIV four years ago. As a volunteer for AIDS Project Los Angeles, he says it is sometimes difficult to get preventive messages through to younger men: "Oftentimes they'll say, 'I'm not at risk because I don't know anyone who's HIV positive.' " Dobbs remembers having a similar feeling of invincibility when he was younger. But during one year in the early 1990s, 36 friends of his died.

"I don't think sex and death are things your mind brings together very easily when you're 20," Dobbs says.

People with HIV are living much longer-sometimes 20 years or more-thanks to sophisticated drug regimens that have drastically reduced the risk of developing AIDS or dying from it. Magic Johnson, perhaps the most recognizable HIV-positive person today, looks fit and healthy in his public appearances-and that may unintentionally be fueling a belief that HIV is not a big deal, despite Johnson's work in AIDS and HIV prevention.

And pharmaceutical companies have occasionally drawn criticism for advertisements that portray HIV-positive people as looking happy and healthy. A few years ago, AIDS activists and city officials in San Francisco were so upset at billboard ads that showed robust HIV-positive men in their 20s that they considered, but later rejected, a plan to ban the ads.

While it's true that AIDS therapies have been remarkably successful in helping many HIV-infected people to have longer and healthier lives, experts worry about an imbalance in the messages the public is hearing. After all, there is still no cure for AIDS, the medications can have severe side effects, and some patients' bodies are resistant to the therapies, said Dr. Ronald Valdiserri, deputy director of the CDC's National Center for HIV, Sexually Transmitted Disease and Tuberculosis Prevention. "The improvements in treatment are wonderful," said Valdiserri, "but unfortunately it minimizes the threat of HIV and AIDS. People say, 'Isn't that cured, like syphilis?' "

This suggests that despite the many millions the government is spending on AIDS prevention efforts, the message is not reaching everyone.

"I thought it was controlled," said Jorge Coronel, a 27-year-old friend of Correa's who was with him at a West Hollywood coffeehouse on a recent night, "and that [people] my age wouldn't have it, but they do. You just don't know. What frightens me is that people younger than I am are even worse about protecting themselves. They feel there's medication out there for it."

'Drug ads spark criticism'

Mark Towns, 28, a sound engineer from Chicago, thinks the image of AIDS that is portrayed in drug company ads is misleading and fails to show the downside of AIDS therapies. "It's like, 'I'm HIV positive, and I'm happy as a clam. You take this designer drug and you're OK,' " he said. "They're painting such a rosy picture that no one's scared of it."

His peers, he adds, aren't fooled into thinking there's a cure but believe that death may be 20, 30 or more years away. "They're thinking, 'Gosh, I'm 28, I'm going to live until I'm 60.' I know people who are positive who have killer physiques. They are on medication, but no one really talks about it. Maybe they don't want to."

Messages about AIDS and HIV prevention that have been around for years are frequently tuned out, or lost in the cacophony of other major issues that attract the media's attention. "There's this sensation of stagnancy," said Tawal Panyacosit, a 23-year-old car rental agent from Los Angeles who volunteers for the National Gay and Lesbian Task Force. "It's like, we've resolved this issue, let's move on to other things. The whole pandemic of AIDS in Africa and Asia-it's not in our borders anymore. It's not important for the media anymore."

The Internet may also be playing a role in the rise of HIV rates, experts said, because it makes it easier for people, especially young people who are technology-proficient, to hook up in chat rooms to arrange casual sexual liaisons. Also, health officials believe the use of crystal methamphetamine is rising among gay men of various ages. The powerful stimulant impairs judgment and may be contributing to an increase in unsafe sex, they said.

Health officials and AIDS groups are also concerned that many of the new HIV diagnoses are occurring among ethnic minorities. For example, one CDC report found that more than half of newly diagnosed HIV infections in 2001 were among African Americans. Another federal study of young gay and bisexual men in six U.S. cities found that 34% were infected with HIV.

There are additional cultural issues in ethnic communities, said Craig Thompson, APLA's executive director. In the African American and Latino communities, religion plays a large role in shaping attitudes about homosexuality. For example, black homosexual and bisexual men often say it's difficult to come out in their communities. "Some of these men are not identifying with the greater gay community, where so much prevention has been done, and it's hard to reach them," said Thompson. "If you're relying on billboards [for information], the message gets washed way down."

The young are vulnerable

AIDS organizations and gay and lesbian centers across the country have for years been reaching out to young people because they recognized their vulnerability and lack of awareness about the disease.

At the Stop AIDS Project in San Francisco, volunteers administer surveys to young men, but in asking questions about safe sex practices "it becomes a conversation, a one-on-one intervention," explained Shana Krochmal, the group's director of communications. "A volunteer sits with a guy for 10 minutes at a bar, and he may ask him the last time he used a condom or talk about ways to change his behavior."

Many AIDS organizations also hope that new rapid HIV testing procedures will prompt more people to get checked.

How can messages reach the college-age generation? Provocative public service announcements, literature in language that speaks to a younger population, online campaigns, and ads featuring big-name stars have all been mentioned by AIDS awareness groups, health officials and young gay men.

No one believes the current slate of programs is enough to handle the epidemic, but groups such as APLA and the Stop AIDS Project are critical of the Bush administration because they believe it directs too much money and attention to abstinence programs as a means of promoting disease prevention. AIDS groups demonstrated at the CDC's National HIV Prevention Conference last month to protest new federal policies that they believe place too little emphasis on preventing HIV infection.

According to Valdiserri, the CDC will continue to fund programs both for people at high risk of becoming HIV-infected and for those already infected. He adds: "Research suggests that the majority of new HIV infections are coming from persons who are infected and don't know it. Making testing more widely available will help people learn of their infection, which, in turn, leads to them taking steps to protect their partners."

Few people are optimistic that the numbers will begin to decline anytime soon. "It is bleak," said Thomas Coates, the outgoing director of the Center for AIDS Prevention Studies at UC San Francisco. "But the only thing we can do is persist in what we know is right. It's not time to give up, it's time to keep persisting. Unfortunately people wait for a crisis to start jumping on it. What we need to learn is that prevention is a lot more cost effective than treatment."