AIDS MORTALITY: Deaths Drop, but Pace Slows
The steep decline in AIDS deaths that began three years ago seems to have reached a plateau, health officials said last week, noting that their optimism about drug therapy may be wearing off, the Los Angeles Times reports. AIDS deaths, which tumbled 42% in 1997 "as patients made growing use of drug combinations," fell only 20% in 1998, researchers reported at the four-day National HIV Prevention Conference in Atlanta, sponsored by the CDC and 17 AIDS organizations (Cimons, Los Angeles Times, 8/31). Most of 1998's reduction in AIDS mortality occurred during the first three months of the year, "with the number of AIDS deaths per month holding relatively steady for the remainder of the year." New AIDS cases followed much the same pattern, researchers said, noting that after declining by 18% in 1997, new cases decreased by only 11% last year. "The data tell us that this is still an unstable epidemic," said Helene Gayle, director of the CDC's division of HIV prevention. Nationwide, AIDS deaths have declined from nearly 50,000 a year in 1995 to about 17,000 a year; however, the figure varies from city to city (Brown, Washington Post, 8/31). In New York City, AIDS-related deaths declined 63% between 1995 and 1997, but only 25% between 1997 and 1998, said Dr. Mary Ann Chaisson of the New York City Department of Health. But in 1998, she said, the "number of deaths did not drop at all" (Altman, New York Times, 8/31). In Seattle, the "slowdown was even more striking." AIDS deaths in that city dropped by only 27% between 1997 and 1998 after "plunging by 66% in the single year from 1996 to 1997."
Sticking to It
CDC officials attributed the leveling-off in part to strides made in making HIV-positive people aware of combination drug therapy. Most people who know they are infected already receive the "maximum benefit" from available treatment. At the same time, the newest AIDS drugs, like their predecessors, "probably have a short duration of impact before the virus becomes resistant to them." Other health officials point to the difficulty of convincing patients to adhere to complex drug regimens. "Of those I started on these drugs two or three years ago, probably only 5% to 10% of them are still on a successful regimen," said Dr. Lawrence Deyton, director of AIDS services for the Department of Veterans Affairs. "The vast majority can't tolerate the medications or (staying with the regimen) is just too much for them," he said, noting that the "drugs have shifted the death curve to the right" (Los Angeles Times, 8/31).
African Americans Hit Hard
The epidemic is taking its greatest toll on women and minorities, health officials said. In the mid 1980s, African Americans accounted for about 25% of new AIDS cases, Hispanics for about 14% and women for about 8%, according to U.S. Surgeon General David Satcher. By 1998, he said, those figures jumped to 45% for African Americans, 22% for Hispanics and 23% for women (AP/Washington Times, 8/30). Similarly, AIDS deaths dropped 35% in 1997 and 17% in 1998 for African Americans, compared with 51% and 22% for whites. The AIDS death rates for African Americans "remained nearly 10 times higher than for whites and three times higher than for Latinos" (Los Angeles Times, 8/31). "One of the major concerns we have about the AIDS epidemic is that increasingly it is affecting communities that tend to be left out of the health care and public health system," Satcher said (AP/Washington Times, 8/30). Gayle agreed, saying, "The quality of services are not the same in the African-American community, and people just don't have the same information. There's still a sense that this is a white, gay disease" (Davis, USA Today, 8/30). Two studies presented last week indicate that a major factor in the high prevalence of HIV among African Americans is bisexuality among men. Challenging "the popular perception that many black women acquire HIV ... through injecting illegal drugs," researchers say they are "infected through heterosexual sex with men who also have sex with men." One study that recruited men at New York City's "gay venues" found that 20% of black men said they had sex with men and women, compared with 12% of Hispanic men and 4% of white men. Another study of 1,001 HIV-positive black men in Michigan found that 36% of those who said they had sex with men, also reported having sex with women (Kim, Atlanta Journal Constitution, 8/31).
"Any drop in AIDS deaths is good news -- but these data suggest that further reductions will require new approaches," said CDC Director Dr. Jeffrey Koplan (Los Angeles times, 8/31). Satcher "stopped just short of expressing support for controversial needle-exchange programs for injection drug users, although he cited 'exposure to drugs, especially the sharing of dirty needles'" as playing a role in the spread of HIV among African Americans. However, Koplan said, "Sometimes public policy lags a bit behind the science. But there should be no doubt. ... Needle-exchange programs reduce HIV transmission" (Kim, Atlanta Journal Constitution, 8/30). "We have got to get people out of this sense of complacency," the CDC's Helene Gayle told CNN's "Sunday Morning News." Even though AIDS mortality rates are declining, she said, "For all we know, those declines could go back in the wrong direction" (CNN, "Sunday Morning News," 8/29).