HIV/AIDS: 1997 Death Rate Plunges
The number of deaths in America due to AIDS has dropped to the lowest level since the 1980s, and the disease no longer ranks as one of the top ten causes of deaths in the U.S., due largely to the dramatic impact of potent drug cocktail therapy and "increases in resources devoted to treatment and prevention," the Los Angeles Times reports (Cimons, 10/8). According to new data released yesterday by the Centers for Disease Control and Prevention's National Center for Health Statistics, AIDS-related deaths decreased 47% in 1997. The "unprecedented decline means that about 16,000 people are alive today who would have died in 1997 had AIDS mortality continued at the previous rate (Brown, Washington Post, 10/8). Researchers say that combination drug therapy is "preventing people who are infected with HIV from developing full-blown AIDS and ... keeping those who have the disease from succumbing to opportunistic infections that in the past easily and painfully killed them." The New York Times reports that AIDS killed 16,865 people in 1997, down "from the 31,130 people who died from the illness the year before." The CDC data is "[b]ased on an examination of birth and death records provided by the states" (Holmes, 10/8).
The Post reports that the astounding decline is the largest "for a major cause of death ever recorded," with the "only decline in mortality even remotely comparable" being the decreased mortality that resulted with the introduction of antimicrobial sulfa drugs and penicillin in the 1930s and 1940s (Brown, 10/8). Dr. Robert Schooley, chair of the executive committee for the federal AIDS Clinical Trials Group, said, "What this says is that the benefits of the research effort that has been ongoing for the last 15 years is clearly paying off for patients. ... I would challenge anybody to come up with any single disease that has had such a dramatic change in mortality in such a short period of time" (Los Angeles Times, 10/8). Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said, "We now have the ammunition and already made a major positive impact on HIV-infected individuals when it comes to longevity and quality of life" (New York Times, 10/8).
The nation's community of AIDS activists expressed a sense of restrained triumph and pride, tempered with the caution that the battle against the virus is by no means over. Daniel Zingale, executive director of AIDS Action, said, "Just a few years ago, those diagnosed with AIDS received a sentence to near-certain death. Today, despair has been transformed into hope" (Perlman, San Francisco Chronicle, 10/8). However, the consensus view from the study authors, public officials, AIDS researchers and activists was that the encouraging figures must not "seduce the public into complacency." Washington, DC-based Whitman-Walker Clinic head Jim Graham said, "I know the old reality of this disease, which is diagnosis, sickness, death, and it just repeats itself mercilessly. I just hope people don't get the message that we're OK here. There are lots of people on these triple therapies that are dying. ... And there are a lot of people who can't get them" (Eversley, Philadelphia Inquirer, 10/8). Dr. Mathilde Krim, chair of the American Foundation for AIDS Research, said, "The inhibitors are not a cure -- it just means we are one step closer to ending this epidemic" (Moritz, New York Daily News, 10/8). Sandra Thurman, director of the Office of National AIDS Policy, echoed those sentiments, saying, "We are a long way off from having either a cure or a vaccine, so we need to invest more of our energies in prevention and education" (Painter, USA Today, 10/8).
The Bad News, Part 1
Although the rapidly improving ability to treat and even prevent AIDS has resulted in substantially improved survival rates, there is evidence that HIV infection continues nearly unabated. The Wall Street Journal reports that "[o]ther government data indicate that the annual number of new HIV infections -- about 40,000 -- hasn't fallen in recent years, and that the total number of people with HIV is increasing (McGinley, Wall Street Journal, 10/8). Dr. Helene Gayle, director of the National Center for HIV, STDs and Tuberculosis Prevention, warned that preventing deaths without preventing future transmission may have unexpectedly negative consequences. She said, "We have people who, in the past, might have been very ill, in bed, not able to be sexually active who now are much more active and potentially could continue to pass on HIV. We don't yet know if people on these therapies are less infectious or not" (New York Times, 10/8). Ronald Johnson, acting head of the Gay Men's Health Crisis, said, "It's certainly good that less people are dying, but it's very serious that the HIV infection rate is not dropping ... That means the epidemic is still raging out of control. It's not over by a long shot" (Delfiner, New York Post, 10/8). Health and Human Services Secretary Donna Shalala said, "[W]e have [not] significantly reduced HIV transmission." She said that "[e]ven more important" than improving the efficacy of and access to therapies "is our continuing task of preventing new cases of HIV" (HHS release, 10/7).
The Bad News, Part 2
The Los Angeles Times reports that although the overall number of deaths from AIDS has decreased, "disparities still exist between whites and minorities ages 25 to 44" -- AIDS remains "the No. 1 killer in the black population" (10/8). The San Jose Mercury News reports that "the epidemic increasingly affects a more disenfranchised population: women, people of color and young gay men, many suffering from mental illness, substance abuse or alcoholism" (Krieger, 10/8). Peter Velasco, spokesperson for the National Minority AIDS Council, said, "Why isn't the decrease happening across the board? Because not everyone can afford these very expensive treatments. It's an economic issue" (Armstrong, Philadelphia Daily News, 10/8). Activists say that their focus will increasingly be on obtaining more federal funding to help those most in need. Zingale of AIDS Action said, "It is a tragedy that current federal policy denies low-income HIV-positive Americans access to Medicaid and AIDS-preventing drugs until they develop AIDS. Medicaid must be modernized" (AIDS Action release, 10/7). Rene Durazzo, programs director for the San Francisco AIDS Foundation, said "with new HIV infections holding steady ... we as a country must redouble our efforts in prevention. Until we see both" the death rate and infection rate declining, "we haven't turned the corner in this epidemic" (San Francisco AIDS Foundation release, 10/7). Click here to obtain a copy of the CDC report.