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New hope, old challenges in AIDS fight

Much has changed since U.S. outbreak in 1980s

Lisel Christian, 20 and HIV positive, says young people know a great deal about AIDS -- but still put themselves in high-risk situations.
Mayo Clinic
AIDS (Disease)
Magic Johnson
Nelson Mandela
Bill Clinton

(CNN) -- Decades after the first reported AIDS cases, public awareness, medical progress and hope have by and large replaced fear, reproach and mystery about the disease in the American consciousness.

The image of HIV, which can develop into full-blown AIDS, has evolved significantly since June 5, 1981, when the Centers for Disease Control and Prevention noted a deadly form of pneumonia that was affecting gay men.

In the United States, in particular, outreach efforts have helped many understand that being HIV positive is no longer a death sentence. Nonetheless, stigmas and ignorance exist in some communities, dangerous lifestyles are common in others, and AIDS victims still face enormous difficulties.

"It's 20 years into the epidemic. You'd think this wouldn't be going on anymore," said Dr. Perry Halkitis, the director of New York University's Center for HIV/AIDS Educational Studies and Training.

By the mid-1980s, thousands had died from the disease, while many others lived with it despite public persecution and slim prospects for a cure.

The stereotype that AIDS struck only gay men slowly faded. Ryan White, a teenager who acquired the ailment from a blood transfusion, earned acclaim for his public struggle. In 1991, NBA great Magic Johnson revealed he had become HIV positive through heterosexual sex. HIV/AIDS "drug cocktails" improved through the 1990s, as did survival rates. Today, the United States ranks 67th in the world in HIV/AIDS prevalence among adults, with 29 of the top 30 countries located in Africa.

But the disease hasn't gone way. About a million Americans are HIV positive -- about half are unaware they are infected or are unable to get proper treatment -- and 14,000 die from HIV/AIDS annually, according to official reports. After a steady decline, the estimated number of annual new AIDS diagnoses leveled off at slightly more than 40,000 in the late 1990s and early 2000s.

Although African-Americans and gay and bisexual men are most likely to be infected, AIDS affects almost every segment of the population.

"There's still that misperception that people are only at risk for HIV if they're gay or if they use drugs or if they're highly sexually active with multiple partners," said Dr. Ron Valdiserri of the CDC. "The reality is, it only takes one partner to become infected."

Although not considered as much of an imminent threat as it has been previously, AIDS remains a prominent issue. Celebrities, dignitaries and advocates have devoted time and money to educate the public and to help those suffering from the disease, while scientists try to create a vaccine.

"There is nothing more important in this world than this," said actress and activist Ashley Judd. "Nothing."

Blacks, gays at high risk

African-Americans comprised less than 13 percent of the U.S. population in 2002, but half of new AIDS cases that year. And black women were 23 times more likely than white women to contract HIV, while black men were nine times more likely than white men.

Experts say several factors contribute to the discrepancy. In 2002, a quarter of African-Americans were living in poverty, meaning many lack health care and HIV-prevention education. Insufficient medical treatment also contributed to blacks' lower survival rates: Only 55 percent of those infected live another nine years, less than any other racial or ethnic group.

African-Americans also have higher rates of substance abuse and sexually transmitted diseases than the national average. Many are slow to admit or ask about drug use, homosexuality and other issues that put them at high risk for AIDS, the CDC reports.

"We don't have open and honest discussions about the sexuality in our communities, and what we get out of that is people being unable to claim the truth of their lives," said Phil Wilson, director of the Black AIDS Institute.

Condom Grandma
Miriam Schuler, a.k.a. "Condom Grandma," promotes safe sex among the elderly in South Florida.

The homosexual community is another group disproportionately affected by AIDS. In the mid-1980s, half of the gay men in New York and San Francisco, California, were HIV positive. The U.S. gay community took action, with condom use rising and the new infection rate plunging.

Yet that momentum has halted in recent years. HIV diagnoses among the group soared 17 percent between 1999 and 2000, compared with 7.3 percent for all men during that same time. Just less than 15 percent of gay and bisexual African-Americans have the disease.

"Safe-sex fatigue set in, and there was also a rise in complacency in what living with HIV actually meant," said Peter Staley, an AIDS activist who was diagnosed with HIV in 1985. "There are young guys that aren't scared of it anymore."

Young and old affected

Although certain populations face higher risks, AIDS touches everyone from school-age children to people in nursing homes.

People under 25 account for half of new HIV infections in the United States, or about 20,000 annually, according to the CDC. All but a handful of those are 13 or older, this despite extensive AIDS-education efforts in schools and in youth-oriented media, like MTV.

A 2004 Kaiser Family Foundation national poll of 15-to-17-year-olds found a high degree of knowledge about safe-sex methods, and 71 percent of sexually active teens said they use contraception or protection (with condoms the most common option) "all of the time."

"We're the ones that are the most educated, and we're still the ones going out there getting infected all the time," said Lisel Christian, a 20-year-old college student who is HIV positive.

Just more than half of teens reported talking to parents (and one-third to their doctor) about HIV/AIDS. Many teens said they keep to themselves about sex because they felt embarrassed or fearful, a 2002 KFF survey reported. Some students said the media spread mixed messages.

"It's really confusing to know what message you're supposed to believe, because there are people that are maybe, like, 16 years old having sex on TV ... Then they show safe-sex commercials," said Kelly Dearth, a senior at Wheeling Park High School in West Virginia. "It's like, what am I supposed to be doing?"

AIDS is also an issue on the other side of the age spectrum. People are living longer, and drugs like Viagra, Cialis and Levitra have extended the sex lives of people in their 70s, 80s and 90s, said Jolene Mullins of the Broward County, Florida, Health Department.

"We were really brought up in ignorance," said Miriam Schuler, 85, known as the "Condom Grandma" for her safe-sex advocation efforts. "We knew only that if we got married, you use a condom to prevent pregnancy and that's all. We didn't have that terrible disease."

Magic Johnson
Magic Johnson's HIV announcement in 1991 and later good health defied stereotypes the disease struck only gay men and was a death sentence.

Those who are 50 and older make up about 15 percent of all AIDS cases in the South Florida counties of Miami-Dade, Palm Beach and Broward, well above the national average of 11 percent for people in that age group.

Mullins said actual infection rates among seniors are likely much higher, because doctors mistake many early HIV symptoms -- rashes, fevers, weight loss, forgetfulness -- as simply signs of aging.

Fighting complacency

Some fear that inroads against AIDS -- and the sense it is no longer viewed as a medical "emergency" -- may spawn complacency in the United States. Yet HIV/AIDS outreach efforts remain very much in the spotlight.

Television and print public service announcements featuring sports and music stars, and initiatives led by world leaders such as former President Clinton and ex-South African President Nelson Mandela, have emphasized treating and preventing HIV/AIDS. The charitable foundation of Bill Gates -- the world's richest man, according to Forbes -- has given hundreds of millions to AIDS-related efforts.

"If we do this work now, we may save 10, 15 million lives," said actor Richard Gere, who donates $100,000 annually to run an orphanage for HIV-infected children in India. "It gives you a lot of focus. I mean, how many things in your life can you do that have that kind of impact?"

U.S. funding of AIDS-related initiatives has surged from $100 million in 1984 to $18.5 billion in 2004. Under the Bush administration, more funds have been focused on fighting AIDS internationally, with money spent on prevention dropping and research holding steady.

What is the future of AIDS in the United States? This summer, scientists tempered predictions that a vaccine could be a few years away, saying it could take much longer.

"The world is inching towards a vaccine," Seth Berkley, president of the International AIDS Vaccine Initiative, told the Reuters news agency.

In the meantime, outreach efforts continue -- to help those suffering from the disease and to inform the public how to prevent its further spread.

"The day will come when all of us will be asked a question, what did you do?" said Wilson of the Black AIDS Institute. "People were dying, people were getting sick. It didn't have to happen, what did you do?"

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