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For First Time in 16 Years, AIDS Deaths Decline in U.S.

By Marlene Cimons
Los Angeles Times

For the first time since the AIDS epidemic began in the United States 16 years ago, deaths from the disease have declined nationwide, federal health officials reported Thursday.

And in a sign the trend will continue, the encouraging numbers do not significantly reflect the growing use by AIDS patients of powerful new drug combinations that include protease inhibitors, which will likely further extend survival.

Deaths among people with AIDS dropped 13 percent during the first six months of 1996, compared with the same period the previous year, according to the federal Centers for Disease Control.

Health officials attributed the reduction to increased resources devoted to treatment and prevention, particularly in improved therapies designed to stave off often life-threatening AIDS-related infections.

The news was not entirely unexpected. Last month, during a major AIDS meeting, New York City health officials reported a substantial and unprecedented drop of nearly 30 percent in AIDS deaths there, and federal officials predicted this was a harbinger of a national trend that would soon become apparent when the latest figures became available in late February.

The federal officials stressed that the trends should not cause complacency among the public.

"We're finally seeing deaths go down, but it's not good enough," Health and Human Services Secretary Donna E. Shalala said. "Too many people are still dying, and too many people are still getting infected. The new drugs don't work for everyone. We must still focus on prevention."

While the overall numbers were upbeat, the patterns varied among gender, racial groups and risk groups, with some not faring as well as others. "The numbers are shifting to our most vulnerable people," Shalala said.

For example, while the number of AIDS deaths declined 15 percent among men, deaths among women were up 3 percent. Also, deaths declined 18 percent among gay men and 6 percent among intravenous drug users, but increased 3 percent among those who had become infected through heterosexual contact.

"We have made a great deal of progress in both prevention and treatment of AIDS, but declines have not yet been seen in all people," said Dr. David Satcher, the director of CDC. "We must ensure we reach women and minority communities with effective prevention programs, and provide access to quality care."

Also Thursday, HHS said it would release an additional $202 million in funds under the Ryan White Comprehensive AIDS Resources Emergency Act, which provides resources for treatment of people with HIV and AIDS.

Many local health officials have credited the drop in AIDS deaths to funding increases in this program that have made therapy and health care services more accessible.

The CDC reported that AIDS deaths increased steadily through 1994, but increased only slightly in 1995, which was viewed as a leveling off when adjusted for increases in the population.

During January through June 1996, there were an estimated 22,000 deaths, compared with 24,900 reported during the same time frame in 1995.

Deaths declined in all four regions in the United States, with the West experiencing the greatest drop, 16 percent. The Northeast experienced a 15 percent drop, while the number was 11 percent in the Midwest and 8 percent in the South.

The number of AIDS deaths declined among all racial/ethnic groups. The drop was greater among whites (21 percent), than among blacks (2 percent) or Latinos (10 percent).

The CDC also reported that while the number of people diagnosed with AIDS continued to grow, the rate of growth has slowed in recent years. Between 1994-1995, the number of people diagnosed increased 2 percent from 61,200 to 62,200. Between 1993 and 1994, the growth rate was 5 percent.

If these trends continue, "hopefully, with a combined strategy to prevent new infections and to provide early diagnosis and treatment for people who are infected, AIDS incidence will soon begin to decline," CDC said.

But, as with deaths, the incidence numbers were not all positive. In 1996, for the first time, blacks accounted for a larger proportion of AIDS cases (41 percent) than whites, and the proportion of female AIDS cases continued to increase. In 1996, women made up one-fifth of the newly reported cases of AIDS.

Most AIDS organizations, while lauding the decrease in deaths, described the trends as a mixed blessing.

President Clinton hailed the CDC report as "further evidence that this terrible epidemic is beginning to yield to our sustained national public health investment in AIDS research, prevention and care." But, he added, "We must not relax our efforts."