DROP IN HIV DIAGNOSES DECEIVING

The number of persons diagnosed with HIV last year plunged to the lowest
level in British Columbia since 1985, but the drop in new infections is
deceiving, say worried epidemiologists.

It may mean only that there is a temporary shortage of vulnerable people
left to infect.

At first glance, new 1998 statistics from the B.C. Centre for Disease
Control show a remarkable turnaround -- a killer beaten into retreat after
millions were spent on medical research, public awareness and initiatives
such as the needle-exchange program.

The 482 who tested positive for HIV in 1998 is fewer than any time since
1985, and far below the peak year of 1987, when 929 positive tests were
recorded.

Companion statistics from the provincial health ministry show there have
also been fewer deaths from the virus. Deaths from AIDS and HIV infection
fell from 250 in 1996 to 108 in 1998, according to unofficial year end figures.

The drop in the death toll is the result of the effectiveness of newer
antiretroviral drugs, researchers say.

But the drop in new infections has a darker side.

"I think this is the epidemic burning itself out," says Dr. Patricia Daly,
director of communicable disease control for the Vancouver Richmond Health
Board. "It's what we call reaching about [the] saturation point."

Dr. David Patrick, who helped compile the statistics as associate director
for the disease control centre, agrees, likening the epidemic to a fire.

"The fuel is susceptible people at high risk," he says. "And once you burn
through the fuel, whether or not you're doing anything active or that's
actually working to douse the flames, you'll see the number of new
infections come down."

This seems true of intravenous drug users. They are the most vulnerable
group in the province to new infection because they share needles. Still,
their rate of infection has dropped in the past two years.

The province spends more than $7 million annually on needle exchange and
education programs for that group, but there's no clear evidence that they
contributed to the decline.

Perhaps expanded needle exchange programs, new services and street-level
education contributed to the decline, says Patrick. "But the truth of the
matter is that you probably would have seen a decline anyway."

Indeed the decline in injection drugs users testing positive was projected
early in a study by researchers at the B.C. Centre for Excellence in
HIV/AIDS at St. Paul's Hospital, says Dr. Martin Schechter.

"It's no comfort," Schechter says of the decline.

Young people especially are adding to the pool of injection drug users, he
says. "As soon as there is that critical number of high risk people again,
then there will be another outbreak."

Schechter, a University of B.C. professor of epidemiology, says the natural
decline of any epidemic doesn't negate measures like needle-exchange and
education programs.

Without such programs, "it's entirely plausible that the epidemic would have
been much larger," he says. "We can't know that, it's an experiment you
cannot undertake."

He notes that the incidence of newly infected homosexual males has been in
decline virtually since 1988. Part of that was the epidemic passing its
peak, but education and safer sex practices played a role, he says.

Heterosexuals are the only group in B.C. in which infections are increasing,
the disease control study found. Last year, a record 89 men and women
contracted HIV from heterosexual contact.

Part of this is explained by men who contract HIV from infected prostitutes,
or women infected by drug-addicted males, researchers say.

The study hints at a looming crisis. While new cases of HIV are declining,
the infected population has never been higher, says the health board's Daly.

She estimates the number of people locally with HIV at between 3,000 and
5,000. Statistics Canada estimates the national number of HIV infections at
54,000.

Drug treatments have extended the lives of those infected, but no one knows
for how long. "They're going to require a lot of health services," she warns.

"We're kind of in a honeymoon period right now because we're really seeing
the benefits of these drugs," agrees Schechter. "If we don't see new classes
of drugs coming along fairly soon, then there's a lot of anxiety that this
bubble is going to burst."