STUDY: AIDS AMONG MEN DROPS SHARPLY IN 4 CITIES

SAN FRANCISCO -- AIDS infection rates have dropped sharply among homosexual
and bisexual men in at least four U.S. cities, representing a potential
turning point in the epidemic's course, according to a study released
Wednesday.

"The levels are still extremely high. But basically we are at a kind of
turning point," Joseph Catania of the University of California at San
Francisco said before presenting his findings to the American Public Health
Association in Washington.

Catania's study found that, among a sample of about 2,800 gay and bisexual
men in San Francisco, Los Angeles, New York and Chicago, the prevalence of
the HIV virus was an average 17 percent -- down from estimated highs of as
much as 50 percent in the mid-1980s.

"Assuming the HIV infection rates in the mid-'80s were similar across these
cities, we conclude that HIV prevalence rates have declined 60 to 70
percent," Catania said. The prevalence rate represents the percentage of a
given population infected with the virus.

Behind the apparently good news were two grim facts, Catania said.

One was that the decrease in HIV cases could be attributed in large part to
the huge toll that AIDS has taken among gay and bisexual men -- many of
those who were once infecting others are dead.

The other, he said, was that the drop was not the same for all gay and
bisexual men. In some subgroups of men, HIV prevalence remained shockingly
high, particularly for minorities, intravenous drug users and heavy users
of drugs and alcohol.

"Their rates are still higher than anything else in the world," Catania
said, noting that gays and bisexuals would continue to number among AIDS'
chief targets.

"What has basically happened is that the situation has gone from the brink
of extinction to one that is just tragic."

The UCSF study was the first to focus solely on "men who have sex with men"
(MSMs) both inside and outside the self-identified gay community.

Mirroring earlier studies, it found that race, education, and socioeconomic
status played a big part in AIDS awareness and access to treatment.

But overall, the prevalence rates are down.

Catania attributed the drop in part to intense prevention work in the gay
and bisexual community.

But death has also played a part, he said. Among the estimated 26,000
people diagnosed with AIDS in San Francisco between 1983 and 1997, about
18,000 have died -- a mortality rate of nearly 70 percent, he said.

The advent of "cocktail" drug therapies that greatly cut AIDS mortality
rates could lead to an uptick in overall prevalence in coming years,
Catania said.

But the real challenge is reaching groups of homosexuals who live outside
the traditional gay community or in specific minority groups, Catania said.
While AIDS prevalence among white gay and bisexual men was 16 percent, it
was 29 percent for blacks, 18 percent for Hispanics and 24 percent for
American Indians.

The HIV infection rate was also alarmingly high for homosexuals who use
drugs: 44 percent for intravenous drug users, and between 22 percent and 33
percent for users of illegal, but non-intravenous, drugs.