AIDS Death Rate in U.S. Declines For First Time

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 that the trend is likely to continue, the encouraging numbers do not significantly reflect the growing use by AIDS patients of powerful new drug combinations that include protease inhibitors, which appear likely to extend survival further.

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

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 federal officials stressed that the new 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 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 are upbeat, the patterns varied among gender and 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% among men, deaths among women were up 3%. Also, deaths declined 18% among gay men and 6% among intravenous drug users, but increased 3% 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, director of the CDC. “We must ensure that we reach women and minority communities with effective prevention programs and provide access to quality care.”

The news was not entirely unexpected. Last month, during a major AIDS meeting here, New York City health officials reported a substantial and unprecedented drop of nearly 30% in AIDS deaths there and federal officials predicted that the news was a harbinger of a national trend.

Also Thursday, the 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 in 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%. The Northeast experienced a 15% drop, while the number was 11% in the Midwest and 8% in the South.

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

In more good news, the CDC said that while the number of people diagnosed with AIDS continues to grow, the rate of growth has slowed in recent years. Between 1994 and 1995, the number of people diagnosed increased 2% from 61,200 to 62,200. Between 1993 and 1994, the growth rate was 5%.

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%) 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.

“The bad news is that there is not equal access to the continuum of care people with HIV/AIDS require to remain alive and healthy,” said Christine Lubinski, deputy executive director of AIDS Action Council. “Thus, AIDS continues to ravage communities of color and women--populations which again represent the fastest growing groups of new AIDS cases.”

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. . . . We must remember that every person who is living with HIV or AIDS is someone’s son or daughter, brother or sister, parent or grandparent.”