New York City Reports Plunge in AIDS Fight

WASHINGTON — In what is likely to be a harbinger of a welcome national trend, New York City recorded an unprecedented and unexpectedly sharp decline in AIDS deaths last year, public health officials said Friday.

Mary Ann Chiasson, an official of the New York City department of health, said that after steady increases in mortality that began in 1983, deaths reached 7,000 a year in 1995 and then plunged to 5,000 in 1996, a 29% drop. Officials said they have no solid explanation, although they speculated that the decrease stemmed from a combination of new treatments and an increase in federal funding for services for AIDS patients.

Dr. John Ward, chief of AIDS surveillance for the federal Centers for Disease Control and Prevention, predicted similar declines nationwide when figures become available in February because AIDS-related deaths stabilized in 1995 “for the first time since the epidemic began.”

Dr. Harold Jaffe, an official of the CDC’s AIDS program, called the decline “good news.”

“It suggests that it is part of a national trend,” he said. “The epidemic is changing.”

The information was given to participants at the Fourth Conference on Retroviruses and Opportunistic Infections, a major AIDS meeting taking place here this week.

In Los Angeles County in 1996, AIDS deaths totaled 2,817, down from 3,198 the year before, a 12% drop, according to Paul Simon, deputy director of the Los Angeles County HIV Epidemiology Program.

Simon said that the drop in AIDS deaths “certainly suggests the possibility that the wider availability and use of the new drug treatments are lowering the mortality related to HIV. That’s consistent with what physicians in the community are telling us.”

In other studies presented at the conference, CDC reported that the incidence of AIDS among young people ages 13 to 25 rose nearly 20% from 1990 to 1995, with substantial increases among heterosexuals, women and African Americans.

Nevertheless, CDC described the AIDS increase among youths as “modest” compared with the 200% rise recorded in the same age group from 1985 to 1990.

“For other infectious diseases, people would be very alarmed with a 20% rise,” Ward said. “But not with AIDS.”

Also, in surprising findings, a needle exchange study conducted in Vancouver, Canada, showed a disappointingly high incidence of new infections among intravenous drug users. The issue of needle exchange programs has been politically touchy in this country, where the Clinton administration has been attacked for its refusal to endorse needle exchanges as a prevention strategy, despite studies that have shown it to be effective.

Vancouver researchers stressed that the city does not provide much AIDS education and counseling for drug abusers, which likely would have made a difference in the outcome.

“We support the overwhelming evidence [from other cities] that [needle exchange] works,” said Steffanie Strathdee, an official of the British Columbia city’s program. “However, we believe it is only one part of what needs to be a comprehensive program.”

In the New York City study, researchers said the reasons for the drop in deaths are unclear, since protease inhibitors, the most powerful of the new AIDS drugs, were not even commercially available when the decline began. Adding to the mystery are overall figures for AIDS cases, which do not show a decline comparable to the drop in deaths.

But experts speculated that greater numbers of AIDS patients have begun aggressive combination therapy using other drugs and that treatments have become more available because of the Ryan White Act, approved in 1990 to provide federal assistance to AIDS patients.

“In New York, one major change was a dramatic increase in Ryan White funding, from $44 million in fiscal 1993 to $100 million in fiscal 1994,” Chiasson said. “Now treatment is widely available.”

Starting in 1983, annual AIDS deaths in New York increased sixfold until 1986, and then rose about 11% per year to 19.4 deaths per day in 1994. They leveled off at 19.3 per day in 1995 and began a steady decline in 1996, from 19.5 deaths per day last January to 11.5 in July.

New York City has 16% of the U.S. AIDS caseload.

Nationally, the number of AIDS deaths increased from 42,114 in 1994 to 42,506 in 1995, which is regarded as a leveling-off when adjusted for increases in the U.S. population, Ward said.

The incidence in 1995 was 15.4 deaths per 100,000 people--the same as in 1994, he said.

“This leveling likely reflects several factors, among them improvements in treatment, including an increasing use of drugs to ward off opportunistic infections, which improves survival,” Ward said.

“I would expect that the protease inhibitors and other new therapies coming along would further prolong life and reduce mortality--if the drugs are widely available.”

The CDC report on AIDS incidence showed the disease rising among young people, jumping more than 130% among heterosexuals from 1990 to 1995, while remaining constant among gay and bisexual men and drug users, said Dr. Paul Denning of the CDC. It rose by more than 70% among women and remained steady among men.

In 1995, more than 70% of all AIDS cases among adolescents and young adults were diagnosed among blacks and Latinos, he said.

That year, he said, the rate was almost eight times greater among African Americans than it was for whites and nearly four times greater among Latinos than for whites.

Finally, from 1990 to 1995, the AIDS incidence among young black heterosexual women rose almost 160%, the largest increase among all groups of young people. At the same time, the incidence among young white and bisexual men dropped more than 30%, accounting for the greatest decrease.

In contrast, the incidence increased 26% among young African-American gay men and 32% among Latino gay men, he said.

“Unless public health programs address the prevention needs of adolescents and young adults, the HIV epidemic will continue to spread to subsequent generations of young persons,” Denning said.

Times researcher Tracy Thomas contributed to this story from Los Angeles.