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"We’ve clearly experienced a huge victory," Haag states of the recent medical advances. "At AIDS Action, we used to lose a client a day. Now we lose one or two a month. On the other hand, we continue to have a huge percentage of those infected with HIV unaware of their status, and they may be infecting other folks. We need to do something about that."

Fenton puts it more bluntly: "More than one million Americans are living with HIV or AIDS, and more than a quarter of them are unaware of their status," he reports. "For me and everyone here at CDC, the fight to get these people into care is more than professional; it’s personal."

In the gay community, Haight and Goldman agree that the stigma of infection taints social lives; when combined with the prevailing thought that the drugs will save lives at virtually any stage of infection (a theory, the medical community grimly reports, based on very little fact), that taint is likely to cause those who have engaged in unsafe sex to postpone testing.

"I think the world is very cold to people with HIV," Haight says. "I’ve been turned down lots of times for dates because of it. Getting infected or not getting tested merely because you know you can get treated for HIV is not OK. There’s a lot more to it than taking pills and going to the doctor."

"It’s just a private conversation now," Goldman adds. "It’s not something you need to talk about when you first meet someone. And as a result, we’re not talking about it."

Beyond the gay community, HIV and AIDS have taken a massive toll on other minorities - and other countries.

"African American men and women are now the hardest hit," Fenton states. "They represent half of all new HIV diagnoses, and more than a third of the AIDS cases to date." By race, 47% of people living with HIV in the U.S. are black, 34% are white, and roughly 17% are Hispanic.

Goldman highlights a larger issue to which, despite increasing press reports, she claims Americans remain blind.

"This is a huge issue for the developing world," she points out. "Not only Africa, where most of the recent news has been centered... but Russia, the Ukraine, Kiev. There’s, like, 500,000 people infected and 5,000 on treatment. Over there it’s devastating - death and dying all the time. And around the world, this is a disease that is now attacking the very poor."

With dramatic cuts in worldwide funding pandering to the headlines documenting the success of treatments has come a gap in the ability of AIDS organizations to execute.

"We have message fatigue," Haag puts it. "We need to do a better job educating people about this disease, and we have to target our message to those communities hardest hit. In Massachusetts we lost 40% of all HIV funding in the last five years, and almost all of the prevention-based funding was wiped out. We’ve created our own problem."

As financial support crumbles, the medical community is increasingly faced with difficult decisions.

"Doctors are leaving us," Goldman reports. "You have to put in a lot of time with a patient who’s infected with HIV, and our doctors are not getting compensated. You work long hours, you don’t get paid more, and a lot of the patients who are now being infected are incredibly needy, with AIDS one of a litany of issues facing them - including homelessness and other diseases like Hepatitis-C. A lot of doctors are leaving HIV practice because we’ve made it so difficult for them to stay in it."

To these data, HIV experts are now adding a distressing new reality: infections among men who have sex with men have begun trending back up, increasing 8% between 2003 and 2004 across all races. And in the wake of the highly successful battle fought in the late nineties, those struggling against the virus are slowly watching their resources desert.

Next: The road forward»