HIV/AIDS continued to shrink in the public eye, which was both a good and a bad thing. On the one hand, it marked a further destigmatization and normalization of the disease, while on the other, it seems to have led to a complacency that has brought a lapsing of safer-sex practices, the possibility of increased numbers of new infections, and a more difficult struggle to obtain the resources necessary to combat the epidemic.
Public health officials in several cities and at the U.S. Centers for Disease Control point to the rise in sexually transmitted diseases among gay men as fueling their concern that a new wave of HIV infections is about to hit that community. The issue is controversial because data is incomplete, often tangential, and lags months or even years behind when the sex actually occurs.
But gays aren't the only ones who seem to be having more risky sex. One study released at the end of the year showed that only 39 percent of the 145 HIV-serodiscordant heterosexual couples interviewed, where one is infected with HIV and the other is not, said that they used condoms all the time.
There was initial public confusion as to whether or not the newly inaugurated Bush administration would retain the position known as the "AIDS czar." That ended in April when Scott Evertz became the first openly gay man to head up the Office of National AIDS Policy. He has kept a low profile, but program funding levels continue to increase, though perhaps not fast enough to meet the need.
The treatment philosophy of "hit it early, hit it hard," adopted with the introduction of protease inhibitors in the mid-1990s, was all but laid to rest with the February revision of federal treatment guidelines. There seems to be little additional benefit from beginning therapy earlier, while side effects such as lipodystrophy seem to correspond with use over time and the total cumulative exposure to particular drugs.
These toxicities encouraged the NIH's Tony Fauci to conduct a small pilot trial cycling patients on and off therapy. He found the cycle controlled the virus just as well as continuous therapy, while exposing the patient to only half the amount of drugs.
Much of the media attention devoted to AIDS focused on the developing world, particularly the struggle to introduce therapy on a broad basis in South Africa and the issue of pricing by pharmaceutical companies.
The UN Special Session on HIV/AIDS in June created guidelines for a $10 billion program to address AIDS in poorer nations. But only a small portion of that money has been committed by the wealthier nations, and now slumping economies and the demands of fighting terrorism makes the commitment of greater resources highly unlikely.
The pharmaceutical companies have slashed prices overseas and allowed licensing for local manufacture of some drugs. Still, therapy is available only on a very limited basis, in part because of the limited healthcare infrastructure necessary to use those drugs safely and effectively.
By the end of the year China had begun to admit the scope of the epidemic within its borders and take action. Evidence also indicates tha the plague is growing rapidly in Eastern Europe.