Posted: December 1, 2005 at 12:40 p.m.

BERKELEY (AP) -- An estimated 150,000 people in California are living with HIV, the largest number since the beginning of the AIDS epidemic, a new analysis shows.

The report from researchers at the University of California, released in conjunction with World AIDS Day on Thursday, indicates new infection rates have decreased from the early years of the epidemic, but the overall pool has grown, from an estimated 108,000 people in 1998 to more than 151,000 now.

One of the reasons for the larger population is better drugs that help people with HIV live longer. But that progress may have blunted prevention efforts; the report indicated more high-risk behavior, including an increase in unprotected sex among men who have sex with men in San Francisco and Los Angeles as well as among clients of the statewide Counseling and Testing Program.

"Our success, paradoxically, is creating new problems for us," said Mark Cloutier, executive director of the San Francisco AIDS Foundation.

Meanwhile, the number of people seeking treatment for drug use associated with higher HIV infection rates has increased as have rates of syphilis infection, a marker for HIV prevalence since nearly 60 percent of people with syphilis also tested positive for HIV, said George Lemp, director of the Universitywide AIDS Research Program.

With the pool of HIV-infected people at its highest level and people living longer, researchers estimate the numbers will continue to increase.

"We're very concerned about the significant increases in higher risk sexual behaviors and also some of the increases that we're seeing in drug-using behaviors that can lead to HIV infection," Lemp said. "There are a number of pieces of evidence in this report that show that all of the indicators are in the wrong direction."

Lemp sees the numbers as "a challenge for California to continue to provide both preventive and health care services for an ever-expanding HIV population. And I think we really have a challenge to try to turn around these indicators."

Cloutier agreed, saying HIV prevention efforts -- besides stressing the importance of using condoms and clean needles -- also should focus increasingly on the root causes of risky behavior. Those range from higher rates of depression and substance addiction among gay and bisexual men to "the misguided sense that if you get infected you can be treated and it's really just a very manageable chronic disease."

The report shows that the effectiveness of current prevention campaigns appears to be waning, Cloutier said. "We need to come up with more targeted campaigns based on people's risk behaviors and their identities."

The report is part of the California HIV Prevention Indicators Project coordinated by the Universitywide AIDS Research Program and funded by the California State Office of AIDS. Data were drawn from a variety of sources, including the California Alcohol and Drug Data System, state and county surveys and the state office of AIDS counseling and testing program.

Among the findings:

• Total federal and state dollars spent for HIV prevention by the state Office of AIDS decreased from $54.8 million in 2002-03 to $47.5 million in 2004-05. The budget is $53.1 million for 2005-06. Looked at in terms of the estimated HIV population, spending decreased from $429 per person with HIV in 2000-01 to $351 per person in 2005-06.
• Blacks comprise about 7 percent of the state population, but account for about 18 percent of people diagnosed with AIDS.
• The annual cost of drugs under the AIDS Drug Assistance Program nearly doubled from $145 million in 2000-01 to $270 million this year.

The report did find one encouraging trend: an apparent decrease in injection drug use and less needle-sharing.

More than 80,000 people with AIDS have died in California since the epidemic began in the 1980s, according to the state Office of AIDS. Nationally, it was estimated that 3.8 per 1,000 people were living with HIV at the end of 2003. The report put the California estimate at about 4.2 per 1,000 today.

Most AIDS cases -- about two-thirds -- have been among men who have sex with men. Also at high risk are injection drug users, people who are transgender and female partners of high-risk groups.

(Copyright 2005 by The Associated Press. All Rights Reserved.)