The American public is justifiably celebrating the recent good news
that opportunistic illnesses and deaths related to acquired immunodeficiency
syndrome (AIDS) declined nationwide in 1996 for the first time since the pandemic
began more than 15 years ago.1 These trends
reflect advances in opportunistic infection prophylaxis and highly active
antiretroviral therapy and interventions to prevent transmission of human
immunodeficiency virus (HIV) infection. Published guidelines have provided
thoughtful distillations of complex research results for widespread clinical
Despite this, some population groups have not benefited from the new therapies.
In fact, increased incidences of AIDS-related opportunistic illnesses in 1996
were experienced by black and Hispanic men and women with heterosexual exposures.1 The disparity in opportunistic infection trends between
population groups most likely reflects differences in access to the full range
of new therapies now available.7 Barriers to
access are depriving many patients with HIV infection of life-extending health
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