WHILE the number of new cases of HIV/Aids is falling in Bermuda, Aids remains a leading cause of death for African-Americans between the ages of 25 and 44, and among the top three causes of death for black women aged 35 to 44 in the US.

Deputy Chief Medical Officer Dr. Brenda Davidson reported that, in Bermuda, there were only three deaths attributed to Aids in 2004, a dramatic reduction from 14 in 2002, and ten in 2003. However, black Bermudians remain disproportionately afflicted by HIV and Aids.

"Black Bermudians have been diagnosed with just over 90 per cent of the new cases of Aids and 88 per cent of new cases of HIV infection," said Dr. Davidson.

"The trend has improved slightly, and education has meant that everyone should be aware of the danger, but there is a concern that the arrival of new and very effective treatments may reduce the 'fear factor' slightly. Some people may think that it is a more manageable condition, rather than a death sentence.

"A large group of people get free HIV treatment because they don't have insurance," advised Dr. Davidson. "Those who do have insurance will find that their insurers will pay for 80 per cent of the cost of their medication, and the balance is taken up by Government."

Although the relatively expensive drug "cocktail" is affordable here in affluent Bermuda, and these anti-retroviral treatments help prolong life, the cumulative statistics are a reminder that HIV/Aids is incurable and deadly. Of the 544 cumulative diagnoses of HIV through 2004, including 11 new cases last year, 492 have developed to "full-blown" Aids, including five new cases last year, and 390 of those cases have died, including the three last year.

Given the lengthy incubation period, and perhaps some reluctance to be tested, the largest number of HIV cases are diagnosed in people in their middle years: 45 per cent of cumulative diagnoses have been found in people aged 30-39, 25 per cent in those aged 40-49, and only 17 per cent in the 20-29 age group.

Cumulatively, 89 per cent of all cases have been diagnosed in blacks, and 75 per cent of all cases were male. In terms of risk factors, 33 per cent of cases were reported in homosexuals or bisexuals, 32 per cent among intravenous drug users, and 28 per cent in heterosexuals.

Of the 492 people who developed Aids, the distribution is almost identical to HIV in terms of age group, race, and gender, except that 39 per cent of the 390 who have died were intravenous drug users, compared to 29 per cent homosexual or bisexual, and 26 per cent heterosexual. Six per cent were reported to have died in some "other" category.

If HIV/Aids appears to be in decline in Bermuda, communities across the US marked National Black Aids Day last week by reporting a deteriorating situation: between 2000 and 2003, African-Americans made up more than half of all new HIV diagnoses in 32 states, although African-Americans made up only 13 per cent of the population of these states.

Black males had an HIV/Aids rate nearly seven times higher than white men, and homosexuals accounted for 49 per cent of new HIV diagnoses among black men during the period. Nation-wide, according to an editorial in the Detroit Free Press, "perhaps 30 per cent of all young, gay black men are infected. Still, media interest has waned and Aids funding has dropped."

According to a report by the Centres For Disease Control and Prevention (CDC), in 2003 the rate of new Aids cases for black women was "20 times that of white women and five times greater then the infection rate for Latinas. Black and Hispanic women accounted for 77 per cent of all new Aids infections in 1994, but nine years later, the rate was 85 per cent."

The Washington Post's Darryl Fears reported that epidemiologists attribute these developments to socio-economic and demographic conditions specific to many African-American communities.

"Black neighbourhoods, they say, are more likely to be plagued by joblessness, poverty, drug use and a high ratio of women to men, a significant proportion of whom cycle in and out of a prison system where the rate of HIV infection is estimated to be as much as ten times higher than the general population."

Debra Frazer-Howze, founding president and CEO of the National Black Leadership Commission on Aids, said that the result for black women had been devastating.

"We should be very afraid," she said, "and we should be planning. What are we going to do when these women get sick? Most of these women don't even know they're HIV-positive. What are we going to do with these children? When women get sick, there is no one left to take care of the family."

Ms Frazer-Howze, a former member of the President's Advisory Council on HIV/Aids under President Clinton, said the number of health facilities in black communities was inadequate when compared with the growing size of the problem.

"Reducing HIV infections among black women will involve more than appeals to avoid risky behaviour, asking women to remain abstinent and passing out condoms," said Adaora Adimora, an associate professor of medicine and an adjunct professor of epidemiology at the University of North Carolina at Chapel Hill. "You also have to eliminate the economic factors that dramatically influence behaviour, disease and risk."

Living conditions were "critically important" to fuelling the spread of the disease, she said, and communities influenced "social networks, partner choices, likelihood of marriage, and types of risk behaviours, as well as their consequences".

Ms Frazer-Howze said her web site "abounded with stories" about women who were infected by husbands who were also having gay relationships.

Black gay rights activists in the US have said that men are more likely to hide their sexual orientation because the stigma against homosexuality is strong in black communities, particularly in the church.

A study by the Pew Forum on Religion and Public Life showed that, since 2000, black Protestants have become much less likely than other Protestant groups to believe that gays should have equal rights. Black Protestant support for gay rights dropped to 40 per cent last year, down from 65 per cent in 1996, and 59 per cent in 1992.

A recent study by Rand Corporation and Oregon State University found that nearly half of all African-Americans, almost regardless of age and income, believe that Aids is a man-made disease, and many believe it was designed by the government to decimate their communities.

The study attributed the belief, in part, to the Tuskegee experiment, in which the US government studied the progression of syphilis in a group of black men between 1932 and 1972 while withholding treatment without their knowledge.

Other studies show that most African-Americans with Aids fall below the poverty line and many believe that there is a cure but the government is withholding it from the black community.