The New York case has reflected the fractured perspectives about how to combat AIDS in an era when the epidemic has lost some of its urgency.
Once AIDS was a virtual death sentence. Today, with appropriate care and drug treatments, most people in this country with HIV or AIDS live relatively long lives. But the improvement has fed a growing complacency among high-risk populations and the general public.
At the same time, widespread use of crystal meth and its tendency to promote unsafe sex has undermined recent progress -- a message that advocacy groups and health officials have tried to convey with limited success.
The New York case offered a rare megaphone to wake people up. Several health officials and AIDS support groups agreed with the high alert.
"The time to issue a warning is when something bad might take place," said Dr. Ronald Valdiserri, AIDS prevention director for the Centers for Disease Control and Prevention. "I don't think it was counterproductive."
Gay Men's Health Crisis, a major New York service and advocacy group that receives health department funding, was a key participant in the New York announcement.
Frieden "handled the announcement prudently," said George Ayala, who directs an AIDS prevention program for the Gay Men's Health Crisis and AIDS Project Los Angeles.
"We want to be mindful of where the epidemic is going, and use these situations to remind ourselves about the seriousness of HIV and AIDS," Ayala said.
But Matt Foreman, executive director of the National Gay and Lesbian Task Force, said the announcement was irresponsible and had damaged the credibility of the effort to combat AIDS.
"It had a very salacious overtone," Foreman said. "What it did was feed stereotypes about gay men and their sexual behavior.... Another two weeks or three weeks to really understand the science and the implications of these findings would have been appropriate -- not this rush to judgment."
Arthur Caplan, director of the Center for Bioethics at the University of Pennsylvania, faulted the news media for blowing the story out of proportion but said New York officials should not have been surprised by the response and might have squandered their credibility.
"When it comes to HIV, it's fair to say there will be no moderation," Caplan said. "People are poised to panic."
Dr. Jonathan Fielding, L.A. County public health director, agreed but added that it was easy to second-guess the New York researchers.
"It's difficult either way," Fielding said. "You're likely to be criticized if you didn't announce it and there were more cases. People would ask, 'Why did you keep it a secret?' "
