More Americans than ever before are living with HIV, according to the latest government estimates, reflecting both the efficacy of drug therapy and a failure to make a dent in the rate of new infections.

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Though the rate of infection appears to be relatively stable and may actually be decreasing among African-American women, researchers say they see some troubling evidence that rates are actually rising among young gay men and, in particular, young gay black men.

"We are encouraged by our collective successes and challenged by the continuing severity of this epidemic," said Dr. Ronald Valdiserri, deputy director of the CDC's National Center for HIV, STD and TB Prevention.

Between 1,039,000 and 1,185,000 Americans with HIV were living as of December 2003, the CDC's Dr. Kate Glynn reported yesterday at the National HIV Prevention Conference in Atlanta. That's up from an estimated 850,000 to 950,000 at the end of 2000.

Part of that increase can be attributed to people with HIV living longer, thanks to antiretroviral drug therapies, Glynn said. Infections that once proceeded rapidly to AIDS and resulted in almost certain death now are being managed almost like a chronic disease.

But that poses new challenges in addressing the epidemic, she emphasized. Longer lives mean greater opportunity to spread the virus, a particular concern because one out of four people with HIV isn't aware of it.

"Because it is perceived as a chronic disease, people aren't being tested like they should be tested," said David Zazac, a spokesman for the Allegheny County Health Department.

Indeed, fewer people at risk for the disease are bothering to get tested. Dr. Joseph Inungu of the Central Michigan University School of Health Sciences said a national survey of more than 31,000 adults in 2002 found that only 12 percent sought out HIV testing, compared with 34 percent four years earlier.

More people -- 14 percent -- learned their HIV status because of mandatory testing for employment, military recruitment or other programs than sought testing on their own, he noted.

Many people just don't consider HIV to be much of a threat, Inungu said, "and that is a scary thought."

Though better treatment is keeping more Americans with HIV alive, the increase in the number of people with HIV also reflects a failure to reduce the rate of new infections. In 2001, the CDC and other health groups had high hopes that this was possible, setting a goal of cutting the rate in half by this year.

"It is clear we have not achieved that goal," Valdiserri acknowledged yesterday. "We're making progress, but I don't want to minimize the fact that we haven't halved the rate."

The CDC estimates that the overall rate of infection is relatively stable, with about 40,000 new cases reported each year.

The CDC's Dr. Maria Rangel said HIV diagnoses among women declined about 20 percent from 1994 to 2003. The rate for men dropped 30 percent from 1994 to 1998, she noted, but then the rate jumped by 41 percent from 1999 to 2003.

The increases among men were driven by a 47 percent increase among gay men ages 20 to 24. Black men were particularly hard hit, representing 60 percent of the cases for all young gay men.

"I can't express the outrage and concern I have for black gay men in this country," said Gary English, executive director of Brooklyn-based People of Color in Crisis Inc.

Valdiserri said the increases among young gay men underscores the need to continue to educate each generation about the risks of HIV and ways to prevent infections.

"Prevention is not a one-shot deal," he added.

"There is always a concern about complacency," said Charles Rinaldo, an infectious disease specialist at the University of Pittsburgh Graduate School of Public Health and the head of the Pittsburgh arm of the four-city Multicenter AIDS Cohort Study.

The study, which tracks HIV prevalence in a population of gay men, was expanded two years ago to include more young men, including black men, he noted, but relatively few of those new recruits have thus far tested positive for HIV.

Though HIV/AIDS once was considered primarily a disease of gay, white men, the latest findings show that it now strikes hardest among African-Americans. The figures for 2003 showed 47 percent of Americans with HIV were black, while whites accounted for 34 percent and Hispanics 17 percent.

In Allegheny County, 881 cases of HIV have been reported since June 1, 2001; of those, 44 percent were in African-Americans and 52 percent were white.

Overall, three out of four Americans with HIV were male, and gay men continue to bear the brunt of the disease. Men who have sex with men accounted for 45 percent of those living with HIV, while those infected through high-risk heterosexual sex comprised 27 percent and those infected through injectable drug use accounted for 22 percent.

In Allegheny County, 51 percent of the cases involved male-with-male sex, 24 percent heterosexual contact and 14 percent injectable drugs.