I am haunted lately by the stories of two patients — separated by a quarter of a century, but connected by a common tragedy. Each patient was an elderly woman who succumbed to AIDS in the pursuit of love, neither of them imagining they were at risk.

The first was a married, Hispanic woman who became ill shortly after her elderly Hispanic husband developed tell-tale signs of AIDS. While for years she had suspected that he was bisexual, she, like many people in the early 1980s, believed that AIDS was a disease confined to white gay men. She had felt safe as a Hispanic, heterosexual woman. In 1985 you could still read in the Journal of the American Medical Association: "It is unknown whether heterosexual transmission will ever become important in the epidemiology of AIDS in the United States."

Unfortunately, we soon discovered that heterosexual transmission of HIV — the virus that causes AIDS — would become extremely "important" throughout the world. The Joint United Nations Program on HIV/AIDS estimates that women currently account for one-half of the 33 million people living globally with HIV. In our own backyard, about 31

 
 
percent of all new HIV infections in the U.S. occur through heterosexual transmission, according to the Centers for Disease Control (CDC).

We've also become grimly aware that HIV/AIDS knows no racial boundaries. Nationally, our new HIV infections are occurring

disproportionately within communities of color — about 45 percent in non-Hispanic blacks, and 17 percent in Hispanics.

My second story takes place in 2008. The patient is a 70-year-old white grandmother who, years after divorcing an abusive husband, is surprised to find herself interested in a new relationship. But the man was mature, respectful, kind, financially independent and "the picture of good health." What could possibly go wrong?

Regrettably, she contracted HIV during their courtship. It manifested within an unusually short time frame and left her with severe brain damage. More commonly, it takes an average of at least seven to nine years after acquiring HIV to begin to feel sick or to physically express the infection. In fact, about one quarter of the million Americans who are living with HIV are unaware that they are infected.

It's easy to see how the spread of HIV can be promoted under these conditions. That's why many public health experts advocate habitual safe sex practices and more routine HIV testing. Also, the availability of life-prolonging AIDS treatments makes testing more compelling — assuming one has access to medical care.

The stories of these two women arise in light of a recent publication in the Journal of the American Medical Association. Last month, the CDC reported that it had significantly underestimated the annual rate of new HIV infections occurring within the U.S.

Employing new detection technology, it figured that about 56,300 new HIV infections had occurred in 2006 — and probably in each of the preceding years. That new figure was 40 percent higher than the CDC's prior estimations.

In that new infections are occurring disproportionately in our communities of color, the CDC's upwardly revised estimates of HIV prevalence sound an alarming note. The Black AIDS Institute said that the new data confirmed "what AIDS watchdogs have been saying for years: Black gay and bisexual men and Black women are being devastated by HIV/AIDS. That ugly reality is now indisputable. But what's just as clear is that resources currently dedicated to changing that reality are woefully inadequate and not targeted at the heart of the problem."

It is not surprising that our domestic AIDS epidemic is worse than officials had expected, both in terms of numbers and racial disparities.

From the beginning, the epidemic has been wrongly filtered through shifting public and political views that tried to focus blame or susceptibility on populations of people defined by social and demographic factors.

That ostracized some communities and it made others feel safe. But HIV transmission always transcended those overly-convenient stratifications because it was always about the exchange of drug needles, semen, blood, vaginal fluids and breast milk. All the while we devised prevention strategies, we should have been crossing demographic divides and focusing on these universal risk factors.

In 2006, the CDC revised its recommendations to include routine HIV testing of patients between 13- and 64-years old. And while it's good to expand testing, the recommendations still resort to detection and prevention strategies aimed at yet another demographic.

Behaviors and universal risks, not age, ought to be the focus so that people can understand and legitimately assess their risk. Clearly, Americans are living longer and erectile dysfunction drugs are selling; already, people 50 years of age or older account for nearly 20 percent of all reported HIV cases in the country.

This brings me back to the unsuspecting women in my stories who were left out of the reigning demographic risk profiles of their time and to the upwardly revised data about the sorry scope of our domestic HIV/AIDS epidemic. I wonder how many people might have been spared their HIV infections had they not been under some false impression of safety, swayed by some public message that sacrificed information to politics or ideology.