The number of reported HIV cases in Florida has jumped 23 percent so far this year, the biggest increase in a continuing upward trend that began in 2012 after several years of decreases.
And the proportion of Floridians infected with the disease is at its highest in seven years.
Experts say the reasons include a decreased fear of dying from AIDS, subpar attempts at safe-sex education and disease prevention, and increased use of injected drugs such as heroin.
"I think we're a victim of our own success because treatment has been very successful in getting people back to health. A generation of people under 40 haven't really lived with people dropping like flies around them," said Michael Weinstein, president of the AIDS Healthcare Foundation.
When AIDS first began to spread in the 1980s, it was a death sentence. Sufferers lost the ability to fight off other diseases, leaving them susceptible to pneumonia, certain forms of cancer, and other life-threatening illnesses. Today, if the virus is detected early, people can live relatively long lives.
Since hitting a low of 4,512 new HIV cases in 2012, the number of new cases in Florida rose 18 percent in 2013 and 11 percent in 2014.
There are 3,555 new cases so far in 2015, a 23 percent increase from the first six months of 2014 to the first half of this year.
The rate of HIV infection has also been rising in recent years. So far this year, about 35.8 per 100,000 Floridians are infected – the highest since 2008.
According to the U.S. Centers for Disease Control, the annual cost for treating a single case of HIV is more than $25,000. With HIV-positive people now living longer lives, that means the cost over a lifetime can come close to $1 million.
While expensive, gone are the days when treatment required taking fistfuls of pills each day.
"Medications have become more user friendly," said Michael Rajner, a Fort Lauderdale man who has been living with HIV since 1995. "They're not necessarily coming out with new medications, but new combinations and new ways of figuring out how to make taking medications easier.''
Florida taxpayers will spend about $30 million this year on HIV/AIDS, a number that has remained flat since 2012 when HIV cases started going back up. That total includes a supplemental insurance program for HIV/AIDS sufferers, patient care, and money to the regional AIDS networks that coordinate testing and prevention efforts and provide assistance to low-income patients.
That $30 million is in addition to the millions of dollars in prescription drugs given to low-income HIV patients, all of which comes out of the state's prescription drug fund.
It's unclear whether Florida's rising HIV rates are unusual compared to the rest of the country since neither the U.S. Centers for Disease Control or health departments in other populous states have 2015 statistics. But as of 2013, new HIV cases had been decreasing for eight years in California. In Texas, new cases remained relatively flat through 2014.
"The primary reason [for Florida's uptick in HIV] is that there is less affirmative effort around safer sex," said Weinstein. "Prevention funding has been flat or cut, and we still have prohibitions on talking more explicitly about sexuality in sex ed classes … so our overall prevention efforts are very muted, very half-hearted."
The most common way in which the disease is contracted is still through male-to-male sexual contact, according to the state health department. That accounted for 78 percent of all new cases in Florida in 2014, a percentage that has risen significantly since 2012, which keeps with national trends.
The number of new HIV cases contracted by heterosexual sex has also gone up, but as a percentage of all cases it has dipped to about 15 percent from 17 percent in 2013.
An "other" category, which includes people who get the disease through blood transfusions or from birth by an HIV-infected mother, has dropped to almost nothing.
On the other hand, the percentage who contracted HIV from intravenous drug use rose slightly from about 5 to 7 percent in Florida between 2012 and 2014.