When it comes to AIDS, the attention is on Africa and other parts of the world. But the epidemic hasn't disappeared from our backyard.

In Sacramento County, an estimated 5,000 people are living with HIV/AIDS. Nationwide, 1.2 million people live with HIV, a larger number than ever before, according to CARES, a Sacramento HIV health care center.

And the face of HIV is changing: Although men who have sex with men are still the largest affected population, other demographic groups are yielding alarming rates.

African Americans make up half of all new AIDS cases. AIDS kills more women than any other disease except cancer and heart disease.

Advances in treatment also have allowed infected people to live longer. And more people older than 50 are becoming HIV-positive, according to the Centers for Disease Control and Prevention. In 2005, older people accounted for 15 percent of new HIV/AIDS diagnoses.

HIV can be managed for years with medication. A study published last week in the journal Lancet showed that because of access to combination drugs, people are living with HIV 13 years longer than a decade ago.

Michael Jentes and Gary Parent are HIV-positive and living longer with the disease than was thought possible 20 years ago.

"The bulb is not as bright as it used to be, and my actions are slower than they were," said Parent, 58. "People have to remember we're in a constant state of infection."

Jentes, 53, lived with HIV for 22 years. His condition has now progressed to AIDS.

Parent is a Vietnam veteran whose partner died of AIDS in 1995.

"I immersed myself in drugs then," Parent said.

In 2003, he became ill and was diagnosed with HIV and hepatitis C. He got clean and became an HIV activist.

Parent said he is grateful to be alive, but acknowledges that life is not easy.

HIV drugs can only suppress the virus and slow down – but not cure – the disease. They often produce side effects that keep patients from leading active lives.

Parent is not healthy enough to hold a job.

Now that people are living longer with HIV, secondary conditions such as cancer and osteoporosis are new concerns. And conditions such as diabetes and high blood pressure are made more likely by certain HIV drugs.

Most HIV-positive patients have onerous drug regimens and take dozens of pills a day. Any lapse may allow the virus to develop resistance.

Research into the new challenges requires continued financial support. Yet federal funding for HIV/AIDS organizations is not keeping up, said Adrienne Rogers, Sacramento County program coordinator at Ryan White CARE.

"They haven't taken into consideration any special needs of special populations," she said.

Primary care doctors cannot treat diabetes, high cholesterol and other secondary conditions in aging HIV/AIDS patients. Medications for HIV and other diseases can counteract one another, so primary care is often left to HIV specialists, Rogers said.

"Also, many of the people we're seeing who have had HIV for 20 years are now in phases of resistance for most of the drugs," she said. These patients require new – often more expensive – drugs.

The need for stronger drugs has helped push up the cost of HIV care by as much as 20 percent a year, Rogers said.

Sacramento HIV/AIDS organizations have had trouble raising funds, and recent county and state government budget cuts will mean fewer preventive services, said Staci Syas, an HIV program coordinator with the Sacramento County health department.

Jentes believes the people who hold the purse strings consider HIV just another disease, like cancer, and forget that it is infectious.

"If we don't keep it under control, it'll spread like wildfire," Jentes said.

Jentes wants a national AIDS strategy, and he has a vision of future HIV education in Sacramento: "Sacramento is the most diverse city in the nation," he said. "If Sacramento can bring the numbers down and become the healthiest city, the rest of California would follow."

Call The Bee's Jane Liaw, (916) 321-1074.