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Lovers, brothers and sons. They were dying by the week just two decades ago as the AIDS epidemic swept Sonoma County.

AIDS, first identified in the United States in 1981, was unsparing. In 1990 in Sonoma County, the disease killed 106 people -- virtually all gay men -- a death rate of two a week.

"It was devastation," said Robert Kavanagh of Santa Rosa, who was diagnosed in 1995 with HIV, the virus that causes the illness.

Today, the landscape of HIV/AIDS has changed significantly. Refined treatment methods and the arrival of new medications have transformed what was a terminal diagnosis into one that far more often augurs a chronic illness.

"It was a death sentence," said David Coppini, 55, of Petaluma, who was diagnosed in 1987.

After years of "having drugs thrown" at him, and having developed resistance to them all, he was near death as recently as five years ago, he said.

Then, new medications saved his life.

Now, said the Penngrove native, "I'm really proud of myself for being a longterm survivor and productive." He has just become certified to provide HIV testing.

The data tell a striking story of despair turning into hope, to the point where those with the illness are commonly referred to as "people living with HIV or AIDS" rather than "victims."

From 1981 through 2010, 2,141 confirmed cases of AIDS were diagnosed in the county. Of those, more than half, or 1,198, have died, according to county Department of Health Services statistics.

But of the 1,198 deaths, 1,025 -- or 85 percent -- took place before 2000, indicating the degree to which the death rate has slowed.

In the past 12 years, just 173 confirmed AIDS deaths have taken place in the county.

Compare that with 106 AIDS-related deaths in 1995 alone. That was the year protease inhibitors became available, the first drugs found to effectively treat HIV.

In 2000, deaths had fallen to 27. In 2005, there were 22. In 2010, there were 10.

"If you're on medication, many people, most people, are living productive, independent, healthy lives," said Rick Dean, executive director of Face to Face, a nonprofit offering people with HIV or AIDS services from housing assistance to counseling.

That development has changed the way medical professionals, advocates and service providers approach their work.

"Back then, it was about quality of life, but it was the end of their life. Now it's quality of life issues that are going to be sustained," Dean said.

"It's how do we get this person housed so they can take care of themselves and be independent and live with HIV, whereas before it was about how do we find this person a skilled nursing facility for the end of their life?"

At the Santa Rosa Community Health Centers, Lead HIV Clinician Danny Toub said, "Instead of HIV care being focused in hospitals and hospices like it was in the 1980s, in 2012 HIV care occurs mostly in outpatient clinics, helping people live long healthy lives."

In other ways, though, severe challenges remain.

AIDS has greatly broadened its reach beyond gay or bisexual men, although in Sonoma County they remain by far the largest group of people with the illness. Of that group, young men are at particular risk.

In the county, AIDS also now regularly affects intravenous drug users, foreign-born Latino men and heterosexual women, including an increasing number of Latinas.

Perhaps most important, an estimated 20 percent to 25 percent of the national population of people with HIV or AIDS is infected without knowing it.

In Sonoma County, an estimated 2,000 residents have HIV/AIDS, of which an estimated 400 to 500 are unknowingly infected, said Mark Netherda, the county's deputy health officer.

Those in the HIV/AIDS health care field consider it a priority to reach those who don't know they are carrying the virus, a group whom Sonoma County insiders sometimes refer to as "The 500."

"I think it's one of the key pieces," said Netherda, a former HIV/AIDS practitioner. "Those people have been out there in the community for anywhere from zero to 10 years not knowing they're infected."

Experts believe that those carriers produce about 75 percent of the new HIV/AIDS cases each year.

Since 2004, Sonoma County has recorded 40 to 45 new cases a year, Netherda said. Though the number dipped in 2010 to 27, preliminary data for 2011 again shows 40 new cases.

Another priority, say those who deal with the illness as patients, practitioners or advocates, is to lessen the shame associated with AIDS.

"There's still this huge stigma attached to it," Coppini said. "Even within our (gay) community, we who are positive are stigmatized."

A belief that HIV is transmitted easily through non-sexual means contributes to that stigma, said Enrique Gonzalez-Mendez, a family medicine doctor and chairman of the Latino Health Forum.

"It's, 'If you have HIV, I'm not sure I want you to hold my baby, or come to my house and eat at my table,' " he said. "It's very sad."

Such feelings are more than a mere hindrance, Netherda said. They are an obstacle that makes some reluctant to seek medical care or even to be tested for HIV.

"I think if we're ever going to get rid of this thing, we have to get rid of the stigma that surrounds it," said Netherda. "People are afraid to get tested. People are afraid to talk about it."

You can reach Staff Writer Jeremy Hay at 521-5212 or jeremy.hay@pressdemocrat.com.

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