While better medicines are keeping more people with HIV alive, government health officials have failed to "break the back" of the AIDS epidemic by their stated goal of 2005. This is believed to be the first time the 1 million mark has been passed since the height of the epidemic in the 1980s.

New Challenges for Prevention

"While treatment advances have been an obvious godsend to those living with the disease, it presents new challenges for prevention," Dr. Ronald Valdiserri, deputy director of the CDC's National Center for HIV, STD and TB Prevention, said as the National HIV Prevention Conference got under way. Among the challenges is reaching an estimated 25 percent of those with HIV who don't even know they have it.

That, in part, is why the CDC has been unable to fulfill the 2001 pledge made by the agency's Dr. Robert Janssen to "break the back" of the epidemic by cutting in half the estimated 40,000 new HIV infections that have occurred every year since the 1990s.

"It is clear that we have not achieved that goal," Valdiserri said.

However, some critics think the number of new annual infections could be even higher than 40,000.

"It just points out how far we still have to go in really dealing effectively with this in this country," said Terje Anderson, who was diagnosed with HIV eight years ago and AIDS four years ago. He now serves as executive director of the National Association of People Living with AIDS. "Maybe passing the million mark will drive home that this thing is getting bigger and it's not going away."

Abandonment of Safe Sex Practices

Health officials say the prevention failure in part has come from an abandonment of safe sex practices by homosexual and bisexual men -- who account for almost half of HIV cases. Experts think they may be weary of STD prevention messages. The majority of the others infected are high-risk heterosexuals and injection drug users.

"In the earlier days of the AIDS epidemic, we didn't know how to get AIDS under control. I think now we do, but we're watching a textbook case of not implementing a good plan," said Julie Davids, spokeswoman for the Community HIV/AIDS Mobilization Project.

Valdiserri said the CDC still is committed to cutting the new infection rate. One difficulty is that despite increases in routine HIV testing, many people have not been tested.