Karin Mongeon, North Dakota's AIDS program manager, said the state must step up efforts to fight the disease, given changing attitudes and a growing methamphetamine problem. "When you look at what we are doing here, we are behind other states," she said.

The state has the lowest number of HIV/AIDS cases per capita in the country, with 312 cases and 117 deaths reported over the last 18 years. An average of 17 new cases are reported annually.

North Dakota receives more than $1 million per year for prevention and surveillance from the federal government. One- fourth of the money goes for housing and medical assistance for low-income patients. Surveillance receives $60,000, including testing and partner identification, while $727,002 per year pays for prevention including advertisements, a Web site and a toll- free information line. A prevention-planning group works with the state to allocate the prevention budget. The group includes gay men, heterosexuals, people with HIV/AIDS and state-level prevention workers.

Complacency due to new drug therapy, coupled with conservative attitudes and inadequate funding, cripple aggressive efforts to stem the spread of the virus, according to Mongeon and Stephen McDonough, state epidemiologist.

Another concern for health officials is a possible increase in AIDS cases due to a rise in methamphetamine use. In the last five years, according to state data, there was a 7 percent increase in the number of people infected with HIV/AIDS because of intravenous drug use.

"As far as education, we have a long way to go," said Steve Wagendorf, an HIV-positive man on the state's prevention board. "People still think you can catch it by being in the same room, and it's simply because they haven't been affected by it. Unless they come up with a cure or vaccine, everyone someday is going to be affected by it."

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