As protesters and cops fought on the ground outside Gracie Mansion, the invitees to Bloomberg’s World AIDS Day breakfast looked on calmly. One said she had never seen them bold enough to sneak right up to the building.

“Last year they were outside,” she said. “I don’t know how they got so far inside the gates.”

New York is—again—the epicenter of a new wave of infections that is—again—sweeping the country, according to the Center for Disease Control. The statistics speak to a trend far too complex and widespread for a single mayor to roll back, but they look bad. And public health experts, not to mention AIDS activists, say that HIV/AIDS policy has long been among the weakest of Michael Bloomberg’s public health portfolio.

As he heads into a third term on a slim margin, an ever-louder group of AIDS activists are threatening to undo some of Bloomberg's shining public image on health.

According to Bloomberg’s office, the city’s AIDS statistics have improved under him. The latest Mayor’s Management Report, released in September, pointed to declining numbers of AIDS cases. Between June 2008 and 2009, there were 2,624 new AIDS cases diagnosed in adults. In 2001, when Bloomberg took office, this number was 5,149. And according to the report, more New Yorkers are now connected to HIV/AIDS services, including testing, health care and other support.

But many activists and service providers say the number of new infections is outpacing Bloomberg’s efforts, arguing that he is not trying hard enough to address the increasingly complex problems.

Infections are rising for the first time in years among young men who have sex with men—described that way because many do not identify as gay men, one of the reasons that it is difficult to reach out to them as a group. And 80 percent of new infections are among African-Americans and Hispanics, many of them young black men who have sex with men.

Andrew Resto, an activist who has been HIV-positive since 1985, said he believes Bloomberg needs to take a much more comprehensive approach to dealing with AIDS in the city.

“I think that he’s tremendously effective—if this were 1987,” Resto said. “But this is 2009. I feel like he’s putting in an obligatory 15 percent when it should be 85 percent.”

One of activists’ most common complaints is that while these racial disparities have only become more obvious under Bloomberg, funding has shifted away from the outer boroughs to more white Manhattan. This leaves fewer local services in places like the Bronx, which has the city’s highest rate of infections and deaths from AIDS.

Significantly, one of Bloomberg’s first moves as mayor was to eliminate the citywide office of HIV/AIDS, which had previously coordinated all services. He then appointed Thomas Frieden as health commissioner, whose efforts to increase testing upset many longtime AIDS service providers who worried that he was overriding the standard for informed consent without enough consultation.

Now, Bloomberg faces another wave of criticism for his lack of support for efforts to provide discounted housing for HIV-positive people, a strategy which advocates believe cuts back on new infections, saving lives and costs at public hospitals.

Housing Works, the high-profile advocacy group whose members protested the AIDS day breakfast, says that Bloomberg’s flaws on AIDS are more obvious going into his ninth year than they ever have been.

“It’s rougher than I’ve seen in a long time,” said Kristin Goodwin, the group’s spokeswoman. “We worked to coordinate with the city. Two months later during budget season, he slashed funding. It’s almost patronizing to the community.”

Doctors and service providers who work every day with the Department of Health tend to be more forgiving, noting that unlike Giuliani, Bloomberg appointed a series of top-notch public health officials who speak their language.

“I don’t want to be an apologist for the mayor because I don’t think he’s led us out of this, but he’s stuck where everyone’s stuck,” said Dr. Donna Futterman, the head of the adolescent HIV/AIDS program at Montefiore Medical Center.

Marjorie Hill, the executive director of Gay Men’s Health Crisis, New York’s oldest AIDS advocacy and service organization, said that Bloomberg understands the extent of the crisis and has made important decisions, including the first expansion of syringe-exchange money in a decade. But she and other leaders say that his lack of inspiration is disappointing, especially at a time when New York is in a position to lead the country again.

Bloomberg’s new health commissioner, Thomas Farley, has more experience managing HIV and AIDS than Frieden did, but health workers say he has a tendency to be cautious and low-profile, when big, splashy social marketing campaigns are needed immediately. Hill noted that Bloomberg launched two of these campaigns against smoking, but none so far against HIV.

Meanwhile, the White House held a series of community forums on HIV/AIDS over the past few weeks in an effort to inform a new federal strategy. At the New York meeting in Washington Heights, Council Speaker Christine Quinn looked at dozens of signs raised in silent protest against her and blithely continued with her speech, turning to the federal reps with a recession-based plea.

“We need help from the federal government, particularly on money and funds,” said Quinn. “We need the pie to be bigger.”