New CDC report on HIV incidence and demographics in the US

The Centers for Disease Control and Prevention (CDC) has announced new figures on HIV incidence in the United States, revealing that the number of new HIV cases each year is probably about 40% higher than previous CDC estimates indicated.  That means that there are “probably about 225,000 more people living with HIV in the USA than official figures have been reporting,” according to Medical News Today.

According to an Associated Press (AP) report, “The country had roughly 56,300 new HIV infections in 2006 — about a 40 percent increase from the 40,000 annual estimate used for the past dozen years. The new figure is due to a better blood test and new statistical methods, and not a worsening of the epidemic, officials said.”  (Comment:“Officials said” is an understatement.  I’ve looked at the CDC press release, and “officials really, really, really, REALLY emphasize” would be more like it.)

According to the BBC,

[T]he CDC said the rise was due to improved detection methods, rather than an increase in infections.

For the first time, new blood tests can tell how recently an HIV infection occurred, allowing researchers to pinpoint the year it happened.

The increase is also thought to be due to new statistical methods.

The CDC’s Richard Wolitski said the 2006 incidence estimate “reveals that the epidemic is, and has been, worse than previously estimated”.

The group added that the annual number of new infections was never as low as 40,000, and that it has been roughly stable since the late 1990s.

The technology behind the new estimates

According to AP, “The new infection estimate is based on a blood test that for the first time can tell how recently an HIV infection occurred.”  Earlier testing technology “could detect only the presence of HIV,” leaving health workers to guess when an individual became infected.

“The new estimate relies on blood tests from 22 states where health officials have been using a new HIV testing method that can distinguish infections that occurred within the past five months from those that were older,” AP reports.  CDC officials say they will be able to update American HIV stats much more frequently.

David Holdgrave of Johns Hopkins University “likened the new estimate to adding a good speedometer to a car.  Scientists had a good general idea of where the epidemic was going; this provides a better understanding of how fast it’s moving right now.”

Trends and demographics

(Graphs)

According to the CDC press release, the agency also “conducted a separate, historical analysis that provides new insight into HIV incidence trends over time – overall and for specific populations.”  This information shows that in the US the number of new infections each year peaked in the mid-1980s, dropped to a low point in the early ’90s, rose again in the late ’90s, and have stayed about the same since.

The historical analysis showed good news for some groups and bad news for others.  On the positive side, “the new report found that infections are falling among heterosexuals and injection drug users” (AP).  The incidence rate among gay and bisexual men, however, has been rising.

According to the CDC, “The analysis also found that new infections among blacks are at a higher level than any other racial or ethnic group, though they have been roughly stable, with some fluctuation, since the early 1990s.”

Implications for prevention efforts

Targeted prevention:

For some, the new CDC findings seem to herald success.  According to the AP, the declining rates of new infection among heterosexuals and injection drug users are “a tribute to prevention efforts, including nearly 200 syringe exchange programs now operating in 36 states despite a federal ban on funding for such projects.”

(Comment: You can bet the federal government will hear about this — soon, often, and loud.  I’ll tip my hand on this one: I hope Washington will listen and act accordingly.  For more on needle exchange, from a sympathetic perspective, see Avert’s page on HIV Prevention, Harm Reduction, and Injection Drug Use.)

Yet many AIDS advocates “also lamented the CDC’s finding that infections continue to increase in gay and bisexual men, who accounted for more than half of HIV infections in 2006. Also, more than a third of those with HIV are younger than 30.”  Many groups, including the CDC, are calling for more effective prevention strategies targetting men who have sex with men.

A recent report from the Black AIDS Institution has called for a dramatic increase in AIDS prevention efforts among African Americans (see this previous post for more).

“Wake-up call” for funding

While the new numbers might mean different things to different groups, just about everyone seems to see it as a call to action.  Dr. Kevin Fenton, the man who oversees CDC’s prevention efforts for HIV/AIDS, called the new estimates “a wake-up call to scale things up,” according to AP.

Many insist that scaling-up demands more funding.  AP reports:

some advocates complain that CDC’s annual spending on HIV prevention in the United States has been held to roughly $700 million since 2001, while costs have risen. (That’s about 3 percent of what the federal government spends on AIDS; much of the rest is on medicines, health care and research.)

The new estimate is ”evidence of a failure by government and society to do what it takes to control the epidemic,” said Julie Davids, executive director of the Community HIV/AIDS Mobilization Project.

According to Medical News Today,

AIDS Action Deputy Executive Director Ronald Johnson said “The higher estimate of annual new HIV infections does not mean that HIV prevention does not work. What is failing is national leadership to fund and support sound, scientifically effective HIV prevention programs.”

AIDS Action says that federal funding for USA HIV prevention has not kept pace with the epidemic, especially with regards to the crisis of HIV/AIDS among African American and Hispanic communities, as well as among men who have sex with men.

In fact, when adjustments are made for inflation, domestic HIV prevention funding has fallen since 2001.

Organization needed

Some experts and activists stress that while funding is essential, planning is needed too.  Medical News Today reports:

Joseph Interrante, CEO, Nashville CARES in Nashville, TN and Chair of AIDS Action Council’s Board of Directors, said “The revised CDC figure represents an unacceptable level of new HIV infections for a preventable disease. The revised estimate underlines the need for a National AIDS Strategy with measurable outcomes, reliance on evidence-based programs, and sufficient funding. Stopping the spread of HIV and treating all people living with HIV must be a high priority for our leaders and the American public.”

According to the New York Times, the Black AIDS Initiative has noted that, while the US international AIDS effort (PEPFAR) “is guided by a strategic plan, clear benchmarks like the prevention of seven million H.I.V. infections by 2010 and annual progress reports to Congress,” there is no similar plan in place for dealing with HIV/AIDS within the country.

Program specifics

Beyond calls for more funding and planning, various groups have already begun using the new HIV incidence estimates in calling for support of specific programs.  According to Medical News Today, the American NGO AIDS Action said:

“Federal law blocks federal funding for syringe exchange programs, which the scientific literature has demonstrated clearly as an effective HIV prevention tool. Support for comprehensive sex education that helps keep young people healthy is neglected while the current administration supports pouring millions of dollars into abstinence-only programs that have been proven to be ineffective.”

(Just in case you were worried that the CDC report wouldn’t breed controversy!)

Conclusion

I’m sure we’ll be hearing a lot more about this in the future.  This week is bound to be an interesting one: new UNAIDS and CDC data to process, plus the World AIDS Conference.  (I may need a vacation from blogging after this!)

One tantalizing hint of what I think is probably coming: the new CDC estimates were controversial long before they even came out, as a lot of people think they should have been released much sooner.  Meanwhile, there’s apparently some question about why the new estimates from the CDC didn’t make it into the UNAIDS 2008 Report.  Hmmm.  More on that later.

CDC Resources

>> HIV Incidence (Main Page) (Summary, and links to more info.)

>> Newsroom (Links to press release and other info sources.)

>> CDC Fact Sheet: Estimates of New HIV Infections in the United States (Six-page PDF: useful summary of key findings.)  

 

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~ by h.e.g. on August 3, 2008.

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