Based on new testing methods, the CDC says there are actually about 56,300 new infections a year -- not 40,000 -- and that rate has been fairly constant for a decade.
By Thomas H. Maugh II
Los Angeles Times
August 3, 2008
Federal officials have been underestimating the number of new HIV infections
in the United States by 40% every year for more than a decade, a finding that
indicates the U.S. epidemic is much worse than thought, researchers said
Saturday.
Using sophisticated testing to identify new infections, the Centers for
Disease Control and Prevention concluded that there are about 56,300 new
infections each year, not the 40,000 figure that has been gospel for so long.
The new numbers do not mean that the epidemic is growing in this country, just
that researchers have been able to provide more accurate estimates, said Dr.
Kevin Fenton, director of the CDC's National Center for HIV/AIDS, Viral
Hepatitis, STD and TB Prevention. He said the number of new infections has
remained relatively constant since the late 1990s.
Still, the higher estimates were a jarring reminder that the United States,
while castigating prevention efforts in much of the world, has not been able
to get a firm grip on its own problems.
The new numbers "reveal that the U.S. epidemic is -- and has been -- worse
than previously estimated and serve as a wake-up call for all Americans," said
Richard Wolitski, acting director of the division of HIV/AIDS prevention at
the national center.
"With more people living with HIV than ever before, there are more
opportunities for transmission," and the need for prevention has never been
greater, he said.
Michael Weinstein, president of the AIDS Healthcare Foundation, called the new
figures "a scathing indictment of how profoundly U.S. and CDC HIV prevention
efforts have failed."
"There is absolutely no good news here. Without an accurate picture of the
epidemic, vastly underestimated for the last 10 years, we have missed
countless opportunities to intervene with effective public health strategies,"
he said.
While the epidemic has remained stable for most of this decade, the new
figures confirm that the brunt of the epidemic is being borne by gay men and
young African Americans and Latinos. There have been small declines among
heterosexuals and injectable-drug users.
Gay men accounted for 53% of new infections in 2006, the most recent year for
which data are available. The infection rate among blacks was seven times that
among whites, and the rate among Latinos was nearly three times as high.
Fenton said blacks are more disproportionately affected than any other racial
or ethnic group in the country. In fact, he said, gay and bisexual black men
"are one of the most severely impacted groups in the world."
He attributed the increase in this group to poverty, lack of access to
healthcare, substance abuse, incarceration and a rise in other sexually
transmitted diseases.
"If you are a young, gay black man, the likelihood that you will encounter HIV
is staggeringly high, even if your personal behavior is no more risky than
people in other communities," said Mark McLaurin, a board member of the
Community HIV/AIDS Mobilization Project.
The new data "confirm that AIDS in America is a black disease and has been
neglected for far too long," said Phill Wilson, founder and chief executive of
the Black AIDS Institute in Los Angeles.
The CDC said that about 1 million to 1.1 million Americans are currently
HIV-positive.
But epidemiologist and AIDS expert Philip Alcabes of Hunter College of the
City University of New York contends that the new numbers indicate there are
about 225,000 more HIV cases in the U.S. than the CDC estimates.
A CDC spokesman rejected his contention, however, saying that the total number
of infections is calculated using a different method, and its figure remains
accurate.
More than 15,000 Americans die of AIDS each year.
The new
data will be formally unveiled today at the International AIDS Conference
in Mexico City and published later this week in the Journal of the American
Medical Assn.
The CDC has been widely criticized for not releasing the new numbers sooner.
Fenton acknowledged that the figures had been available since November, but he
said the agency delayed releasing them until they had been accepted for
publication.
Dr. Julie Gerberding, director of the CDC, said the paper had been heavily
revised during the peer-review process and that she had much more confidence
in the findings as a result.
Some critics suspect the results were delayed to avoid embarrassing the Bush
administration, which has shrunk the CDC's prevention budget by 19% in current
dollars since 2002, according to Rep. Henry A. Waxman (D-Beverly Hills).
"This administration continues to insist on funding ineffective
abstinence-only programs that are failing to equip our children with the
skills and knowledge necessary to protect themselves," Rep. Barbara Lee
(D-Oakland) said.
The new estimates are certain to bring calls for increased spending to combat
the epidemic. Even at the old estimate of 40,000 new infections per year,
nongovernmental organizations were calling for the United States, which spends
$700 million annually on prevention efforts, to boost that figure by at least
$300 million.
On Wednesday, President Bush approved $39 billion to fight AIDS around the
world, nearly triple the $15 billion spent over the previous five years.
"The United States can be proud of . . . its remarkable commitment to the
global HIV/AIDS epidemic," said Dr. Daniel R. Kuritzkes, director of AIDS
research at Brigham and Women's Hospital in Boston. "These new figures from
CDC demonstrate that the domestic epidemic needs a similar response."
Since the AIDS epidemic began in 1981, the actual incidence in the United
States -- and globally -- has been a matter of controversy. The problem was
that researchers used "by guess and by golly" techniques to extrapolate
overall HIV numbers from limited data.
In the case of the world numbers, better data led to a recent downward
revision, a 40% decline to about 2.5 million new infections each year and a
total of about 33 million people living with the virus.
In the past, U.S. figures for HIV were extrapolated from the number of newly
diagnosed AIDS cases. But as better treatments have lowered the number of
people progressing to full-blown AIDS, those estimates have become more iffy,
experts said.
The new numbers rely on newer testing methods that allow technicians to
determine whether an HIV infection occurred in the last five months or is an
older infection. More states have also begun reporting newly diagnosed HIV
infections as well as new AIDS cases.
"These data, which are based on new laboratory technology developed by the
CDC, provide the clearest picture to date of the U.S. HIV epidemic, and
unfortunately, we are far from winning the battle against this preventable
disease," the CDC's Gerberding said.
Using the new estimates for 2006, researchers also reanalyzed the historical
data. They concluded that the number of new infections peaked at about 150,000
per year in the mid-1980s, then declined to about 50,000 per year in the early
1990s.
By the end of that decade, the numbers had climbed back up to the current
level of about 56,000 and have remained fairly constant ever since, they
found.
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