New HIV infections in the U.S. topped 56,000 a year in 2006—about 40 percent more than previous estimates. The Centers for Disease Control and Prevention ( CDC ) released those numbers at a hastily arranged telephone news conference Aug. 2 after an embargoed paper in a special issue of the Journal of the American Medical Association ( JAMA ) was made public early.
The CDC said the total number of new infections is not increasing; rather, it said that its previous estimates were inaccurate. The revised figures reflect use of better technologies that identify recent infections, those that have occurred within the last six months, and affect estimates of when older infections occurred.
A draft of the report was prepared last fall and news of the revised numbers began circulating almost immediately, but the CDC refused to release them pending full peer review and publication. The previous estimate of 40,000 new infections a year was generated more than a decade and a half ago and was never changed. Most knowledgeable observers have long believed them to be an underestimate.
The new numbers show no significant changes in the demographics of the groups most affected; 73 percent are male while 53 percent of total infections are attributed to men who have sex with men ( MSM ) . People of color are disproportionately affected, with rates per 100,000 persons of 83.7 among Blacks and 29.3 among Hispanics, compared with 11.5 among whites.
The retrospective analysis went all the way back to initial infections in the late 1970s. It showed that new infections in gay men peaked about 1985, then declined dramatically with broad adoption of safer sex practices within the community.
'Infections have, in fact, been rising among men who have sex with men as the data show a steady increase since the early 1990s,' said Kevin Fenton, who heads up the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention at the CDC. 'These data among men who have sex with men point to an urgent unmet need.'
Reactions
Community outrage has been fueled by the games that CDC played in withholding the numbers for months on end, the limited effectiveness of its prevention efforts, and a bipartisan political response that has neglected the domestic epidemic while focusing overseas.
'These new estimates paint a soberingly accurate portrait of the AIDS epidemic and reveal an utter lack of investment in prevention research and programs, especially for gay men and African Americans,' said Mark Ishaug, president of the AIDS Foundation of Chicago.
Funding for CDC HIV prevention, $750 million, has been stagnant for years and since 2002 the purchasing power of those dollars has declined by 19 percent. The imbalance is further demonstrated by the fact that domestically, only 4 percent of federal HIV funds go to prevention, while the international U.S. program PEPFAR dedicates 22 percent of its money to prevention.
'Rather than investing in domestic HIV prevention, the U.S. government has cut funding to state and local heal departments more than $28 million since fiscal year 2003,' said Julie Scofield, executive director of the National Association of State and Territorial AIDS Directors.
Gene Capello, executive director of the AIDS Institute, said the current CDC HIV prevention budget has been cut $3.5 million from last year and President Bush's budget for next year proposed an additional $1 million in cuts.
'Neither the U.S. House of Representatives nor the U.S. Senate has proposed any increased funding for HIV prevention. This is completely unacceptable, particularly in light of the new incidence numbers.' He called upon Congress to increase domestic HIV prevention funding by at least $30 million as a necessary first step.
'An awful lot of money is being spent,' but we don't know how much of that is being spent effectively, said Ernest Hopkins, the federal lobbyist for the San Francisco AIDS Foundation. 'It becomes very difficult to advocate for more resources if we haven't evaluated what we are already doing.'
Walt Senterfitt, cochair of the national prevention group CHAMP, said it isn't just the need for more money but of how that money is spent. 'Jesse Helms-era restrictions on proven means of effective prevention, the pernicious intersection of HIV and major social injustices' such as racism and homophobia are important contributing factors that must also be addressed.
'Better numbers tell us that we need to better target and tailor our scarce prevention dollars,' said Craig E. Thompson, executive director of AIDS Project Los Angeles. 'Gay men and other men who have sex with men of every race and ethnicity are the single largest group affected by HIV/AIDS in this country. Under-funded, 'cookie-cutter' prevention is no longer viable if we want to control the epidemic in the United States.'
Housing Works President Charles King said, 'This should serve as a bombshell wake-up call to both Senators Obama and McCain that America's response to domestic AIDS has failed. We need a comprehensive, national blueprint for ending AIDS and that blueprint is a national AIDS strategy.'
Obama has committed to formulating a national strategic plan on AIDS and has spoken publicly on the issue, but McCain has done neither, Phill Wilson, executive director of the Black AIDS Institute said in a conference call with reporters last week.
