Gay Infections Still Lead

Four years of HIV data show persistent prevalence

Gay and bisexual men continue to bear the brunt of the AIDS epidemic, according to four years worth of data released by the federal Centers for Disease Control and Prevention on November 17.

“HIV continues to exact a tremendous toll on all MSM especially MSM of color,” said Dr. Ronald O. Valdiserri, acting director of CDC’s National Center for HIV, STD, and TB Prevention. “[Men who have sex with men] once again account for the majority of diagnosis during this four-year period.”

The data, from 2001 to 2004, was from 33 states that have had a names-based HIV case reporting scheme in place for at least four years. New York State was part of the CDC’s analysis for the first time and it accounted for roughly 20 percent of all the new diagnoses reported during the four years. Most of the New York cases were from New York City.

“Although it is not a complete picture, it is the most complete picture of what is happening today in the United States,” Valdiserri said during a telephone briefing with reporters.

The CDC reported that there were 157,252 new HIV or AIDS diagnoses during the four-year period. Summarized by transmission categories, gay or bisexual men accounted for 44 percent of the cases followed by heterosexuals of both sexes at 34 percent, injecting drug users at 17 percent, gay or bisexual men who inject drugs at four percent, and “other” at two percent.

Seventy-one percent of all the new cases were among men and, among men, gays or bisexuals accounted for 61 percent of the new cases and gay or bisexual men who inject drugs accounted for another five percent. Among men, heterosexual contact accounted for 17 percent of the cases followed injection drug use at 16 percent.

African-Americans accounted for 51 percent of all the new cases followed by whites at 29 percent and Latinos at 18 percent, while Asian/Pacific Islanders and Native Americans accounted for less than two percent of the new cases.

“Overall, we found that new HIV diagnoses continue to severely and disproportionally affect African-Americans both men and women,” Valdiserri said.

The CDC reported that the total number of new cases in the four-year period reflected an overall decline in the rate of new diagnoses from “22.8 per 100,000 in 2001 to 20.7 in 2004,” but that was not “statistically significant,” according to Dr. Lisa M. Lee, a senior epidemiologist at the CDC’s Division of HIV/AIDS Prevention. The decrease was “driven largely by declines among injection drug users,” Valdiserri said.

The CDC reported that from 2001 to 2003 there was an increase in new diagnoses among gay or bisexual men, but it was not statistically significant. An eight percent increase among those men from 2003 to 2004 was statistically significant. That increase could reflect more HIV testing among those men, more unsafe sex, or both.

“We’re not exactly certain what is happening with MSM in these national data, but there are clearly reasons for concern,” Valdiserri said. “It’s very important for communities, particularly communities of gay and bisexual men, to be aware that HIV could rebound.”

Responding to a follow up e-mail, a CDC spokesperson wrote that the agency could not say if the eight percent increase was driven by a particular region or state.

“We really can’t describe the increase regionally or by state,” the spokesperson wrote. “The data was examined as an aggregate so state by state analyses are not available.”

The CDC is building a network of 34 sites across that will use a testing technology that identifies new infections as opposed to new diagnoses. That will allow the agency to estimate whether and where the epidemic is growing. That data should be available in “the very near future,” Valdiserri said.

The agency also continues to push for more HIV testing.

“I think that as a general statement CDC has said and is continuing to say that we estimate that as many as 25 percent of persons infected with HIV are unaware of their infection,” Valdiserri said.

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