August 3, 2008

HIV Epidemic 40% Higher Than Thought

By Fred Tasker, The Miami Herald

Aug. 3--The U.S. HIV epidemic is sharply worse than previously estimated, with thousands more people infected than realized, according to a new government way of calculating cases, officials said Saturday.

The new count shows the number of new HIV infections was closer to 56,300 per year than the 40,000 per year previously reported -- a 41 percent increase for the 15 years up to and including 2006, said the U.S. Centers for Disease Control and Prevention.

The CDC report stressed the higher numbers do not reflect an increase in HIV, only a more accurate count. It released the report at the 17th International AIDS Conference in Mexico City.

"This new picture reveals that the HIV epidemic is -- and has been -- worse than previously known and underscores the challenges in confronting this disease," said Dr. Kevin Fenton, director of the CDC's National Center for HIV/AIDS.

In Florida, new HIV cases have been reported at about 4,500 a year for the past 15 years; the correct number is closer to 6,000, said Tom Liberti, chief of the Bureau of HIV/AIDS for the Florida Department of Health.

South Florida numbers were not recalculated, but the region has among the highest HIV rates in the country.

HIV/AIDS activists reacted with anger and sorrow. Decisions about government funding for research are often based on how widespread the condition is.

"We've known this," said Charles Martin, executive director of the South Beach AIDS Project, which administers HIV tests to about 2,000 people a year. "But I'm saddened to know that we've been getting the short end of the stick in funding."

Dr. Margaret Fischl, pioneering AIDS researcher at the University of Miami School of Medicine, said experts have suspected for some time that the HIV epidemic was worse than reported.

'What's disturbing is that we continue to see new cases among the relatively young. They have no memory of what it is to have HIV infections. They say, 'I thought you had cured this.' "

More than a third of new infections nationwide are in young people from 13 to 29; people over 50 have the lowest rate. More than half of new cases come from men who have sex with men. Other high-risk groups include blacks and Hispanics.

U.S. funding of the global AIDS fight has risen from $2.3 billion in 2004 to $6 billion this year, with a five-year commitment of $48 billion. Federal spending for domestic HIV prevention, at about $660 million today, faces proposed cuts next year.


"We need a national AIDS strategy, an acknowledgement that this is an epidemic that requires a large and coordinated effort," said Julie Davids, of the Community HIV/AIDS Mobilization Project in Chicago.

"We've neglected the domestic epidemic," said Phill Wilson, founder of the Black AIDS Institute in Los Angeles. "And as a result, black people in particular have suffered."

He called for spending at least $1.3 billion a year on HIV prevention.

CDC officials acknowledged that the too-low HIV estimates might have hampered funding.

"We certainly know that some people who are at risk have not been reached by HIV prevention programs," said Rich Wolitski, acting director of the CDC's HIV/AIDS Prevention Division. "We know that 25 percent of persons infected don't know they're HIV positive. We know that 80 percent of gay and bisexual men have not been reached by individual HIV prevention programs in the past year."

Wolitski said the CDC is working on an HIV prevention strategy for the years 2010-2020. He declined to say how much funding it might need.

Martin, the South Beach AIDS activist, said his group's staff must wait for those at risk to come to them for help. "We're just not funded to go out to bars and hand out condoms," he said.

Still, there are victories in HIV prevention programs aimed at the groups most at risk, said Dr. Michael Kolber, medical director of the Comprehensive AIDS Program of the University of Miami School of Medicine.

He said the pastor of an African-American Miami church recently changed his mind about condom use and welcomed a UM program to come in with education, information and condoms.

"One of his parishioners had become infected," he said.

CDC officials said the improved HIV numbers come from a new statistical tool they say is more accurate in determining when a new HIV infection actually occurs, rather than when it is diagnosed. The old method relied on extrapolations of estimates from the 22 states that require name-based reporting of new HIV cases; the new method extrapolates actual case counts in those states.


AIDS statistics, which always were based on actual case counts, are not impacted, the CDC said.

The CDC said while the overall HIV numbers were consistently higher, the trends did not change dramatically over the 15 years leading up to 2006.

"New infections peaked in the mid-1980s at approximately 130,000 infections per year and reached a low of about 50,000 in the early 1990s," the report said. "Incidence then appears to have increased in the late 1990s, but has stabilized since that time with estimates ranging between 55,000 and 58,555 during the three most recent time periods analyzed."


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