STD Quarterly

HIV is on the rise — Take aim with rapid testing, prevention initiatives

African-Americans, Latinos, gay and bisexual men most affected

The most comprehensive analysis of U.S. HIV cases completed to date reveals that new HIV diagnoses in 29 states increased in 2002, according to the Centers for Disease Control and Prevention (CDC).1 Overall, new diagnoses rose by 5.1% from 1999 to 2002, which sends a clear signal that the fight against the AIDS epidemic is far from over.

"These new findings strongly support three key realities of today’s epidemic: The HIV epidemic in this country is not over; more often than not, the face of HIV in this country is black or Latino; and gay and bisexual men in several communities are facing a possible resurgence of HIV infection," says Julie Gerberding, MD, MPH, CDC director.

The 29 states included in the analysis have conducted confidential, name-based HIV case reporting since 1999. The analysis of 102,590 people diagnosed with HIV between 1999 and 2002 shows that African-Americans continue to account for more than half (55%) of the new diagnoses.1 Increases in new HIV diagnoses were recorded among Latinos (26%) and non-Hispanic whites (8%), while HIV diagnoses grew 17% among gay and bisexual men and 7% among men overall.1

The new study is based on reported new HIV diagnoses, which are defined as the point at which an individual learns of his or her HIV infection. According to the CDC, increases in HIV diagnoses don’t always reflect increases in new infections since figures showing new diagnoses include individuals who were recently infected, as well as those who were infected long ago but only recently tested and diagnosed.

While increases in HIV testing can lead to more numbers of people being diagnosed with HIV, study authors believe the new data suggest a rise in actual new infections.1 More people who had progressed to AIDS before their HIV diagnoses might have been detected if increased testing were a major factor; this was not evidenced in the study, they note.1

Move to rapid testing

The year 2003 was a watershed one for HIV testing, as rapid testing options finally became available to U.S. clinicians. Shipments of the OraQuick Rapid HIV-1 Antibody Test, manufactured by OraSure Technologies, Bethlehem, PA, began early in 2003 following the November 2002 approval by the Food and Drug Administration (FDA). The FDA issued another approval in April 2003 to a second rapid testing option, the Reveal Rapid HIV-1 Antibody Test, manufactured by MedMira of Halifax, Nova Scotia.

OraQuick Rapid Test changed

Two important changes have been made in the OraQuick Rapid HIV-1 Antibody Test since its FDA approval. It now has been approved for use with venipuncture whole blood specimens, which will allow OraQuick testing on whole blood samples routinely drawn from patients by venipuncture. Also, the maximum time for reading results of the OraQuick test has been reduced from 60 minutes to 40 minutes to minimize the possibility of false-positive test results. The test’s revised instructions now indicate the test should be read no sooner than 20 minutes and no later than 40 minutes after the test device is inserted into the developer vial. This change applies to fingerstick whole blood and venipuncture whole blood specimens.

In 2003, the CDC distributed more than 250,000 rapid HIV tests to health departments and community-based organizations to increase testing among persons at highest risk for HIV, says Ronald Valdiserri, MD, MPH, deputy director of the CDC’s National Center for HIV, STD, and TB Prevention. The CDC has purchased the same amount of tests to distribute in 2004, he reports.

The agency also has trained more than 475 people at 20 regional training sessions and initiated demonstration projects using rapid testing in nonclinical settings, acute care hospitals, and prisons, he reports. Giving same-day results for HIV tests puts greater responsibility on outreach staff, counselors, clinicians, and others who now administer the test in addition to offering client-centered counseling and referral.2 Thus, it is important that staff be properly trained.2

The testing push already is yielding results, says Valdiserri. The CDC’s routine monitoring indicates an increase in testing among persons at highest risk for HIV in areas where rapid HIV testing has been deployed; however, the CDC has not yet released data on the amount of the increase.

Work with communities

How are public health officials taking aim at the rise in new diagnoses, particularly among African-Americans and Latinos?

According to Valdiserri, the CDC is partnering with African-American communities and other government agencies to ensure appropriate HIV prevention programs for all those at risk to provide access to early testing, treatment, and prevention programs.

"CDC funds hundreds of community-based organizations for HIV prevention programs, that, for example, recruit and train peer educators to do street outreach, educate low-income African-American women to adopt safer sexual practices, and also work to reduce the risk of HIV among African-Americans living in shelters and other transitional living facilities," states Valdiserri.

CDC also funds community-based prevention programs that focus on reaching Latinos at high risk for HIV infection. Examples include programs targeting recent immigrants who may not relate to traditional HIV prevention messages, efforts to educate Latino intravenous drug users at high risk for HIV and connect them to drug treatment programs, and also programs that provide HIV education, testing, and counseling to young Latino men who have sex with men and counseling of their friends, family and peers.

Minority populations targeted

The CDC also recently has launched a new initiative to help reduce the number of new HIV infections and includes working with local communities to help those at risk in hard-hit African American and Latino communities learn their HIV status, understand ways of preventing HIV infection, and seek treatment if they test positive for HIV. 

Know that the CDC is committed to making progress in HIV prevention, says Valdiserri.

Seeking those unaware of HIV status

The agency’s Advancing HIV Prevention Initiative, part of its comprehensive approach to HIV prevention, represents approximately $145 million of the CDC’s $793 million prevention budget. Through this initiative, the agency is working to identify the estimated 180,000-280,000 people infected and unaware of their HIV status in order to link them to prevention and treatment services, he says.

"Studies show infected individuals are more likely to take steps to protect their partners after learning their HIV status," observes Valdiserri. "Making testing more widely available also increases opportunities to provide prevention information to both infected individuals and HIV-negative people at risk." 

References

1. Centers for Disease Control and Prevention. Increases in HIV diagnoses — 29 states, 1999-2002. MMWR 2003; 52:1,145-1,148.

2. Centers for Disease Control and Prevention. Resources for rapid testing. Presented at a CDC satellite broadcast April 24, 2003. Available at: http://legacy.cdcnpin.org/broadcast/past/2003/0424/transcript.htm.

Resources

For more information on rapid testing, visit www.cdc.gov/hiv/rapid_testing, the rapid HIV testing web site developed by the Centers for Disease Control’s National Center for HIV, STD, and TB Prevention, Divisions of HIV/AIDS Prevention. The web site offers an overview of rapid testing, information on HIV counseling with rapid testing, and state and agency resources for rapid testing. Also included are studies on rapid testing and links to package inserts for the OraQuick and Reveal rapid tests.

Implementing Rapid HIV Testing: A Primer for State Health Departments is available at www.nastad.org, the web site for Washington, DC-based National Alliance of State and Territorial AIDS Directors (NASTAD). This document is designed to assist health departments in adopting rapid HIV testing technologies. It describes the potential benefits of rapid HIV testing; suggests key steps in planning for implementation, and highlights key issues and challenges that health departments may face in adopting rapid HIV testing. To access it, go to www.nastad.org, click on "NASTAD Programs," "HIV Prevention," and the publication title.