CDC's most recent data on HIV epidemic now include stats from New York state
CDC's most recent data on HIV epidemic now include stats from New York state
Overall picture shows little has changed recently
The new HIV epidemic data coming from the Centers for Disease Control and Prevention (CDC) of Atlanta, GA, includes statistics from New York state for the first time, which means that it finally provides a more comprehensive national picture.
It's most disturbing finding is that many people still are diagnosed with HIV infection within a year of their AIDS diagnosis, public health officials say.
In all, 33 states have data from 2001 to 2004 that is based on confidential, name-based reporting, which is the only HIV surveillance data trusted by the CDC.
"We're presenting data from a national perspective, and it's the most complete picture of data to date in the United States," says Ronald O. Valdiserri, MD, MPH, acting director of the CDC's National Center for HIV, STD and TB Prevention. Valdiserri spoke about the report at a teleconference in November, 2005.
"In regard to advances in treatment, AIDS cases no longer provide a reliable indication of trends," Valdiserri notes.
"AIDS cases do provide an invaluable measure of the impact of the disease in various populations," Valdiserri says. "Over 40,000 Americans develop AIDS, and 18,000 die from AIDS every year, so AIDS remains a serious and fatal disease."
But there was nothing surprising in the 2004 AIDS death data, other than how it helps CDC officials analyze issues related to entry to care, Valdiserri says.
"We continue to see a substantial number of late diagnoses, meaning someone who has the HIV test and within that year develops AIDS," Valdiserri says. "That's about 38 percent, and that's a very important figure we need to keep our eye on because we are emphasizing early diagnoses of HIV infection for medical and epidemiological reasons."
"From the perspective of our members, the most distressing thing about the CDC data, and it's what providers see on a daily basis, and that is people newly presenting for care who have recently found out they are HIV infected and yet they are very late in the disease process," says Christine Lubinski, executive director of the HIV Medicine Association in Alexandria, VA.
The CDC is addressing this problem through its national push to expand rapid HIV testing, Lubinski notes.
Also, the CDC will announce early this year the new guidelines for HIV counseling and testing in medical settings, Lubinski says.
"They're going to push for making testing much more routine, and they'll push for making modifications to counseling requirements which they feel are a barrier to providers doing the testing," Lubinski says.
For instance, providers find it too time-consuming to have to counsel people before they test for HIV and then to counsel them again on risk reduction behavior if they test negative for the virus, Lubinski says.
"The idea is to make it more routine, so if someone comes in for an annual check-up, and the person is sexually active, then in addition to doing the basic sexually-transmitted diseases (STD) screening and cholesterol screening, then the physician will do an HIV test," Lubinski explains. "There's a feeling that if you have to have special people doing the test and counseling, then it just doesn't happen because the majority of tests are performed in private practice settings."
There now are 38 states that report HIV data by name, and as other state laws change and name reporting becomes available, those data can be added into the national surveillance figures, Valdiserri says.
The CDC collects name-based data from a state for a few years before including the information into its surveillance reports.
New York is a high morbidity state with over 20 percent of all HIV/AIDS diagnoses, Valdiserri says.
The inclusion of New York statistics provides a much bigger picture of the epidemic than what was available in prior analyses, Valdiserri says.
However, data from California and Illinois still are not included, and these also are high morbidity states, he notes.
Future HIV data will improve as more states move to name-based reporting and as the CDC is able to distinguish between new HIV infections and new HIV diagnoses, Valdiserri says.
CDC officials continue to point out that while new HIV diagnoses give some information about trends, these new diagnoses include everyone who has had an HIV infection for years to people who were infected a month ago, so it's difficult to pinpoint exactly why a particular state might have an increase or decrease in diagnoses.
Overall, the number of diagnoses in the 33 states decreased slightly from 39,207 to 38,685 in 2004, a decline that was not statistically significant, says Lisa M. Lee, PhD, senior epidemiologist in the CDC's Division of HIV/AIDS Prevention. Lee also spoke at the teleconference.
Diagnoses among men who have sex with men (MSM) remained stable from 2001 to 2003, and then it increased eight percent between 2003 and 2004, consistently for all races, Lee says.
"In terms of the upturn among MSM, it may reflect an increase in HIV incidence, consistent with increases in syphilis in MSM," Lee says. "We hope this increase is partly a reflection of efforts to increase HIV testing in this population."
One key finding is that from 2001 to 2004, the rate of HIV diagnosis among blacks declined by 5 percent per year, from 88.7 per 100,000 population in 2001 to 76.3 per 100,000 population in 2004.1
This figure remains much higher than the diagnosis rate for whites, which was 9.0 per 100,000 in 2004.1
"Overall, we found that new HIV diagnoses continue to disproportionately and severely impact African Americans, both men and women," Valdiserri says.
"Despite that drop, the rate of HIV among African Americans remains over eight times higher than among whites and 2.5 times higher than Hispanics, which was 29.5 per 100,000 population," Lee says.
Just over half of all HIV diagnoses from 2001 to 2004 were among blacks, while whites accounted for 29 percent of the diagnoses, and Hispanics were 18 percent, Lee says.
"Overall, men who have sex with men (MSM) continue to account for the largest proportion of diagnoses of any risk group at 44 percent, followed by heterosexuals at 34 percent, and injection drug users at 17 percent," Lee says.
Among men, 61 percent of diagnoses were among MSM, she says.
Newly-diagnosed white men reported heterosexual behavior as the mode of transmission only 6 percent of the time, while 25 percent of black men said they were infected through heterosexual exposure, Lee adds.
"This underscores the need for prevention programs for minority men to target multiple ways of exposure," she says.
Although the data present the most accurate picture to date, there are many limitations, which hinder some meaningful analyses, Valdiserri notes.
For instance, the addition of New York data comes mainly from New York City and its boroughs, where considerable city and state resources enhance Ryan White funding for testing, treatment, and prevention. However, the data offer no clues as to how a higher-resource state like New York might compare in HIV diagnoses to lower resource states in the Southeast or elsewhere.
"I wish we could answer that question of the relationship of distribution and scale of prevention programs and HIV prevention outcomes, but these data don't enable us to do that," Valdiserri says. "What these data do tell us is we're continuing to have high levels of HIV in MSM, especially African American MSM, and we do need to mobilize communities to work on it."
Likewise, the CDC is working on responding to the recent increase in crystal methamphetamine use, which plays a significant role in high risk sexual behaviors, Valdiserri says.
"The concern is it might be likewise implicated in HIV infection, and we're looking at that very carefully right now," Valdiserri says. "Gay communities in New York, particularly, have mobilized very aggressively, and you find campaigns in New York and Chicago, and we're seeing an active response particularly among gay and bisexual communities to address this as a dangerous practice that could lead to an increase in HIV infection, as well."
Reference:
1. New HIV diagnoses, 33 states, 2001-2004. Report by Centers for Disease Control and Prevention, Atlanta, GA. November, 2005.
The new HIV epidemic data coming from the Centers for Disease Control and Prevention (CDC) of Atlanta, GA, includes statistics from New York state for the first time, which means that it finally provides a more comprehensive national picture.Subscribe Now for Access
You have reached your article limit for the month. We hope you found our articles both enjoyable and insightful. For information on new subscriptions, product trials, alternative billing arrangements or group and site discounts please call 800-688-2421. We look forward to having you as a long-term member of the Relias Media community.