U.S. HIV cases up in 2006 - Maybe

by Bob Roehr

Names-based reporting of HIV diagnoses totaled 52,878 in the United States in 2006, according to data released by the Centers for Disease Control and Prevention (CDC) March 24.
At first glance that was significantly higher than the 35,537 diagnoses reported in 2005, but once one sorted through the technical explanations of what was counted and where, there was no increase at all.
The confusion comes from the fact that the CDC has always required the reporting of AIDS diagnoses by name, but not HIV diagnoses. Initially that made little difference because of rapid disease progression and death, but the introduction of powerful antiretroviral therapies in the mid-90s changed the natural course of the disease.
Some states sought to protect patient confidentiality by developing alternatives to names-based reporting for HIV. However, the CDC demonstrated that those alternatives can lead to duplication when people test several times or move, so it began to require names-based reporting. It takes several years for a state system to become established and report "clean" data.
The big jump in diagnoses in 2006 came from adding figures for the first time from seven newly reporting jurisdictions: California, Delaware, Illinois, Maine, Oregon, Rhode Island and Washington, DC.
If you compare data from just the states that reported in both 2005 and 2006, the total number of new HIV diagnoses actually declined by about 2 percent. Five states did not have names-based reporting of HIV in place in 2006 and their data was not included in the national totals. They are Hawaii, Maryland, Massachusetts, Montana, and Vermont.
Among adolescents and adults, 75 percent of the HIV diagnoses were in males and 25 percent were in females. There were 566 reported cases in children. The epidemic disproportionately affects people of color and more than 60 percent of those living with AIDS contracted the disease through male-to-male sexual contact.
HIV diagnosis does not necessarily reflect recent infections. In fact the vast majority of those diagnoses occur when the patient shows up at an emergency room with an opportunistic infection and a low CD4 count, generally below 200. The infection occurred several years, perhaps more than a decade earlier.
The CDC is pushing increased testing for HIV so that more people will learn if they are carrying the virus and would be able to begin therapy before too much damage is done to their immune system.
Last March the CDC launched a program of heightened prevention outreach to the African American community. It has not gone well. Revolving leadership, poor communications with the community and no new funding for anything beyond testing has limited outreach success.
"This seems like yet another grand vision outlined in a glossy document that is, in fact, ill-equipped to make any real dent in new infections," said Kenyon Farrow, spokesman for the Community HIV/AIDS Mobilization Project (CHAMP).
HIV prevention advocates are calling for the U.S. to adopt a national AIDS strategy with measurable goals, rather than the status quo of programs fragmented between various government agencies. It is something that the U.S. government requires of other nations that it assists in the fight against AIDS.

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