by Bob Roehr
The Centers for Disease Control and Prevention has offered a more detailed breakdown of HIV infections in the US, which offered few surprises.
The analysis is based on the 40 percent increase in estimated infections, to 56,300 in 2006, that was released in early August. It was published in the Sept. 12 edition of Morbidity and Mortality Weekly Report.
Estimates are that in 2006, 53 percent of new HIV infections were in men who have sex with men. Among MSM, 46 percent were white, 35 percent were black and 19 percent were Hispanic.
Blacks were more likely to become infected when they were younger – 48 percent of total MSM infections in the age group 13-29 – and then their risk tapered off as they aged. The decline in later years is in part statistical; there were fewer people left who could become infected.
White MSM showed a lower rate of infection at an early age (31 percent) but increased likelihood to become infected in their thirties and forties.
Hispanics showed an age pattern similar to blacks, but at much lower rates of infection at every time point.
"The data really confirms what we had suspected and known before…the disproportionate impact on gay and bisexual men, and on blacks and Latinos," said Kevin Fenton, who heads up all HIV activities at the CDC.
Steve Morin, director of the Center for AIDS Prevention Studies at the University of California San Francisco, said, "The number of infections seems unacceptably high in the United States given the resources that we should be able to direct to HIV prevention."
The federal government "has underfunded prevention for years." Morin noted that early HIV funding, circa 1984, was split 50-50 between prevention at CDC and research at NIH. "The prevention budget now is roughly 4 percent (of total spending)…so it is not surprising that there is little prevention activity going on."
Show me the money
"Congress, the President and the philanthropic sectors (need) to put forward the resources necessary in prevention, research and treatment to address this epidemic with the urgency it demands," said the National Black Gay Men's Advocacy Coalition in a written statement.
Earlier in the month, on Sept. 5, a broad coalition of HIV organizations wrote to the congressional leadership pressing for "a minimum investment of $1.3 billion per year" for HIV prevention. That is nearly double the current CDC prevention budget, which has shrunk 19.3 percent in purchasing power since fiscal year 2002.
It urged that a down payment of $200 million be added to the continuing resolution for the 2009 fiscal year budget that will begin on October 1.
"The new incidence estimates demonstrate the relationship between federal funding and HIV prevention program effectiveness," they wrote. "CDC estimates a remarkable decline fro a high of approximately 130,000 annual HIV infections in the later 1980s to a low of close to 50,000 in the early 1990s. During this time, CDC's prevention budget increased by 50 percent."
As of press time, Rep. Henry Waxman (D-Calif.) was scheduled to hold an oversight hearing on Sept. 16 on HIV prevention activities in light of the revised CDC numbers. Leading government officials, academic researchers and community advocates are scheduled to testify.
Puetro Rico
Hispanic leaders are outraged that Puerto Rico, with the fifth-largest number of HIV cases and 20 percent of all Hispanic cases in the country, was not included in the revised estimates. The CDC says it is because they rely upon census data to calculate rates of infection and that data is gathered differently on the island.
According to the CDC, Hispanics are 17.3 percent of the total national caseload, but adding in Puerto Rico boosts that to 22 percent. Prevention funds are allocated by the local caseload.
Guillermo Chacon, vice president of the Latino Commission on AIDS, said, "We will not allow our experience of the epidemic to be invisible. Our health crisis is real. We want an accurate picture of the impact of HIV/AIDS now."
The situation is compounded by the fact that the CDC recently announced it is eliminating funding to track HIV infections to Puerto Rico and eight other states because of budgetary constraints.
