By Bob Roehr
The numbers of HIV infections are stable, but they’re disproportionately affecting more minority gay men, according to a troubling new analysis by the Centers for Disease Control and Prevention.
The estimated number of new HIV infections in the U.S. averaged about 50,000 a year between 2006 to 2009. The most significant change in the overall stable numbers was the dramatic 48 percent increase in new infections among young black men who have sex with men, also known as MSM. The number of those infections increased from 4400 to 6500 over the study period.
“While we’re glad (the overall number of new infections) is not increasing…(it) masks a large increase among black men who have sex with men in the 13 to 29-year-old age group. We are very concerned about this trend,” said CDC Director Thomas Frieden during an Aug. 3 conference call with reporters.
The analysis was based on surveillance begun in 2004 using a test for serologic markers that distinguish recent from more established infections. The data was gathered from 16 selected states and two cities and extrapolated to the entire country.
While MSM account for just 2 percent of the U.S. population, they represented 61 percent of all new HIV infections in 2009, said Joseph Prejan, the lead author of the study. The four largest demographic categories of infection were white MSM, black MSM, Hispanic MSM, and black women.
Blacks constitute 14 percent of the U.S. population but 44 percent of HIV infections, the analysis showed. “HIV remains one of the most glaring health disparities for African Americans and Latinos,” Prejan said, adding that the overall infection rate among blacks is almost eight times as high as whites. For Hispanics, the infection rate is three times as high as whites.
Behavior does not appear to account for the differing rates of infection between racial groups. Previous research has shown that black MSM have fewer sex partners, are less likely to use illegal drugs associated with HIV risk, and are no more likely to report unprotected anal intercourse than white MSM.
Prejean said among the factors that likely are contributing to this outcome among young black MSM are higher rates of syphilis and other sexually transmitted infections that can increase the risk of acquiring and transmitting HIV. They also are less likely to know they are infected with the virus and unknowingly transmit the virus to their partners and they have lower access to healthcare, Prejean added.
Researchers increasingly believe that the “community level” of HIV infection is another important explanation for the higher rates of new infections among blacks.
Most sexual activity is within a relatively small, closed geographic and socio-economic community. Once the rate of a disease becomes elevated within that community, then the same level of risky behavior carries greater odds of spreading the infection, Frieden explained.
“That means we need to target our resources and support for patients and communities to those at highest risk,” Frieden continued. “We have come to understand the importance of the linkage between prevention and treatment. It is not enough to promote testing; we have to promote testing and linkage to care and continuity of care.”
Responding to a question on the AIDS Drug Assistance Program waiting lists now approaching 9,000, Frieden said the CDC is working with the federal agency that has responsibility for that program. “It is important that each state recognize that they have a responsibility to provide treatment for the people who live within their jurisdiction and who have treatable infections,” Frieden added.
CDC’s HIV prevention chief Kevin Fenton acknowledged that the federal budget means that they are going to have to do more with less. Some of the earliest and hardest hit areas, such as New York and California, are likely to see funding shifted to the southeastern part of the U.S. where the epidemic has grown most rapidly in recent years.
Johns Hopkins University HIV prevention researcher David Holtgrave and others have pointed out that the CDC HIV prevention budget essentially has been held flat for a decade, and those dollars have lost more than a fifth of their purchasing power over that time period.
“At a time when Washington policy makers are debating ways to cut budgets, we cannot risk cutting HIV prevention programs, which account for only 4 percent of all federal HIV spending. Instead we should be increasing our investment,” said Carl Schmid with the AIDS Institute.
“We need an immediate, sizable investment and a sustainable plan to address HIV health disparities, on which the new HIV incidence estimate shines a bright spotlight,” said Ronald Johnson, vice president of policy and advocacy at AIDS United. “We have seen 30 years of disturbing and unacceptable reports. We now need to see action to stop the HIV/AIDS epidemic in the United States.”
The National Black Men’s Advocacy Coalition pressed for several specific actions, including an immediate increase from $9 to $14 million in grants scheduled to be awarded next month to organizations providing services to young MSM and transgender individuals of color.