by Bob Roehr
Estimates of just how many Americans become infected with HIV each year are at the center of a controversy at the 2007 National HIV Prevention Conference that opened in Atlanta on Dec. 2.
The Centers for Disease Control and Prevention (CDC) has used an estimate of 40,000 new infections per year since the early 1990s, before the introduction of highly active antiretroviral therapy. The new estimates could increase that by more than fifty percent and top 60,000, according to news stories that have appeared in the major media.
But the CDC isn’t saying; it will neither confirm nor deny the figures at its own premier meeting on HIV. Kevin Fenton, who heads up the agency’s HIV efforts, acknowledged that it has been working with testing technologies that give a better sense of whether or not an infection is recent.
In a statement released to the media, and in a speech at the opening session of the conference, Fenton said, “Given the importance of the new estimates in guiding HIV prevention policy and programs, CDC’s public health responsibility is to ensure accurate information.”
“The estimates are currently being reviewed and analyzed by external experts prior to acceptance and publication in a scientific journal…This expert external peer review is important to make sure that the methodology used and the conclusions derived are accurate.” He anticipates publication in early 2008.
Until then, it remains unclear whether there are have been more infections recently, or that the numbers have been higher all along. One thing is clear, the CDC HIV prevention budget has been flat over the last five years, and that has resulted in a 19 percent decline in the purchasing power of the dollars because of inflation.
Speaking from the same stage, AIDS advocate Jesse Milan Jr. grumbled, why couldn’t that peer review analysis have been ready by this meeting, the first in two and a half years.
Thomas J. Coates had a different take saying, “It kind of doesn’t matter” what the number is. “The important point is that it is better surveillance. Better numbers are going to help us know how much of a difference there is, and how to make the situation better.”
The HIV prevention guru, now at the University of California Los Angeles said, “What we need to do is roll out what we know works” at preventing HIV infections in both the domestic and international settings.
Coates urged AIDS services organizations (ASOs) to adapt to new conditions with new strategies, expertise, and delivery methods. In addition to educating and counseling people, “we may need new kinds of motivations, like economic motivations.” He cited the example of New York City that is experimenting with financial incentives for kids to finish high school, and it has worked well with methadone users. “We need to incorporate these strategies into our public health response.”
ASOs need to acquire medical skills or partner with organizations that have them, “Because we now have male circumcision; we may have pre-exposure prophylaxis [the use of antiretroviral drugs to prevent infection]; we may have provision of acyclovir [to repress herpes and reduce the risk of HIV transmission]; we may have microbicides.”
“And we need organizations with on the ground experience to partner with clinical groups so that when these strategies come along they can be disseminated quickly to the communities that need them the most,” Coates said.