As the world continues to learn more about coronavirus and its spread, it's vital to stay up-to-date on the latest developments. However, it's also important to make sure that the information being distributed is from credible sources. To that end, Between The Lines has compiled, [...]
by Bob Roehr
LOS ANGELES – “The AID epidemic in the United States is appreciably worse than the epidemic in any Western European country,” said Harold Jaffe. The former head of HIV programs at the CDC is now a resident scholar at Oxford University. “Deaths due to AIDS are twice as high as the highest Western European country, which is Portugal, and ten times higher than the United Kingdom.”
One fact not widely discussed at the 14th retroviral conference is that the number of new AIDS cases reported to the CDC, which had been chugging along at about 40,000 per year, jumped up to about 45,000 in 2005, the last year for which complete data is available. Jaffe said, “Whether that number represents a real trend or whether it is an artifact, I don’t think we know yet.”
He refused to comment on why there has been a dramatic decline in reported HIV cases in San Francisco over the last several quarters.
African Americans accounted for 50.5 percent of persons newly diagnosed with HIV/AIDS in the U.S., even though they make up only 13 percent of the surveyed population, the CDC said on March 8. While the lead sentence of the report focused on the racial disparity, buried in the seventh paragraph was the fact that 51.7 percent of those transmissions were ascribed to men having sex with men (MSM), and 4.6 percent to the dual risk of MSM and injection drug use.
MSM constitute perhaps 5 percent of the US population. That would mean that as dismal as the racial disparity is in terms of rates of infection, the MSM disparity likely is three times worse.
The CDC report is based on data reported 2001-2005 by 33 states that used confidential names-based reporting during that period. It was published in Morbidity and Morality Week Report.
“In Quebec, there is clearly a resurgence of the epidemic in men who have sex with men ,” said Bluma Brenner at the retroviral conference. She is a researcher with the McGill University AIDS Center. She said, “One of the largest drivers of the epidemic is the misconception that we have indeed no problem any more in North America.”
The province conducted a genetic analysis of the virus of 891 individuals whose infection was less than six months old, and about 3,000 persons when their treatment failed. That is about 30 percent of the total HIV-infected population in the province.
Brenner found that about half of all new infections are associated with clusters. Of those clusters, half the time, “one primary infection is associated with 3 other primary infections. But in the other 50 percent of the cluster transmission, 1 primary infection transmission is linked to, on average, 8.4 other transmissions.”
She said 37.1 percent of MSM transmissions are in large clusters, compared with only 15 percent among heterosexual injection drug users. “Clearly there is a problem in the MSM community.”
“There is onward transmission of people who are in early infection, spreading it to other individuals.” Brenner believes that much of it is due to the extremely high viral load that characterizes initial infection, prior to the immune system exercising some control over the virus and establishing a lower viral set point.
Estimates have been that half of all HIV infections in the U.S. occur in persons who are 25 or younger. So the common wisdom was that younger persons are more likely to have been recently infected than older persons. But a four-year survey of blood samples by the New York City Department of Health and Mental Hygiene found just the opposite.
The test they used measured antibodies that show up in blood over the course of time and can identify infections that have occurred within the last six months.
What they found was that those 35 to 39 had the highest rate of new infections (0.54 percent), while those 40 to 44 (0.45 percent) and 45 to 49 (0.49 percent) also were high. In contrast, the rate of new infections was less than half of that for all age groups under the age of 30.
Perhaps, on reflection, it should not have come as a surprise. The total number of people who are infected in any age cohort increases with time, and most people tend to have sex with people more or less their own age. So the risk of having sex with someone who is HIV+ increases as a person grows older.
Assuming that one has the same degree of safe/unsafe sexual practices at all points in life, each year brings an increased risk of exposure to the virus through those acts, which result in an increasing number of infections with age.
University of Pittsburgh prevention researcher Ron Stall calls it “another disconnect between people’s take on where risk lies and what the sero-incidence data tell us.”
“You have to remember, these are the folks who lived through the worst of the epidemic,” said Tom Coates, now a prevention researcher at UCLA. He says there are reports from Florida and elsewhere of increased unsafe sex among older adults.
“Perhaps some of it has to do with life transitions. Partners may die, or partnerships split up, and that always puts folks at higher risk of unsafe sex. Another is that life is short, so why not enjoy it. A third possible explanation is that perhaps older men are selecting younger partners who may be at higher risk of having HIV and thus getting it themselves,” Coates says, “We have to get the target population together and understand what’s going on.”