Los Angeles Times - September 17, 2008
Cynthia Dizikes, cynthia.dizikes@latimes.com

WASHINGTON -- The HIV epidemic in the United States is a crisis, federal health officials told a House panel Tuesday, urging additional programs to specifically protect and educate African Americans, Latinos and gay and bisexual men -- the groups hardest hit by the virus that causes AIDS.

Their testimony before the House Committee on Oversight and Government Reform came a little more than a month after the Centers for Disease Control and Prevention released a study indicating that new HIV infections in the United States had been underestimated by 40% every year for more than a decade. The study concluded that there are about 56,300 new infections each year, not the 40,000 usually cited.

"We need to do so much more than we're doing right now," said Dr. Julie Gerberding, director of the CDC. "And we need to get AIDS back on the radar screen. . . . This is something that is still posing a threat to college students and to young men and women across our nation's fabric."

The new numbers, published last month in the Journal of the American Medical Assn., were found through improved testing and were not an increase in new infections, which have remained relatively constant since the late 1990s.

The higher estimates, however, served as a reminder that preventing transmission of the human immunodeficiency virus is still an issue in the United States, where the prevalence of HIV is greater than in Canada, Australia, Japan or any Western European country except Switzerland.

More than 1 million Americans are HIV-positive, according to the CDC, and more than 15,000 Americans die of acquired immune deficiency syndrome each year.

"The message these new findings sends is clear: We're not doing enough to limit the spread of this deadly disease," said Rep. Henry A. Waxman (D-Beverly Hills), the committee chairman.

Perhaps even more disturbing than the overall hike in HIV cases were the disparities the new numbers laid bare.

Gay and bisexual men accounted for 53% of the new infections in 2006, the most recent year for which data are available. Blacks, who make up about 12% of the total population, accounted for 45% of the new HIV infections. The infection rate among blacks was a staggering seven times higher than among whites, and the rate among Latinos was nearly three times higher.

"Serious HIV-related health disparities, often fueled by stigma and discrimination, continue to undermine HIV prevention efforts in communities of color," Dr. George Ayala of AIDS Project Los Angeles told the panel.

Young black gay men have been especially hard hit, representing 48% of new infections among gay and bisexual males ages 13 to 29. Yet only four of the CDC's 49 recommended intervention programs specifically target gay men, and only one of them is designed to address gay men of color, according to Ayala.

The 2009 budget request for domestic HIV prevention efforts is $892 million, a slight decrease from last year. That figure includes $752.6 million requested by the CDC. On Tuesday, Gerberding told the committee that based on the new data, the CDC would need an additional $877 million in 2009 and an additional $4.8 billion over the next five years.

In July, President Bush signed legislation reauthorizing U.S. participation in a global program against HIV/AIDS.

Waxman said he would try to work with the Appropriations Committee to increase funding for domestic HIV prevention programs this year, but he was "not very optimistic" it would result in an allocation change under the current administration.

"I think the purpose of this hearing has been to sound an alarm," Waxman said.

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References:

Estimation of HIV Incidence in the United States JAMA. 2008 Aug 6;300(5):520-9

Centers for Disease Control and Prevention - HIV/AIDS Statistics and Surveillance: HIV Incidence

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