San Francisco Chronicle - Friday, November 18, 2005
Sabin Russell, Chronicle Medical Writer

A new snapshot of the AIDS epidemic in the United States is showing a possible decline in HIV diagnoses among African Americans over a three-year period but also indicates a more recent jump in positive tests among gay men of all races.

African Americans account for just over half of the new HIV cases reported each year in the United States, but new data tracking the epidemic in 33 states show a 5 percent decrease in positive tests each year among blacks from 2001 to 2004.

The report by the Centers for Disease Control and Prevention in Atlanta found that new HIV diagnoses among gay men were relatively stable in 2001-03 but increased 8 percent in 2004 -- coinciding with reports of increases in unprotected sex and in incidence of sexually transmitted diseases.

The federal study found that Latinos accounted for 18 percent of HIV cases, and that the infection rate among Latinos was 2.5 times that among non-Hispanic whites.

Dr. Ronald Valdiserri, acting director of the CDC's National Center for HIV, STD and TB Prevention, said this year's report provided "a more representative picture" of the AIDS epidemic in the United States because it included, for the first time, data from New York.

New York in June 2000 adopted the CDC's preferred system of reporting new HIV cases by patients' names to state health authorities. Four years of such data are required to be included in the CDC study. California has yet to adopt a names reporting system, and hence HIV statistics from it and 16 other states are still not included in the federal analysis.

The data from New York -- where state health department officials said there has been "a steady decline in reported cases of HIV/AIDS" -- may have contributed to the favorable trend seen among African Americans nationwide. That is because the epidemic in New York started two decades ago, and the spread of the disease there is slower now than in regions of the South, where outbreaks began more recently.

Researchers thought it was possible that the latest federal study would show an increase in HIV diagnoses among blacks, because in recent years there has been a big push by the CDC to promote testing. More testing is likely to turn up more infections. Instead, the results in minority communities show a trend in the opposite direction.

Studies are under way to determine what may account for the change: a real drop in HIV cases or changes in the way the CDC collects its data, such as including the New York cohort.

Two other nationwide trends affecting all races may have indirectly lowered HIV infection rates among blacks: a 9 percent decline among injection drug users, and a 4 percent decline in cases linked to heterosexual contact. Among African American men, injection drug use is linked to a quarter of all HIV infections; and among black women, nearly 80 percent of cases involve heterosexual contact.

HIV rates in the black community still remain high -- 8.4 times higher than for whites. "Overall, we found that new HIV diagnoses continue to disproportionately and severely impact African Americans, both men and women," Valdiserri told reporters during a telephone news conference.

He cited a July study of five American cities where a combined total of 46 percent of African American gay men were found to be HIV positive, many of them unaware that they were infected.

"We need to increase the opportunity for, and acceptance of, HIV testing," Valdiserri said. Studies show that risky sexual behavior decreases when people in a community know whether or not they are infected.

In the 33 states that the CDC now monitors closely for HIV trends, the federal agency said that the number of new positive tests has declined slightly, to 38,700 in 2004 from 41,200 in 2001. Many of these newly reported HIV infections may have in fact occurred years ago and either are just being recorded in names-based systems or are just being discovered through tests.

The CDC is working on a nationwide system, first tried in San Francisco, which uses a blood test specially designed to distinguish between recent HIV infections and old ones. Such a tool will give researchers a better idea where HIV is actually spreading. Its first use in federal surveys will be reported next year.

E-mail Sabin Russell at srussell@sfchronicle.com.

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