United Press International - February 10, 2004
Ed Susman, UPI Science News

The finding puts the prevalence of the deadly epidemic in the city at levels usually seen in Third World nations.

"Overall, about 1 percent of the total population of New York City is living with human immunodeficiency virus," said Denis Nash, an epidemiologist with the Center for Urban Epidemiologic Studies, part of the New York Academy of Medicine.

In a report at the 11th Annual Retrovirus Conference, Nash said the new figures, which were developed after the state of New York required health officials to report HIV cases, also show:

-- About 2.8 percent of all the men in New York City have HIV infection or have been diagnosed with AIDS, the late stage of infection.

-- About 3.9 percent of all men between the ages of 40 to 49 years have HIV infection or AIDS.

-- An estimated 25 percent of the people who live in New York and are infected with HIV are not aware of their status. Those people are not included in the totals.

According to the World Health Organization, an infection rate of 1 percent is a threshold at which government and civil services begin to feel the pinch of the health crisis caused by the epidemic. That puts New York City's epidemic on a par with half a dozen nations in Central and South America, as well as some countries in Africa and Asia.

"Most of the people with HIV and AIDS in New York," Nash said, "are in concentrated groups, such as injecting drug users." In much of the developing world -- where HIV infection rates are into double digits -- the explosive epidemic is transmitted by heterosexual contacts. In the industrial world, drug abuse and sex between men fuel the epidemic.

Nash said, however, that among the 6,662 new infections recorded in New York City in 2001, 65 percent were men and 35 percent were women. "These data suggest that a significant amount of HIV transmission is occurring among females as well as males, and that HIV transmission is occurring at disproportionately high rates among minorities in New York City," he said.

"These figures are disconcerting," said Dr. Ronald Valdiserri, deputy director of the National Center for HIV, STD and TB Prevention, part of the Centers for Disease Control and Prevention in Atlanta. "It shows that we need to play close attention to prevention of HIV."

He said the figures presented for New York City should represent a wake up call for "those people who think we no longer have to worry about HIV/AIDS in the industrialized world."

Nash said since the appearance of HIV infections -- and resulting AIDS cases -- in 1981, one of the hot spots for the epidemic in the United States has been New York City. Although the metropolis contains just 3 percent of the nation's population, it accounted for 15 percent of U.S. AIDS cases and 18 percent of AIDS-related deaths in 2001.

Until 2000, however, the New York City Department of Health and Mental Hygiene was not required to keep track of the numbers of HIV infections, just the cases of AIDS -- a far lower number. Beginning in June 2000, a new state law required tracking both HIV and AIDS cases, Nash explained during a news briefing at the conference, which attracted nearly 4,000 doctors, scientists and allied health care officials and advocates.

Unlike other figures, which are estimates based on epidemiology, Nash said the figure of 75,550 persons living with HIV/AIDS is a "hard number" and the actual figure could be as many as 90,000 if one considers that 20 percent to 25 percent of people infected do not realize their HIV status.

Nash said data comparing the prevalence of HIV/AIDS in New York with other major metropolitan areas are not readily available.

He said African Americans and Hispanics are more likely than whites in New York to be infected. African Americans are five times as likely as whites to carry HIV/AIDS. Hispanics are 2.5 times as likely as whites to have the disease. HIV/AIDS remains incurable, although treatment has taken the disease out of the ealm of imminently deadly to a more chronic type of ailment.

"Nevertheless," Nash said, "HIV remains a fatal disease in New York City despite the state of the art medical care that exists for persons with HIV disease."

He said researchers have found persons diagnosed and living with HIV/AIDS in New York City die at a rate more than four times that of the rest of the city's population. "HIV remains the leading cause of death among New Yorkers aged 25-44 years and is the third leading cause of death among non-Hispanic black and Hispanic New Yorkers of all ages, following heart disease and cancer," he added.

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Ed Susman covers medical research for UPI Science News. E-mail sciencemail@upi.com
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