Washington Blade - August 8, 2008
Lou Chibbaro Jr.

Compiled by the U.S. Centers for Disease Control & Prevention, the data show that gay and bisexual men of all races continue to lead other population groups in contracting HIV, accounting for 53 percent of all new infections.

The Washington Blade was first to report the numbers in November, but the government only now released the figures.

Blacks have an HIV incidence rate seven times higher than that of whites and a rate higher than any other racial or ethnic group in the U.S., the new data show. And black men who have sex with men, or "MSMs," have the largest number of new infections among black Americans, the data show.

"These numbers are a scathing indictment of how profoundly U.S. and CDC HIV prevention efforts have failed," said Michael Weinstein, president of the Los Angeles-based AIDS Healthcare Foundation, in a statement released from Mexico City.

"Despite the way the CDC is spinning these new numbers, which AHF has been calling for the public release since last October, there is absolutely no good news here," he said.

Julie Scofield, executive director of the National Alliance of State & Territorial AIDS Directors, said federal AIDS prevention programs have largely failed to reach population groups most susceptible to contracting HIV.

"For years, prevention efforts serving gay men have been stifled by ideologues," she said.

"It is clear that the nation's HIV prevention efforts must be delivered in a manner that respects the real-life experiences of gay and bisexual men and African Americans, all who unacceptably bear the greatest burden of HIV disease."

Scofield and officials with other AIDS advocacy groups said the new CDC data highlight concerns they have raised for years: That the United States, while emerging as a leader in helping to fight AIDS in poor countries throughout the world, has neglected to adequately prevent the epidemic from spreading to many of its own citizens.

"Gay men of all colors face significant health disparities that directly compound chances of becoming HIV positive," said Jim Pickett, director of advocacy for the AIDS Foundation of Chicago, in a statement released in Mexico City.

"The rising incidence in our communities is a direct result of years of policies and programs that demonize and ignore the sexual health needs of gay men, especially African-American and Latino gay men, who bear the brunt of the epidemic in the United States," he said.

The findings of the CDC's new HIV-surveillance study were published this week in the Journal of the American Medical Association. The release was timed to coincide with the opening of the 17th Inter-national AIDS Conference, which occurred Aug. 3-8 in Mexico City.

Using a new technological development called Serological Testing Algorithm for Recent HIV Seroconversion (STARHS), CDC officials said they now estimate that 56,300 new HIV infections occurred in 2006, the most recent year for which data is available. The officials said the new figure represents the estimated number of new HIV cases in the U.S. since the early 2000s.

Prior to the new surveillance technique, the CDC has estimated that about 40,000 new HIV infections occurred each year since the 1990s.

"It is important to note that the 2006 estimate does not represent an actual increase in the annual number of new infections," said Richard Wolitski, acting director of the CDC's Division of HIV/AIDS Prevention.

"Rather, a separate CDC historical trend analysis published alongside the incidence estimate suggests that the number of new HIV infections was never as low as 40,000 and has been roughly stable since the early 2000s," he said in a statement released Aug. 2.

Wolitski said that while the new infection rate was unacceptably high, the total number of new infections have remained relatively stable at a time when new anti-retroviral AIDS drugs have enabled large numbers of Americans with HIV to remain healthy.

This has greatly increased the number of people living with HIV, yet the total number of new infections has remained flat, he said.

According to Wolitski and other CDC officials, this phenomenon indicates that U.S. HIV prevention programs are working for at least some population groups.

"The estimates indicate that HIV infections have been relatively stable to declining among people who inject drugs, women of all races, and high-risk heterosexuals," he said. "We have significant evidence that prevention works.

"But the fact remains that many populations at risk are not being reached by our prevention efforts, and much more must be done. For example, recent data indicate that in the past year, 80 percent of MSM have not been reached by the intensive interventions we know to be most effective."

The Washington Blade reported in November that new U.S. HIV infections were much higher than previously estimated, and scientists and AIDS researchers working with the CDC had begun talking about the data with colleagues at non-government organizations.

At the time, CDC officials said they would not release the new findings until the data were scrutinized by an independent scientific journal, which the CDC declined to identity.

Spokespersons with AIDS advocacy groups attending the Mexico City AIDS conference this week voiced strong objections to the CDC's decision to delay releasing the new findings, saying it prevented activists and their allies in Congress from citing the findings as justification for increasing HIV prevention funding.

Dr. Gene Copello, executive director of the AIDS Institute in Washington, D.C., noted that President Bush proposed cutting the CDC's HIV prevention budget by $1 million for next year.

Although the Democratic-controlled Congress rejected the president's proposal, it left HIV prevention funding at the same level as the current year, which had been reduced by $3.5 million from the previous year.

"Neither the U.S. House of Representatives nor the U.S. Senate has proposed any increased funding for HIV prevention," Copello said. "This is completely unacceptable, particularly in light of the new incidence numbers. Congress must increase funding for HIV prevention for next year by at least $30 million."

The AIDS Institute joined other AIDS advocacy and gay rights groups to call on the CDC to develop more HIV-prevention programs that target gay and bisexual men.

Activists have long complained that the Bush administration has acquiesced to conservative, religious organizations that oppose HIV-prevention programs that might "promote" homosexuality. In recent years, the president has also pushed through Congress increased funding for abstinence-only-until-marriage programs that critics say are ineffective in halting the spread of HIV.

In a statement released on Monday, Democratic presidential candidate Sen. Barack Obama said the new CDC data demonstrate the need to "focus our efforts to address AIDS and HIV here at home."

Obama said that as president, he would develop a national AIDS strategy to decrease the new HIV infection rate and expand access to HIV testing and "comprehensive education" programs for all population groups.

"We must also overcome the stigma that surrounds HIV/AIDS, a stigma that is too often tied to homophobia," he said.

Republican presidential candidate Sen. John McCain said that, if elected, he would address the HIV infection rate by working "closely with non-profit, government, and private sector stakeholders to continue the fight against HIV/AIDS."

McCain proposed a coordinated program that calls for "promoting prevention efforts, encouraging testing, targeting communities with high infection rates, strengthening research and reducing disparities through effective public outreach."

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