Important note: Information in this article was accurate in 1996. The state of the art may have changed since the publication date.
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The Wall Street Journal - May 16, 1996
Amanda Bennett, Staff Reporter of The Wall Street Journal
A researcher for the Centers for Disease Control and Prevention has pulled together hundreds of pieces of scattered information to show just how many people are already infected with the human immunodeficiency virus in 96 U.S. cities and metropolitan areas, and how many people in each of those areas are likely to become infected each year.
The paper, prepared by Scott Holmberg, a CDC epidemiologist, and published today in this month's American Journal of Public Health, breaks out estimates of HIV prevalence not only by city, but by major risk groups.
Dr. Holmberg estimates, for example, that in Atlanta there are 23,000 injection drug users, of whom 3,340 are HIV positive, and that the city could expect about 393 new HIV infections among injection drug users a year. Similarly, the paper estimates that there are 35,100 men in Detroit who have sex with men, and that over 4,800 of them are HIV positive, with an estimated 151 new cases a year in that group.
This type of detailed information, which has never before been available on such a comprehensive basis, is important because everything from the health messages directed to the general public to the amount of money allocated for research, prevention and the care of AIDS patients depends in large measure on precise information on where the virus is spreading.
While some states with many AIDS cases, like New York, have developed similar data on their own, for others this information is new. "It will be for some areas, the first opportunity to . . . give an indication of where the epidemic is going in a local area," says Helene Gayle, in charge of AIDS prevention at the CDC.
State officials say this kind of information is invaluable in their politically charged task of directing AIDS-prevention funding away from lower-risk groups toward groups that need it most.
While most scientists agree, for example, that injection drug use is a major factor in spreading AIDS, no researcher has previously been as specific in calculating the national impact on a city-by-city basis.
"If you can estimate the prevalence in any particular city and any risk group, then we can go back and say, `This is how many people we have and this is where we should look to direct the dollars that we get,'" says Michael Wallace, director of the HIV division of the Indiana State Department of Health.
He says such detailed information will help to get money directed toward needle-exchange programs. Dr. Holmberg estimates that nearly half of all new HIV infections are occurring in injection drug users. But needle exchanges, widely seen as among the most effective means of stopping the spread of HIV, remain barred from federal funding.
The study also shows the vast gulf between the perception that AIDS is spreading widely into heterosexual groups and scientific data. While Dr. Holmberg estimates the spread of HIV among heterosexuals in each of the cities, he defines "heterosexuals" as the partners of injection drug users and bisexual men -- reflecting most scientists' conclusions that heterosexual spread of HIV is largely confined to those two high-risk groups.
The American Journal of Public Health accompanies the article with a lengthy description of the methodology, which was unusual. Dr. Holmberg developed a statistical model that pieces together data from more than 350 documents and information from 220 public-health officials. The journal cautions that the unorthodox method might lead to errors. For example, the study used the number of gay bars listed in a gay travel magazine as one of the factors in calculating the number of men who have sex with men.
Still, public-health officials in states that do their own such calculations say his conclusions are similar to theirs. And the journal's editor, Mervyn Susser, notes that each local estimate was cleared with local officials before publication.
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Estimating Infection
Estimated number of HIV-positive individuals in selected cities by risk group
--HIV-Positive Individuals--
CITY INJECTION MEN WHO HAVE AT RISK POPULATION DRUG USERS SEX WITH MEN HETEROSEXUAL
Chicago 7,586,706 10,500 12,040 1,300
Dallas 2,801,818 540 7,100 340
Detroit 4,303,014 3,460 4,860 500
New York 8,557,768 69,000 44,000 11,800
San Francisco 1,640,990 3,300 22,000 640
Source: American Journal of Public Health, May 1996
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WJ960503
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