HIV Incidence Higher Than Previously Known: Waxman Blasts Administration

J0321082 There will be a great deal of news this week about the HIV epidemic given the fact that the XVII International AIDS Conference (IAC) will be starting this weekend in Mexico City.  Therefore, you may notice more postings about this than usual, especially since the epidemic occupied so much of my professional and personal life for so many years.

Here is a reprint of news from the Centers for Disease Control and Prevention (CDC) about HIV incidence in this country, followed by a rare Saturday press release from the office of Congressman Henry Waxman in response to this very upsetting news.

From the CDC:

New technology and methodology developed by CDC show that the incidence of HIV in the United States is higher than was previously known. However, the incidence has been stable at that higher level for most of this decade. HIV incidence is the number of new HIV infections occurring during a certain time period, in this case, the year 2006.

These findings, published by in a special HIV/AIDS issue of the Journal of the American Medical Association (JAMA) that was released August 3, 2008, show that in 2006, an estimated 56,300 new HIV infections occurred – a number that is substantially higher than the previous estimate of 40,000 annual new infections. It should be noted that the new incidence estimate does not represent an actual increase in the numbers of HIV infections. Rather, a separate CDC historical trend analysis published as part of this study suggests that the annual number of new infections was never as low as 40,000 and that it has been roughly stable since the late 1990s (with estimates ranging between 55,000 and 58,500 during the three most recent time periods analyzed).Trans_pie_3

The new estimates show that gay and bisexual men of all races and ethnicities and African American men and women are the groups most affected by HIV. Fifty three percent of all new infections in 2006 occurred in gay and bisexual men. African Americans, while comprising 13% of the US population, accounted for 45% of the new HIV infections in 2006.

Race_chartThe analysis revealed some encouraging signs of progress as well significant challenges. Findings documented reductions in new infections among both injecting drug users and heterosexuals over time. Yet, the findings also indicate that HIV incidence has been steadily increasing among gay and bisexual men since the early 1990s, confirming a trend suggested by prior data showing increases in risk behavior, sexually transmitted diseases, and HIV diagnoses in this population throughout the past decade. The analysis also found that new infections among blacks are at a higher level than any other racial or ethnic group, though they have been roughly stable, with some fluctuations, since the early 1990s. The new estimates highlight the need for expanded HIV prevention services and should serve as a wake-up call that the US HIV/AIDS epidemic is far from over.

Reaction from Congressman Waxman:

Saturday, August 02, 2008
Public Health, HIV/AIDS

Chairman Waxman’s Statement on the New CDC HIV Incidence Numbers

WASHINGTON, DC — Chairman Henry A. Waxman released the following statement today upon the release of new Centers for Disease Control (CDC) HIV incidence numbers.

“The HIV epidemic within our own borders is even worse than we had believed. This is a stark reminder of the importance of evidence-based HIV prevention programs. But under this Administration, HIV prevention has been underfunded and too often hindered by politics and ideology.

There are proven measures that change people’s behavior and reduce HIV transmission. As the total number of people with HIV in the United States has risen, so has the need for these programs.

But unbelievably, in recent years the HIV prevention budget has gone down. Since fiscal year 2002, when adjusted for inflation, CDC’s prevention budget has actually shrunk by 19%. The President has recently requested decreases in funding for HIV prevention at CDC.

So, even as the agency’s experts have identified a growing list of interventions that work, they’ve had less and less money to actually get these programs to the communities that need them. And they’ve had less money for crucial research for some of the highest-risk populations, like minority men who have sex with men.

In the meantime, this Administration has remained indefensibly dedicated to narrow abstinence-only programs, spending almost $1.5 billion on an initiative that has not been shown to have any positive impact on health. We’ve seen accurate public health information on condoms removed from Administration websites, and multi-year delays in the dissemination of HIV prevention information to the community.

The Administration has also contradicted the science on needle exchange. There is strong public health consensus that needle exchange programs reduce the risk of HIV without increasing drug use. Unfortunately, we have a statutory ban on the use of federal funds for these programs. Instead of taking a lead on changing this unwise policy, some Administration officials have repeatedly criticized needle exchange programs and disseminated inaccurate information about them.

Ideological interference like this should have no place in public health.

We know that HIV prevention does work. The tragedy is that despite this knowledge, our scientists, prevention experts and community leaders haven’t been able to implement evidence-based prevention at funding levels high enough to really take on this disease.

We need to refocus on what works in HIV prevention. We need to move away from policies that hinder those efforts. And we need to understand how to best invest resources in this fight. When Congress returns in September, I will be holding a hearing to investigate these questions.”

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