As the 17th International AIDS Conference opens today in Mexico City, researchers from the U.S. Centers for Disease Control and Prevention are reporting that the HIV epidemic at home is substantially worse than was thought.
It's been hard to know just how many Americans get infected with HIV each year. For a long time, states didn't collect the names of newly infected people, making it hard to get a count. And when someone had a positive HIV blood test, there was no way to know if the infection occurred yesterday or five years ago.
That's changed. Now all states keep confidential reports of who's infected, and a new test can tell if an infection occurred within the past five months.
Kevin Fenton, who heads the CDC's AIDS prevention efforts, says the new data give the clearest picture yet of the U.S. AIDS epidemic.
"What the data actually show is that the 2006 estimate of roughly 56,000 new infections is substantially higher — it's about 40 percent higher than what had previously been estimated," he says.
The old estimate had been 40,000 new infections a year, 16,000 fewer.
New methods permit researchers to go back and see how many infections have occurred over the past decade. They found that even though the number of infections is higher than thought, it's remained stable.
"This stability in the presence of a growing population of HIV-infected individuals is encouraging," Fenton says. It suggests that people with HIV are largely heeding advice to practice safer sex.
Another prevention success is an 80 percent drop in new infections among injecting drug users since the late 1980s. Fenton says this is due, in large part, to drug users' access to clean needles.
"This certainly is an effective prevention intervention," he says, while pointing out that federal law prohibits federal funding for needle-exchange programs for drug users.
It's state and local governments that get the credit for setting up clean-needle programs, he says.
The prevention failures portrayed in the new numbers are not revelations, but their magnitude has never been clearer.
For instance, new infections are dropping in some groups, but not in others. Infections among men who have sex with men have been steadily increasing. Twenty-seven years into the epidemic that started in this group, gay and bisexual men still account for more than half of all new cases.
"The data really confirm that the most severe impact of the epidemic continues to be among gay and bisexual men of all races and among black men and women," Fenton says.
Blacks account for 45 percent of new HIV infections. Their infection rate is seven times that of whites. Infections among Hispanics are three times higher.
That, experts say, is where more HIV prevention money needs to be spent.
But Ronald Johnson of the AIDS Action Council says funding has been going down.
"When you have nearly flat funding for HIV treatment and care and reduced funding for HIV prevention, it means we're not doing what we need to do," he says.
Johnson says, with inflation, the CDC's HIV prevention budget has declined about 20 percent over the past six years.
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