The Centers for Disease Control and Prevention (CDC) released new estimates on the HIV incidence rate on August 3. Incidence rate means the number of new infections during a specific time period. The CDC estimates that the current number of HIV incidence in the United States has gone up from 40,000 to 56,300, a 40 percent increase (read the full article here). The revised estimate does not represent an actual increase in the number of new HIV infections but reflects better HIV testing, more precise measures of HIV incidence, and better reporting of HIV cases to the CDC.[i]
The release coincides with the largest HIV/AIDS gathering in the world, the International AIDS Conference (IAC) in Mexico City, Mexico and comes on the heels of other data suggesting the HIV epidemic is worse than we thought (see SIECUS’ March policy update “CDC Releases New Reports Showing an Increase in STD Prevalence, Increase In HIV Cases”).[ii] For at least a decade it had been estimated that at least 40,000 new HIV infections occurred annually. The new estimate shows that older surveillance technology has underreported HIV incidence by about 15,000 to the CDC (see SIECUS’ press release here).[iii]
The estimate is taken from reported HIV diagnoses to the CDC of individuals 13 years or older (with or without a concurrent AIDS diagnosis) from 22 states in 2006. Several states and territories that have reported relatively high HIV incidence data in the past such as California, Massachusetts, Washington, DC, and Puerto Rico, were not included in the data.[iv] A new and more precise method of HIV incidence surveillance allows for distinguishing new HIV infections from longstanding ones and helps determine how long the individual has been infected with the virus (for more information, see “Using the BED HIV-1 Capture EIA Assay to Estimate Incidence Using STARHS in the Context of Surveillance in the United States”).
Many HIV/AIDS advocacy groups have taken the revised estimate as further proof that there continues to be a lack of support and resources for effective prevention efforts in the United States; especially since domestic HIV/AIDS prevention funding continues to be cut and the annual HIV incidence rate has reportedly remained stable for over a decade.
In an election year, both presidential candidates Senator Barack Obama and Senator John McCain emphasized their commitment to decreasing HIV infections and treating and caring for Americans who are already infected. Senator Obama has pledged to develop a National AIDS Strategy to effectively respond to the HIV/AIDS epidemic. Senator McCain has pledged to work with non-profit, government, and private stakeholders to reduce drug costs and increase HIV testing in order to prevent more cases of HIV in America.
“The new estimates of annual HIV infections must be viewed by policymakers and the public as a renewed call to arms to fully fund domestic prevention efforts,” said William Smith, vice president for public policy at the Sexuality Information and Education Council of the United States (SIECUS). “While the number of people in the U.S. becomes infected by HIV each year remains extremely troubling, our government’s response gets a grade of ‘F’ because prevention funding has declined in real dollars every year since 2001.”
[i] Questions and Answers: Advances in Methods of Measuring Incidence, Last Modified: August 3, 2008, Divisions of HIV/AIDS Prevention National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (Washington, DC), accessed 4 August 2008, <http://www.cdc.gov/hiv/topics/surveillance/resources/qa/incidence.htm>.
[ii] US government to release revised US HIV estimates (22 July 2008), Thomson Reuters 2008, accessed 23 July 2008, <http://www.reuters.com/article/americasCrisis/idUSN22348483>.
[iii] Public Health & Education | Number of Annual New HIV Cases in U.S. Might Be Higher Than Previously Thought (3 December 2007), Kaiser Daily HIV/AIDS Report, accessed 23 July 2008, <http://www.kaisernetwork.org/daily_reports/rep_index.cfm?hint=1&DR_ID=49158>.
[iv] Table 12. Estimated numbers of persons living with HIV infection (not AIDS) or with AIDS at the end of 2006, by area of residence and age category—United States and dependent areas, Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention (Atlanta, Georgia), accessed 4 August 2008, <http://www.cdc.gov/hiv/topics/surveillance/resources/reports/2006report/table12.htm>.