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Why the U.S. Has Not Stemmed HIV
An international AIDS conference in Toronto this week will focus on global progress against HIV and, perhaps, the lack of progress in the United States.
(By Nathan Denette -- Associated Press)
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Consequently, a stable rate of 40,000 new cases a year is a "very, very significant finding," Ronald O. Valdiserri, deputy director of the CDC's HIV and AIDS activities, said last week. "We think it represents some level of success in HIV prevention. We will not deny that we have a ways to go."
What would it take to lower the infection rate?
Holtgrave, who worked at the CDC and at Emory University before moving to Johns Hopkins, tried to answer that in 2002 and recently updated his calculations.
He estimates that the number of new infections could be cut in half if the 5 million Americans at highest risk of HIV -- 4 million because of sexual activity and 1 million because of drug use -- received the full battery of proven interventions. Those include HIV counseling and testing, free condoms, one-on-one or small-group counseling sessions, and needle exchange.
The CDC now spends $720 million a year on HIV prevention. It would need to spend $415 million more to reduce new cases by 50 percent, according to Holtgrave's calculations.
He and his collaborators further estimated that the country would need to prevent 12,000 infections each year to save money in the long run. HIV infection is expensive to treat, and newly infected people will need to be treated for decades -- a huge cost to the health-care system.
There is a lot of evidence that there is much more prevention to be done.
The CDC last month published a survey of 10,000 men who have sex with men -- the term preferred by epidemiologists, as some such men do not consider themselves gay or bisexual. They were questioned at bars, dance clubs, gyms, raves, beaches and on the street in 17 cities between 2003 and 2005.
The survey found that 77 percent had been tested for HIV in the previous year. Testing is a crucial prevention tool. Studies have shown that each year, 11 percent of people who do not know they are infected transmit the virus to someone else, compared with 2 percent of those who do know. Overall, it is estimated, about one-quarter of infected Americans do not know their status.
Forty-seven percent of those interviewed said that in the past year they had engaged in unprotected anal sex -- the riskiest activity. Ninety-eight percent had gotten free condoms. But only 15 percent had had one-on-one risk counseling, and only 8 percent had had peer-group sessions -- two interventions found to change behavior.
The population most vulnerable is young black men who have sex with men. In a study of five cities -- Baltimore, Los Angeles, Miami, New York and San Francisco -- published last year, CDC researchers found that 46 percent of people in that category were infected. Two-thirds of them did not know it.
Many of those men are difficult to reach for testing and risk counseling, and some organizations that work with that population have found it increasingly difficult to get government money for their efforts.
