Rate of New US HIV Infections Higher Than Previous Estimates

Bob Roehr

August 04, 2008

August 4, 2008 (Mexico City) — New HIV infections in the United States reached 56,300 in 2006, according to long-anticipated figures released by the Centers for Disease Control and Prevention (CDC) on August 2. That is about 40% more than the previous estimate of 40,000 annual infections, which the CDC has been using since the early 1990s.

The numbers are contained in an article published in a special issue of the Journal of the American Medical Association. They were made public on August 2 via a telephone news conference after the embargo on publication was broken.

The study is based on analysis of stored blood samples using a detuned enzyme-linked immunosorbent assay that can determine whether the infection occurred within 6 months of collection or earlier. It allowed the agency to reconstruct incidence of infection going back to 1977.

"The new estimate does not represent an actual increase in the number of new infections but reflects our ability to more precisely measure HIV incidence and secure a better understanding of the epidemic," said Kevin Fenton, MD, director of the CDC's National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention.

As a result, the CDC's estimates of the incidence of HIV infection may have been off by more than a third, not just this year, but stretching back 2 decades.

The analysis was known, and a draft of the paper circulated for publication, as early as last October, but the CDC did not release the numbers pending publication in a peer-reviewed journal, despite repeated requests for them to do so.

Although total HIV incidence has been revised upward, there are no significant changes in the demographics of the groups most affected by the epidemic: 73% are male, and 53% of total infections are attributed to men who have sex with men. People of color are also disproportionately affected, with rates per 100,000 persons of 83.7 among blacks and 29.3 among Hispanics compared with 11.5 among whites.


"The new numbers highlight that we have an ongoing, potentially increasing problem here in the United States," Scott Hammer, MD, told Medscape HIV/AIDS. The infectious disease specialist at the Columbia University College of Physicians and Surgeons, New York City, said many clinicians have long felt that their experience at the local level was not being reflected in the national numbers and that the epidemic was larger than those figures indicated.

"We have known for years that we have a number of different subepidemics in this country — particularly among African American men who have sex with men in urban areas, there is a clear increase and a clear risk."

This comes despite the most recently reported data from places like San Francisco and Florida, which show declines in the number of new infections. Dr. Hammer said, "When you have an aggregate number, it washes away a lot of different issues. You have to look behind the numbers to certain focal subepidemics.

"Even in places where the numbers go down, we can't be complacent. Until we see a halving of the numbers, and a clear trend of that magnitude at the national level, complacency is a real risk for a breakout."

Julie Scofield, executive director of the National Association of State and Territorial AIDS Directors, said the data provide "definitive evidence that HIV prevention has not been adequately funded to decrease the number of new HIV infections."

She made the comparison with the President's Emergency Plan for AIDS Relief, the United States' international HIV effort, in which 22% of total funding is dedicated to prevention, but domestically, only 4% of total federal HIV dollars go to prevention.

The CDC's HIV prevention budget has been cut, and when combined with the ever-rising cost of living, there has been a 19% decline in purchasing power since fiscal year 2002.

"Better numbers tell us that we need to better target and tailor our scarce prevention dollars," said Craig E. Thompson, executive director of AIDS Project Los Angeles. "Gay men and other men who have sex with men of every race and ethnicity are the single largest group affected by HIV/AIDS in this country. Underfunded, 'cookie-cutter' prevention is no longer viable if we want to control the epidemic in the United States."

Walt Senterfitt, cochair of the national prevention group Community HIV/AIDS Mobilization Project, said it is not just the need for more money but how that money is spent. "Jesse Helms—era restrictions on proven means of effective prevention, the pernicious intersection of HIV, and major social injustices" such as racism and homophobia are important contributing factors that must also be addressed, he said.

JAMA. 2008;300(5):520–529.


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