Aug. 2, 2008 -- The U.S. AIDS epidemic is -- and has been -- much worse than we'd thought.
More than 56,000 Americans -- 40% more than previously known -- get a new infection with the HIV tests virus every year. And although that overall rate isn't going up, it hasn't gone down since it dropped to that level in the early 1990s from a peak of about 130,000 in the mid-1980s.
The new estimate, which ranges from 48,200 to 64,500 annual HIV infections, comes from the CDC's sophisticated new surveillance system, which includes name-based reporting of HIV tests and lab tests that show how long a person has carried the virus.
"These data underscore the critical importance of HIV infection and emphasize the toll it is having not only worldwide but in this country as well," Wolitski tells WebMD. "We need to recognize the HIV epidemic as the crisis that it is and ensure we are responding in a manner that matches the severity of the problem."
Who Gets HIV in America?
The new data prove what other CDC studies have suggested: New HIV infections are going up among gay and bisexual men. Gay/bisexual men get more than half of the new infections every year.
This is a slap in the face to prevention efforts by gay/bisexual men that slashed new infections from a peak of about 75,000 new infections a year in the mid 1980s to under 20,000 in the early 1990s. Since then, every two-year reporting period has seen steady backsliding. Now, more than 30,000 gay/bisexual men get a new HIV infection each year.
"A lot of people had mistakenly thought that HIV was not as severe a problem as it really is among gay and bisexual men," Wolitski says.
There's another huge disparity at work in the U.S. AIDS epidemic. Black Americans get seven times more new HIV infections than do white Americans. In 2006, nearly half of new HIV infections -- 45% -- were in non-Hispanic blacks.
"It is a very large and disturbing disparity," Wolitski says.
Race itself is not the risk. Wolitski points to factors and situations that disproportionately affect black Americans' HIV risk.
"Poverty, stigma, misperceptions of risk, disparities in rates of sexually transmitted diseases, and the destabilizing effects incarceration has on individuals, families, communities, and substance use -- all may be playing a role here," he says.
Black men who have sex with men are at particularly high risk. A 2005 CDC study showed that in some U.S. cities, 46% of black gay/bisexual men were infected with HIV. That's twice the 21% infection rate seen for white gay/bisexual men, and far higher than the 17% rate for gay/bisexual Hispanic men.
Drug Users -- Clue to AIDS Prevention Success?
The CDC's new figures aren't all gloom and doom.
A ray of light comes, of all places, from intravenous drug users. Since the mid-1990s, fewer and fewer Americans have been getting HIV from intravenous drug use. That's due not to a decrease in drug use, but to prevention success among those who continue to use illicit drugs.
"It is exciting to see the continued declines in new infections among intravenous drug users," Wolitski says.
What makes this so exciting is that drug users are a hard-to-reach population that obviously ignores mainstream health messages. Yet prevention efforts succeeded in dropping new HIV infections from a high of about 35,000 per year in the late 1980s to fewer than 6,000 per year in 2003-2006.
"It underscores the importance of a comprehensive approach that included a focus on individuals' needs, and includes needle and syringe exchanges that have been implemented in many communities around the country," Wolitski says. "Here it shows why we really need a comprehensive approach to HIV prevention. No single strategy is going to be a solution to the epidemic."
The Future of AIDS in America
Often lost in discussions of new HIV treatments is the fact that nobody has to get HIV. It's a 100% preventable infection. But prevention means dealing with sexual issues in a practical, forthright manner.
Last year, 14,000 Americans died of AIDS. That brings the U.S. AIDS death toll to more than 545,000 men and women.
"We all have to be doing more as individuals, as communities, and as a nation to stop this disease that continues to take a devastating toll on so many Americans," Wolitski says. "We need to ensure people who need intervention are being reached. We have to make sure HIV infection is not a rite of passage for new generations of gay and bisexual men. We need to be strongly fighting against this disproportionate burden that HIV has for African-American and other communities of color, and have to ensure that all young people have the knowledge, the skills, and the confidence they need to protect themselves from HIV throughout their lives."
The CDC report appears in the Aug. 6 issue of The Journal of the American Medical Association.