The United States has significantly underreported the number of
new HIV infections occurring nationally each year, with a study
showing that the annual infection rate is 40 percent higher than
previously estimated.
The study, conducted by the Centers for Disease Control and
Prevention and released here on Saturday, found that 56,300 people
became newly infected with HIV in 2006, compared with the 40,000
figure the agency has cited as the recent annual incidence of the
disease.
The findings confirm that HIV, the virus that causes AIDS, has
its greatest effect among gay and bisexual men of all races (53
percent of all new infections) and among African-American men and
women.
The new figures are likely to strongly influence a number of
decisions about efforts to control the epidemic, said the disease
centers' director, Dr. Julie Gerberding, and other AIDS experts.
Timely information about trends in HIV transmission, they said,
is essential for planning and evaluating prevention efforts and the
money spent on them.
Gerberding said the new findings were "unacceptable," adding that
new efforts must be made to lower the infection rates. "We are not
effectively reaching men who have sex with men and African-
Americans to lower their risk," she said.
Dr. Kevin Fenton, who directs HIV- prevention efforts at the
agency, said, "CDC's new incidence estimates reveal that the HIV
epidemic is and has been worse than previously known." A separate
historical trend analysis published as part of the study suggests
that the number of new infections was probably never as low as the
earlier estimate of 40,000 and that it has been roughly stable over
all since the late 1990s.
CDC officials said the revised figure did not necessarily
represent an increase in the number of new infections but reflected
the ability of a new testing method to more precisely measure HIV
incidence and secure a better understanding of the epidemic.
Dr. Philip Alcabes, an epidemiologist at Hunter College in New
York, raised questions about the validity of the findings. If they
are true, Alcabes said in a statement, the agency has undercounted
new HIV infections by about 15,000 per year for about 15 years.
"Therefore, there are roughly 225,000 more people living with HIV in
the U.S. than previously suspected," he said. "The previous estimate
was 1 million to 1.1 million."
A CDC spokeswoman said Alcabes' estimates were incorrect because
the new figures could not be used to calculate the total number of
people with HIV. The CDC does not know the total number but is
expected to determine it later in the year.
The CDC, the agency responsible for tracking the AIDS epidemic in
the United States, said its new monitoring system provided more
precise estimates than were previously possible of new infections in
specific populations. Infection rates among blacks were found to be
seven times as high as for whites (83.7 per 100,000 people versus
11.5 per 100,000) and almost three times as high as for Hispanics
(29.3 per 100,000 people), a group that was also disproportionately
affected.
The CDC has known of the new figures since last October, when the
authors completed a manuscript and sent it to the first of three
journals. But the agency refused to release the findings until they
were published in a peer- reviewed medical journal. The first two
journals rejected the authors' request for a fast-track review.
The paper is being published in the Aug. 6 issue of The Journal
of the American Medical Association. The journal and the disease
centers had planned to release it at a news conference on Sunday at
the opening of the 17th International AIDS Conference here. But the
paper was released on Saturday because the embargo was broken.
A number of leading health experts have criticized the agency for
not releasing the information earlier. On Nov. 21, CDC officials
told AIDS advocacy groups and reporters that the data would be
released soon. In an editorial on June 21, The Lancet, an
internationally prestigious journal published in London, severely
criticized the disease centers for failing to release the
information and said, "U.S. efforts to prevent HIV have failed
dismally."
Kevin Robert Frost, chief executive of the American Foundation
for AIDS Research, said the AIDS conference would exert increasing
pressure on "governments to focus on reaching the marginalized
populations that are most affected by the epidemic," like gay men,
injecting drug users and African-Americans.
"The shameful reality is that most governments and global health
institutions are only now beginning to develop strategies to reach
these vulnerable groups," Frost said.
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