Last
week, the Centers for Disease Control and Prevention (CDC) released long-awaited
updated estimates of the number of people in the U.S. living with HIV/AIDS. As
previously reported activists and media speculated that the rates could be
as much as 50% higher than the steady 40,000 estimated annual cases the agency
has been reporting for the past several years.
The
new report reflects the shift to nation-wide name-based reporting of HIV cases,
which many states had previously utilized only for AIDS diagnoses. These included
some of the largest states with the highest case burdens, including California
and Illinois.
According
to the latest estimates, between 1,039,000 and 1,185,000 people in the U.S. were
living with HIV/AIDS at the end of 2003. In 2006, there were an estimated 35,314
new cases of HIV/AIDS in adults, adolescents, and children in the 33 states that
have consistently used name-based reporting.
Among the adults and adolescents
diagnosed with HIV/AIDS in 2006:
•
By sex:
•
73% were men •
26% were women
•
By race/ethnicity:
•
49% were black (though they make up just 13%
of the population) •
30% were white •
18% were Hispanic •
1% were Asian/Pacific Islander •
<1% were Native Americans
•
By age:
•
32% were age 35-44 years •
26% were age 25-34 years •
20% were age 45-54 years •
15% were age 13-24 years •
6% were age 55-64 years •
2% were older than 65 years •
<1% were under 13 years
•
By transmission category overall:
•
50% were men who have sex with men (MSM); •
33% were high-risk heterosexual contact; •
13% were injection drug users (IDUs); •
3% were both MSM and IDUs. •
Looking only at men:
•
67% were MSM •
16% were high-risk heterosexual contact •
12% were IDUs •
5% were MSM and IDUs
•
Looking only at women:
•
80% were high-risk heterosexual contact •
19% were IDUs
Importantly,
these new cases represent new diagnoses of HIV/AIDS, but not necessarily
new infections, since some people who were only recently diagnosed were
infected in previous years. The CDC plans to release estimates of actual new HIV
infections later this year.
Of note, the report contains estimates of case
of HIV infection (not AIDS) in 45 states and 5 dependencies that now have name-based
reporting. States reporting HIV by name for the first time were California, Delaware,
Illinois, Maine, Michigan, Oregon, Rhode Island, and Washington (Hawaii, Maryland,
Massachusetts, Montana, and Vermont still do not so).
For this larger
group of states, the figure was 48% higher, rising from 35,537 in 2005 to 52,878
in 2006. The CDC claims that these numbers do not represent an increase in either
HIV diagnoses or HIV incidence, but rather reflect the larger total population
when considering these additional areas. Combined, the new states account for
more than 18,000 of the 2006 HIV cases.
In
addition, the CDC issued a "Dear Colleague" letter to help explain the
agency's methodology and put the findings into context. The text of that letter
is included below.
Dear
Colleague:
This
week, the Centers for Disease Control and Prevention (CDC) released its annual
report, HIV/AIDS Surveillance Report -- Cases of HIV Infection and AIDS in
the United States and Dependent Areas, 2006 Vol 18. This report presents data
for cases of HIV infection and AIDS reported to CDC through June 2007. We recognize
this report is being issued later than normal in the data cycle, due to unavoidable
delays. We appreciate your patience and support as we transition to a new electronic
HlV/AIDS reporting system.
This
report contains estimated numbers of cases of HIV/AIDS from the 38 areas (33 states
and 5 dependent areas) that have had confidential name-based HIV infection reporting
since at least 2003. According to the number of reported ADS cases, these 33 states
represent approximately 63% of the epidemic in the 50 states and the District
of Columbia.
The
2006 HIV/AIDS Surveillance Report is organized into 5 sections: (1) cases of HIV/AIDS
and AIDS, (2) deaths of persons with AIDS, (3) persons living with HIV/AIDS, AIDS,
or HIV infection (not AIDS), (4) length of survival after AIDS diagnosis, and
(5) reports of cases of HIV/AIDS, AIDS, and HIV infection (not AIDS).
Key
conclusions of this report include
•
African Americans and gay and bisexual men
of all races continue to be most severely affected. •
From 2003 through 2006, the estimated number
of HIV/AIDS cases in the 33 states with confidential name-based HIV infection
reporting remained stable. •
From 2002 through 2006, the estimated number
of newly diagnosed AIDS cases in the 50 states and the District of Columbia remained
stable, while the estimated number of deaths of persons with AIDS decreased.
Although
the total number of new cases of HIV/AIDS remained stable, HIV prevalence (i.e.,
the number of persons living with HIV/AIDS) increased steadily from 2003 through
2006. It is important to note that HIV prevalence differs from HIV incidence,
which reflects the annual incidence, which reflects the annual number of new HIV
infections each year. CDC is currently working with states to implement the first
national system for estimating HIV incidence based on direct measurement of new
HIV infections that will provide a critical missing piece in tracking the U.S.
epidemic. In addition, data from this new system, when available, will provide
the clearest picture to date of HIV infections in the U.S. and, over time, will
allow us to better target prevention efforts and measure progress in populations
at highest risk.
In
the interim, data on estimated HIV diagnoses provide the best indication
of the impact of the epidemic. It is important to note that estimated HIV diagnoses
do not necessarily represent new infections. This is because some individuals
with new HIV diagnoses were infected recently, while others were infected many
years ago.
Also
please note that Table 16 contains data on reported cases of HIV infection. The
table titled "Reported cases of HIV infection (not AIDS), by area of residence,
2006 and cumulative - 45 states and 5 U.S. dependent areas with confidential name-based
HIV infection reporting" reflects an increase in the number of states with
confidential name-based HIV infection reporting from 2005 to 2006. These data
do not represent an increase in HIV diagnoses or HIV incidence. In 2005, CDC received
reported cases of HIV infection from 38 states and 5 dependent areas. In 2006,
CDC received reported cases of HIV infection from 45 states and 5 dependent areas.
This increase in the number of states reporting has resulted in an increase in
the number of reported cases of HlV from 35,537 in 2005 to 52,878 in 2006.
This
HIV/AlDS Surveillance Report confirms that more than 25 years into the
AIDS epidemic, HIV continues to exact a tremendous toll in the United States.
While the total number of new cases of HIV/AIDS remained stable through 2006,
certain populations remain disproportionately affected such as African Americans
and gay and bisexual men of all races. While the 2006 analysis has not yet been
finalized for young (aged 13-24) black men who have sex with men, 2005 data suggest
this population may be particularly vulnerable, underscoring the need for expanded
access to HIV prevention services for everyone at risk. We hope this report will
be useful to you as we continue to work together to reduce the unacceptable burden
of HIV/AIDS. The HIV/AID Surveillance Report is available on the CDC
HIV/AIDS Web site, and fact sheet at http://www.cdc.gov/hiv/resources/factsheets/us.htm.
Thank
you for your continued commitment to HIV/AIDS prevention.
Sincerely,
Robert
S. Janssen, MD Director, Division of HIV/AIDS Prevention National Center
for HIV/AIDS, Viral Hepatitis, STD and TBPrevention
