Text: CDC Reports on U.S. HIV/AIDS Infection Rates

14 August 2001

Text: CDC Reports on U.S. HIV/AIDS Infection Rates

Death rates stable; officials fear increasing infection

Rates of new U.S. AIDS cases and AIDS deaths stabilized in the period from July 1998 to June 2000, in contrast to sharp declines in the two previous years, according to findings released by the U.S. Centers for Disease Control (CDC).

"Two decades into the epidemic, these latest data show us that we are at a turning point -- we either move forward toward further reducing HIV, or risk going back to a period of elevated infections," said Dr. Helene Gayle, director of CDC's National Center for HIV, Sexually Transmitted Diseases (TD) and Tuberculosis (TB) Prevention, in an August 13 release from Atlanta, Georgia.

The earlier sharp decline in the number of cases and deaths has been attributed to the emergence of highly active antiretroviral therapy (HAART), which has been successful at easing the symptoms and prolonging the lives of many AIDS patients.

The data were released at a National HIV Prevention Conference sponsored by a range of government health agencies and nongovernmental organizations fighting the epidemic.

Through December 2000, the most recent data available, the CDC's HIV/AIDS Surveillance Report cites almost 775,000 cases in the United States, with slightly more than 448,000 deaths.

Gayle cited several possible causes of the apparent changing trend in HIV infection: individual delays in testing; treatment side effects and failure; and the lack of some citizens' access to health care.

Other notable findings reported by the CDC:

-- The cases of mother-to-child transmission in the United States have reached a record low;

-- Risk behaviors are increasing among homosexual men after earlier periods of decline;

-- Almost half of low-income African-American women are engaged in high-risk behavior;

-- Infection rates are declining in selected populations of intravenous drug users.

Following is the text of the CDC news release:

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CENTERS FOR DISEASE CONTROL

2001 National HIV Prevention Conference

State of the HIV and AIDS Epidemic

Monday, August 13, 2001

Overview Release on State of Epidemic

AIDS Cases and Deaths Hold Stable for Second Year

-- Risk Behaviors Increasing Among Gay Men; Little Variance by Race/Ethnicity Despite Higher HIV Rates Among African Americans

-- Bisexual Behavior Common Among Young MSM (men who have sex with men); Many African-American Women Unaware of HIV Risk

-- Risk Behavior Among Gay and Bisexual Men and African-American Women

-- Declines in HIV Rates for Injection Drug Users

Atlanta, GA -- Between July 1998 and June 2000, AIDS cases and deaths in the United States remained stable, underscoring the urgent need for earlier HIV testing and expanded access to prevention and treatment services, the Centers for Disease Control and Prevention (CDC) announced today. The agency released the latest U.S. data on adult and perinatally-acquired AIDS cases and deaths at the second National HIV Prevention Conference in Atlanta.

"The marked decline in deaths we saw when new AIDS treatments first became available appears to have stabilized," said CDC Director Jeffrey P. Koplan, M.D., M.P.H. "In order to make further progress against AIDS, we continue to face formidable challenges, including re-energizing the fight to prevent HIV infections in the first place, getting more at-risk individuals tested for HIV, and developing new AIDS treatment options."

At a press briefing at the conference today, Helene Gayle, M.D., M.P.H., director of CDC's National Center for HIV, STD, and TB Prevention, will discuss the new data along with new studies to be presented at the Prevention Conference on continued increases in sexual risk behavior by men who have sex with men (MSM) in some areas. Additionally, research reported today showed high rates of unprotected sex among low-income African-American women, while other data indicated the lowest rates of AIDS cases among infants in nearly a decade, and marked declines in HIV rates among injection drug users.

"Two decades into the epidemic, these latest data show us that we are at a turning point -- we either move forward toward further reducing HIV, or risk going back to a period of elevated infections," Gayle said. "Gay men and minority women continue to be at elevated risk. It's time for new strategies and new commitments to HIV prevention -- not only among gay men and communities of color, but among all Americans at risk for HIV."

LATEST AIDS DATA

National AIDS Cases And Deaths Stable: Today, CDC released its year-end HIV/AIDS Surveillance Report for the year 2000. Through December 2000, 774,467 Americans had been reported with AIDS, of whom 448,060 had died.

Because AIDS cases and deaths must be adjusted to account for delays and incomplete information in order to estimate trends over time, the new report provides AIDS incidence (estimated number of cases occurring annually) and deaths through 1999.

Additionally, in the opening plenary session, Dr. Gayle released preliminary information on trends in AIDS incidence and deaths through June 2000.

The latest CDC data confirm a trend which began in mid-1998, when the falling rate of new AIDS cases and AIDS deaths slowed dramatically compared to the significant declines of the previous two years associated with the introduction of highly active antiretroviral therapy (HAART). Data for the first two quarters of 2000 demonstrate a continued stabilization, with roughly 4,000 AIDS deaths and 10,000 AIDS cases diagnosed each quarter since July 1998.

Dr. Gayle said that lack of progress in further reducing AIDS cases and deaths is likely due to several factors:

-- Delays in HIV testing that prevent many HIV-positive people from learning they are infected so they can obtain treatment that will delay the onset of AIDS

-- Treatment side effects, drug resistance, and treatment failure

-- The considerable proportion of Americans who lack access to adequate health care

Data to be presented at the Prevention Conference this week show that many Americans with HIV do not get tested until they already have or are about to develop AIDS -- missing the opportunity for years of prevention services and medical care. (See accompanying press release: "Research Reveals Gaps in HIV Testing and Prevention for HIV-Positive Americans.")

Perinatally acquired AIDS cases reach record low. The latest CDC data on perinatally acquired AIDS cases (those among infants who contracted HIV from their mothers) demonstrate a decline of 84 percent since these cases peaked in 1992. Only 156 cases were diagnosed in 1999, down from 901 in 1992. The first two quarters of 2000 indicate continued declines, with 47 cases reported in the first two quarters in 2000, compared to 87 cases in the first two quarters of 1999. Declines in perinatally acquired cases occurred in all racial/ethnic groups. CDC researchers attribute the declines to continued increases in the number of women tested for HIV during pregnancy and in the number of HIV-infected women provided therapy for their own health and to reduce transmission to their child.

STATE OF THE EPIDEMIC...

Risk Behaviors Increasing Among Gay Men; Little Variance by Race/Ethnicity Despite Higher HIV Rates Among African Americans

Numerous studies released at the conference show elevated and in several cases increasing risk behavior among both HIV-negative and HIV-positive men who have sex with men (MSM) across the United States. New data from CDC's Young Men's Survey, a study of behaviors and infection levels among young gay men, suggest that risk behaviors do not differ appreciably among racial/ethnic groups.

"These studies show that action is needed now to stem the HIV crisis among gay and bisexual men," said Ronald Valdiserri, M.D., M.P.H., deputy director of CDC's HIV, STD, and TB prevention programs. "HIV prevention is a lifetime commitment. We must target our prevention efforts to meet the needs of diverse gay and bisexual communities, including African-American and Latino MSM -- many of whom do not identify as gay -- young MSM who have little knowledge of the epidemic's early years, and older MSM struggling to maintain safer sex practices over a prolonged period of time. As the studies today illustrate, we also need new strategies to reach HIV-positive MSM and MSM who also have sex with women, placing both their male and female partners at risk."

The new data come on the heels of a recent six-city CDC study with preliminary data indicating that young MSM ages 23-29 in several cities are becoming infected at an annual rate of 4.4 percent -- a rate comparable to levels seen among some populations of gay men in the mid-1980s. Rates were especially high among African-American MSM, at 14.7 percent, compared to 3.5 percent among Latinos, and 2.5 percent among whites.

MSM Risk Behavior High, but Does Not Appear to Differ Among Racial/Ethnic Groups

A new analysis of risk behavior among young gay and bisexual men from CDC's Young Men's Survey reveals that despite disproportionately high HIV infection rates among young African-American MSM, these men are no more likely to engage in high-risk sexual behavior. The high rates of new infection among African Americans prompted researchers to examine potential differences in risk behaviors among racial/ethnic groups.

The study, led by CDC's Dr. Linda Valleroy, found that self-reported risk behavior did not differ by racial/ethnic group among those newly infected, nor did it differ significantly among all 2,942 MSM aged 23 to 29 in the study:

--Of all participants, 30 percent reported five or more male sex partners in the past six months: 27 percent of African Americans, 30 percent of Hispanics, and 32 percent of whites.

--Similarly, the percentage who reported having unprotected anal intercourse in the previous six months was actually somewhat lower among African-American MSM: 46 percent overall; 40 percent among African Americans; 48 percent among Hispanics and 48 percent among whites.

Given that recent risk behavior patterns do not explain the high rates of new infection, researchers believe the high infection rates among young African-American MSM may be due to higher HIV prevalence among their sexual partners. While more research will be needed to confirm this theory, if young MSM are likely to choose partners from their own racial/ethnic group, the high level of HIV prevalence -- that is, the total number of people infected, regardless of when they became infected -- in African-American communities would result in any risk behavior carrying a much higher chance of infection, therefore contributing to high levels of incidence -- or new infections in this group.

Resurgence of Unprotected Sex Among MSM in Seattle

Rates of unprotected sex among HIV-negative MSM in Seattle have increased by 17 percent since 1994-1995, and the proportion of men reporting six or more sex partners in the last year has risen by 28 percent, according to new analysis from the Seattle-King County Health Department. The findings, by researcher Edward White and colleagues, are drawn from data gathered between 1994-1999 on over 13,000 men tested for HIV at sites targeting MSM across the city. In 1994-1995, 43 percent of men tested reported unprotected anal sex. In 1998-1999, that number increased to 51 percent. Increases appeared to be greatest among men aged 14-25. The proportion of men who reported six or more sex partners in the last year increased from 45 percent in 1994-1995 to 58 percent in 1998-1999, a relative increase of 28 percent. The research also showed that increases in the number of partners were greatest among those having unprotected sex.

Unprotected Sex On The Rise Among HIV-Positive MSM In Seattle

A new study of HIV-positive MSM in Seattle has found recent increases in unprotected anal intercourse (UAI). Following a two-year decline, the percentage of HIV-positive MSM reporting recent UAI with an HIV-negative partner or one whose HIV status was unknown doubled, from 10 percent in 1998 to almost 20 percent in 2000. Among study entrants who had recent anal intercourse, the percentage reporting UAI climbed from 50 percent in 1996 to 68 percent in 1998. The study was conducted by Thomas Lampinen Ph.D., Nancy Kiviat M.D., and their colleagues at the University of Washington.

More Than One In Seven Young MSM In South Miami Beach Study Is HIV Positive

Sixteen percent of a representative sample of young MSM ages 23-29 living in the South Beach section of Miami Beach, Florida, are infected with HIV, according to a study by Robert Webster and colleagues at the University of California at San Francisco, and Florida International University in Miami. Unmarried men who reported ever engaging in sex with a man and who resided in South Beach for at least 30 days were eligible. Most of the 94 participants in the 1996 study were white or Latino, with HIV prevalence -- the total number of infections -- similar in each group: 15.2 percent among whites and 17.5 percent among Latinos. Risk behavior in the study was high, with 45.7 percent of participants reporting unprotected anal sex within the past year, and similar levels of unprotected sex between HIV-positive and HIV-negative individuals -- 40 percent and 46.8 percent, respectively. A companion 1996 study by the researchers of 105 older MSM in the same area found that a significantly higher proportion -- 34.3 percent -- were HIV positive. The men, who were aged 30 and above, also reported a similar level of risk behavior as their younger counterparts, with 44.8 percent engaging in unprotected sex in the past year.

A related study evaluated a prevention strategy being used by some MSM, which has been termed "negotiated safety." Negotiated safety arrangements vary, but often include agreements in which HIV-negative MSM partners either agree to remain monogamous, or have rules prohibiting unprotected sex outside the relationship, and/or agree to disclose any breaches of their agreement to the other partner. The study demonstrates that this strategy, like other prevention measures, will only work effectively when individuals fully comply.

Potential Pitfalls Of Negotiated Safety

A San Francisco study of 38 HIV-negative men practicing "negotiated safety" to reduce HIV risk found that 39 percent either failed to comply or lacked explicit agreements to disclose any breaches. This may place their partners at risk of infection as the couple continues to have unprotected sex under the pretext that neither has been exposed to HIV. Led by Robert Guzman of the San Francisco Department of Public Health, the study underscores the need to emphasize full compliance with negotiated agreements, and for prevention programs to explain the high potential for, and consequences of, broken and inadequate agreements.

STATE OF THE EPIDEMIC

Bisexual Behavior Common Among Young MSM; Many African-American Women Unaware of HIV Risk

Two studies highlight unique prevention challenges for reducing infection in women. The first study highlights the role bisexuality may be playing in the epidemic among women. The second indicates that many African-American women, despite engaging in unprotected sex with partners of unknown serostatus, do not perceive themselves to be at risk for HIV infection.

High HIV Risk Behavior Among Young Minority MSM; 17 Percent Also Have Sex with Women

Nearly one in three young men who have sex with men (MSM) had unprotected anal sex with a man in the past three months, and nearly one in five had sex with a woman, according to new research by the CDC. The study, conducted by Carolyn Guenther-Grey and colleagues, surveyed 2,621 MSM aged 15-25 in thirteen communities across the U.S. The majority of the young men were minority -- 32 percent were Hispanic/Latino, 28 percent African American, and 23 percent were white. Thirty percent of the men reported unprotected anal sex with a man in the three-month period before the survey, and seventeen percent reported sex with a woman in the same period. The study was conducted in Atlanta, Birmingham, Ala., Chicago, Detroit, Milwaukee, Minneapolis, Seattle, San Diego, Orange County, Calif., West Hollywood, Calif., San Gabriel Valley, Calif., Jackson Heights/Queens Borough, NY, and Washington Heights/South Bronx, NY.

High Risk Among Low-Income African-American Women in Atlanta

Almost half of African-American women surveyed in an Atlanta study did not use a condom during any sexual encounter in the previous two months, and 60 percent did not know their partner's HIV status. The study, by Elleen Yancey, Ph.D., of the Morehouse School of Medicine, surveyed 250 women aged 17-44 in six metropolitan areas of Atlanta, 65 percent of whom had annual incomes less than $10,000 and 58 percent of whom had not completed high school. Preliminary findings show that of those who were sexually active, 45 percent had not used a condom at all in the past two months. Forty-nine percent of all those surveyed said their partner had not been tested for HIV or that they did not know. An additional 11 percent of women said their partner had been tested but that they did not know the result. Seventy percent reported that they perceived no risk or very little risk for contracting HIV. Abstract 587, "Analysis of Levels and Predictors of HIV Risk Behavior Among African-American Women Ages 17-44 Years: Prevention and Intervention Implications," Poster, Monday, August 13, 2001.

Declines in HIV Rates for Injection Drug Users

Data released today showed declines in HIV rates among injection drug users (IDUs) in New York City over the past decade. Study investigators attribute these declines in part to the success of syringe exchange and counseling and testing programs.

HIV Rates Fall Sharply Among IDUs in New York

The proportion of injection drug users (IDUs) in New York City who are HIV positive has fallen by more than half since the 1980s, according to analysis of surveys and studies conducted since 1990 and involving over 11,000 IDUs. The analysis, led by Don Des Jarlais, Ph.D. of the Beth Israel Medical Center, found that HIV prevalence decreased from 50 percent in 1990 to 20 percent in 2000. The research also found that the annual infection rate among injectors had dropped from four percent in 1990 to one percent in 2000. The study suggests that IDU participation in syringe exchange and counseling and testing programs over the same time period contributed to the decline. Participation in syringe exchange increased from 20 percent to 45 percent between 1990 and 2000, and the proportion of IDUs ever tested for HIV increased from 40 to 80 percent during the same period.

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