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HIV Incidence: The Latest Numbers

January 1, 2013

Paul E. Sax, M.D.

Paul E. Sax, M.D., is director of the HIV Program and Division of Infectious Diseases at Brigham and Women's Hospital in Boston.

The CDC has recently issued the latest report on HIV incidence (i.e., new infections) in the United States, and as always it's fascinating to review the numbers.

To start, the year-by-year estimated incidence:

2007: 53,200
2008: 47,500
2009: 45,000
2010: 47,500 (38,000 men, 9,500 women)

Nope, not much change. Will data from HPTN 052 -- published in the summer of 2011 -- eventually have an impact? I think so, as the results strongly influenced both treatment guidelines and patients' willingness to start therapy. A more pessimistic view is that the treatment-as-prevention message from 052 won't have much of an effect, since data like these show that only a minority of people with HIV are actually on successful treatment. We'll see.

This latest CDC report then highlights two important trends, one good news, one not-so-good:

The new analysis also finds two noteworthy trends among heavily affected populations: early signs of an encouraging decrease in new HIV infections among black women (21 percent decrease between 2008 and 2010), and a troubling and continuing increase in new infections among young gay and bisexual men (22 percent increase over the same time period).

In these days of fiscal cliff wrangling, I could use my taxpayer's prerogative and show you a whole slew of figures -- but these three really stand out as giving us a snapshot of who gets HIV in the United States these days:

1. Incidence in 2010 among various "risk groups" (MSM, men who have sex with men; IDUs, injection drug users):

New HIV infections 2010

Click image to enlarge.

2. Proportion of new infections by transmission category:

New infections by category

3. Rate of new infections by race, ethnicity, and sex:

Rate of new infections

The glass-half-full message is that HIV prevention efforts are clearly working, at least to some extent, as the prevalence of HIV -- the number living with the virus -- continues to increase, yet the incidence stays the same.

The half-empty view? The continued shift of the epidemic to younger MSM of color will make additional gains difficult, as this is a patient population that could be challenging to reach.

Paul Sax is Clinical Director of Infectious Diseases at Brigham and Women's Hospital. His blog HIV and ID Observations is part of Journal Watch, where he is Editor-in-Chief of Journal Watch AIDS Clinical Care.

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This article was provided by Journal Watch. Journal Watch is a publication of the Massachusetts Medical Society.
 

Reader Comments:

Comment by: Jamie (Toronto, Canada) Wed., Jan. 9, 2013 at 1:23 pm EST
The chart reveals a significant anomaly in the reported incidence among black hetero males, which is unmatched among white & Latino males. I also don't buy the notion that 20% of transmissions among blacks are F-to-M via hetero sex, where this mode doesn't even register among whites & Hispanics.

A culture of denial is not conducive to understanding, and I'd be inclined to add the two figures for blac males (MSM & hetero). Anyway, HOW they got it is far less relevant than A) how treatment, and support, are made available; and B) ho prevention efforts need to better adapt to and address the disproportionate rate of infections among black males, per population.

This is as much a matter of culture as it is of public health -- I don't know the answers, but I don't hear the question being asked clearly, or nearly often enough.
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Comment by: Cleber (WiqAbDWQpuihefR) Tue., Jan. 8, 2013 at 8:36 am EST
What a joy to find such clear thniking. Thanks for posting!
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Comment by: Ramadhan (South Africa) Mon., Jan. 7, 2013 at 11:08 pm EST
You can try so hard,but nothing will ever stop the increasing of H.I.V expept by implementing strong punishment for those who commit sexual intercause without being married
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Comment by: jim (boston) Thu., Jan. 3, 2013 at 6:12 pm EST
Part of the solution has to be honest, non-judgmental sex and health education. These things need to be learned before people become sexually active. Once bad attitudes and habits have been established it's much harder to influence behavior. Unfortunately the blue noses and those who need to appease them will never allow that to happen. At least not in this country. The determination of some people to preserve the mythical "innocence" of children actually preserves nothing but their ignorance and imperils their future. I'm appalled at how often I meet young gay men who are sadly and dangerously ignorant about HIV and STD's in general.
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