- New data indicate continuing impact on African Americans and gay and bisexual men
- HIV prevention interventions for at-risk and HIV-positive populations show effectiveness
- Rapid HIV testing efforts increase number of people receiving counseling and test results
Atlanta -- Data presented today at the 2005 National HIV Prevention Conference in Atlanta indicate that roughly one million Americans were living with HIV at the end of 2003 and that HIV prevalence remains extremely high among African-American men who have sex with men (MSM) in several U.S. cities. Other data show that while HIV diagnoses reported among adolescent and young adult females have declined steadily, diagnoses in males have increased in recent years. Data presented today also show that some prevention programs are substantially reducing sexual risk behavior among people with HIV and those at risk for infection, and that voluntary rapid testing efforts are increasing the number of people who find out their HIV status.
African Americans and MSM Most Affected
New Centers for Disease Control and Prevention (CDC) estimates of HIV prevalence in the United States indicate that between 1,039,000 and 1,185,000 people were living with HIV in December 2003. The estimates provide the clearest picture to date of the scope of the U.S. epidemic overall and among specific racial and ethnic and risk groups.
The new estimates indicate that HIV continues to have the greatest impact among African Americans and MSM. At the end of 2003, blacks accounted for 47 percent of people estimated to be living with HIV in the U.S.; whites accounted for 34 percent and Hispanics for 17 percent. Asian/Pacific Islanders and American Indians/Alaska Natives each represented roughly 1 percent of the HIV-positive population. By transmission category, MSM remained the most heavily affected group, accounting for 45 percent of people living with HIV. Individuals infected through high-risk heterosexual contact comprised 27 percent, and those infected through injection drug use accounted for 22 percent of the HIV-positive population. Roughly three-quarters (74%) of Americans estimated to be living with HIV are male.
The study suggests that the make-up of the HIV-positive population may begin to shift in coming years, as non-Hispanic blacks, females, and individuals infected through high-risk heterosexual contact account for a higher proportion of infections among people living with HIV (not AIDS) than among those already living with AIDS.
The last estimate of HIV prevalence, released in 2002, suggested that at the end of 2000, between 850,000 and 950,000 people were living with HIV. These estimates, however, did not include breakdowns by racial and ethnic or risk groups. Besides updating the prevalence estimates, researchers also examined the proportion of the HIV-positive population aware of their infection status. Results indicate that as of 2003, between 24 and 27 percent of individuals living with HIV infection remained undiagnosed. As improved treatments have increased the lifespan of HIV-positive persons in recent years, overall prevalence has steadily increased in the U.S. (Presentation T1-B1101).
A separate CDC analysis suggests that undiagnosed HIV infection continues to play a significant role in the extremely high rates of infection among African-American MSM. Consistent with earlier research, black MSM in a new five-city study were more than twice as likely to be infected with HIV as other MSM, and were less likely to be aware of their infection. Forty-six percent of black MSM in the study were HIV-positive, compared to 21 percent of white MSM and 17 percent of Hispanic MSM. Among HIV-infected MSM, 67 percent of black men, 48 percent of Hispanic men, and 18 percent of white men were unaware of their infection before study participation, underscoring the need to reach MSM with testing and prevention services. The study surveyed 1,767 MSM over age 18 at public venues in Baltimore, Los Angeles, Miami, New York City, and San Francisco between June 2004 and April 2005 (Plenary session, "New Approaches to Tracking the HIV Epidemic in the U.S.").
Other CDC data point to the continuing impact of HIV on young African-American MSM across the nation. Researchers examined trends in new HIV diagnoses (with or without AIDS) among persons 13 to 24 years of age between 1994 and 2003 in 25 U.S. states with longstanding, name-based HIV reporting.1 Results indicate that new diagnoses declined significantly among young women, but rose among young men. Among 13- to 24-year-old females, new HIV diagnoses fell 20 percent over the 10-year period. HIV diagnoses also declined among young men for the first few years of the period (by 30% from 1994 to 1998); but the decline was offset by a 41 percent increase from 1999 to 2003. The increase among young men was driven by a 47 percent rise in diagnoses among MSM ages 20-24, 60 percent of whom were black. While researchers were unable to determine if the increases in HIV diagnoses among young men were the result of increased testing or an actual increase in new infections, the findings are consistent with other recent data suggesting a possible resurgence of HIV among young MSM (Presentation M1-B0802).
"These new data underscore the need to deploy the full spectrum of HIV prevention strategies to confront today's epidemic," said Dr. Ronald O. Valdiserri, co-chair of the 2005 National HIV Prevention Conference and deputy director of CDC's HIV, STD and TB prevention programs. "HIV-positive individuals are living longer than ever before, and we must reach them with services that can help them stay healthy and protect others from infection. Reaching at-risk populations with HIV testing and providing infected and at-risk individuals with effective, ongoing prevention services will be critical to reduce the number of new infections."
Reducing Risk Behavior in HIV-Positive and -Negative Populations
A range of research on effective prevention programs will be presented, including the first comprehensive review of prevention interventions specifically for people living with HIV. CDC researchers found that these programs reduced occurrence of unprotected sex by an estimated 43 percent. Researchers also examined the characteristics of effective interventions and found that programs delivered by health care providers as part of routine medical services were generally most effective (Presentation TP-050).
Similarly, multiple programs for HIV-negative populations will be highlighted, including a group intervention for HIV-negative, African-American MSM. The program, "Many Men, Many Voices (3MV)," has been shown to reduce the frequency of unprotected sex in this population and is being carried out by community organizations across the country. The 3MV program comprises six weekly facilitated discussion sessions which include HIV prevention information, role-playing, group problem solving, and discussions that address the attitudes and beliefs that impact African-American MSM and their sexual practices (Presentation M1-C1204). In addition, community organizations and health departments are collaborating with CDC to expand the use of four specific interventions shown to reduce sexual risk behaviors among HIV-positive and HIV-negative African-American women. Through individual and group counseling sessions, these programs improve women's sexual health communications skills, enhance skills in correct condom use, and work to help African-American women build the self-worth and confidence needed to take control of their health (Presentation T1-D1003).
Growing Acceptance of HIV Testing and Expanded Use of the Rapid Test Dramatically Increase Counseling, Testing, and Diagnosis
An analysis of nationwide survey data found that the proportion of adults ever tested for HIV while visiting their doctors more than doubled between 1998 and 2002. Based on responses from more than 31,000 people surveyed in each of the two years, researchers at Central Michigan University determined that the proportion of people tested for HIV during "routine medical checkups or surgical procedures" increased from 11 percent of people ever tested in 1998 to 25 percent in 2002. The study is one of the first to show, on a national scale, the growing acceptance of testing in routine medical settings (Presentation M3-L0303).
"Knowing your HIV status is key to protecting your health and that of your sexual partners," said CDC's Dr. Valdiserri. "Ensuring that people have access to testing and receive their HIV test results -- along with post-test prevention counseling -- is essential to reducing the number of new HIV infections in the U.S. Voluntary testing links people at risk for HIV to counseling to help them stay uninfected, and helps ensure that HIV-positive individuals are linked with medical care and prevention services to help them protect others from infection."
Expanded HIV testing initiatives in New Jersey are significantly increasing the number of people who learn their HIV status and receive risk-reduction counseling. A New Jersey state program to expand availability of a rapid HIV test (OraQuick®) increased by 52 percent the proportion of individuals statewide who received post-test HIV prevention counseling and their results, compared to previous efforts using conventional testing techniques. Conventional techniques, including the standard ELISA test, require blood samples to be sent to a lab and take up to two weeks for processing results.
Among people tested through this program, the HIV prevalence rate was found to be 15 percent higher than among those tested statewide before the rapid test was available (2.3 % vs. 2.0% of people tested). This finding suggests the program is more effectively reaching high-risk individuals, including minority populations (Presentation MP-039). A $2 million multimedia campaign during the summer of 2004 is largely credited with a 135 percent increase in the number of rapid tests, and a 42 percent increase in the number of all types of HIV tests, conducted statewide (Presentation MP-037).
Results were also presented on other innovative programs to reach high-risk populations with HIV testing, such as a rapid testing mobile unit that has helped The Night Ministry in Chicago reach more than 1,000 of the city's homeless with opportunities to be tested and referred to needed services and care. The program's outreach staff uses a specially outfitted bus and van that travel into the city between 7:00 p.m. and 1:00 a.m. to provide HIV counseling and testing and other services in nine Chicago neighborhoods (Presentation MP-101).
- HIV case reporting from the following states is included in the analysis: Alabama, Arizona, Arkansas, Colorado, Idaho, Indiana, Louisiana, Michigan, Minnesota, Mississippi, Missouri, Nevada, New Jersey, North Carolina, North Dakota, Ohio, Oklahoma, South Carolina, South Dakota, Tennessee, Utah, Virginia, West Virginia, Wisconsin, and Wyoming.
The 2005 National HIV Prevention Conference, convened by the Centers for Disease Control and Prevention (CDC) and dozens of other public, private and government agencies, is taking place in Atlanta, Georgia, from June 12-15, 2005. This biennial meeting focuses exclusively on the important science of HIV prevention, giving community organizations, public health professionals, clinicians, advocates and other interested individuals the opportunity to exchange information about effective prevention approaches. For more information, please visit www.2005hivprevconf.org.