HIV infections in U.S. more likely due to social networks, says New England Journal of Medicine

The New England Journal of Medicine says HIV cases in the U.S. are more likely tied to social networks rather than behavior.

In an article on the Journal’s website, authors Wafaa M. El-Sadr, Kenneth H. Mayer, and Sally L. Hodder write:

Traditionally, researchers and policymakers concerned with HIV acquisition have concentrated on specific high-risk transmission behaviors, including injection-drug use, sex with multiple partners, and failure to use protective measures such as condoms or safe injection practices. It is now evident that among men who have sex with men, the use of drugs such as crystal methamphetamine — especially at sex parties and in venues such as bathhouses — has contributed to risky behavior and HIV acquisition. Other disinhibiting substances, including alcohol and cocaine, are also associated with increased risk taking in these populations.

However, the extent of the risk of acquiring HIV in the United States today is largely defined by a person’s sexual network rather than his or her individual behaviors. Understanding the context and settings in which risk is increased may lead to more robust and effective preventive interventions. For example, black men who have sex with men are at increased risk for HIV infection in part because of its high prevalence in their sexual networks and their likelihood of choosing racially similar partners; they have also been shown to be less likely than their white counterparts to be aware of their HIV status and thus are more likely to unknowingly transmit HIV.5 Moreover, even those who are aware of their HIV infection may be less engaged in HIV care and less likely to avail themselves of antiretroviral therapy — behavior that limits the potential benefit of such therapy as a preventive strategy.

The piece also offers some startling stats in relation to HIV infection in Washington D.C. as well as New York City.

Over the past decade, limited attention has been paid to the human immunodeficiency virus (HIV) epidemic in the United States. The global epidemic — particularly the epidemic in sub-Saharan Africa, where approximately two thirds of the world’s population living with AIDS resides — has rightfully received most of the focus. Meanwhile, however, the prevalence of HIV infection within some U.S. populations now rivals that in some sub-Saharan African countries (see graph). For example, more than 1 in 30 adults in Washington, D.C., are HIV-infected — a prevalence higher than that reported in Ethiopia, Nigeria, or Rwanda.1 Certain U.S. subpopulations are particularly hard hit. In New York City, 1 in 40 blacks, 1 in 10 men who have sex with men, and 1 in 8 injection-drug users are HIV-infected, as are 1 in 16 black men in Washington, D.C.2 In several U.S. urban areas, the HIV prevalence among men who have sex with men is as high as 30%3 — as compared with a general-population prevalence of 7.8% in Kenya and 16.9% in South Africa.

What the study fails to mention is the prevalence rate in Detroit, where over 50 percent of the zip codes in the city have a prevalence rate of three percent or higher, and one zip code tops out at six percent prevalence– on par with Uganda. Those numbers have lead Detroit leaders to call the HIV epidemic in that area a “crisis” and an “emergency.”

But evidently not emergency enough according to budget information provided by the Michigan Department of Community Health.

Those numbers show the state spends significantly more money on the AIDS Drug Assistance Program (which spends $11,000 per year on providing medications to just under 2,800 HIV-positive individuals in the state). The ADAP program costs the state $25,706,072 per year, while all prevention services are at $9,923,579 — under half what the state spends in medications.