CDC: New HIV infections stable but demographically skewed

Wednesday the Centers for Disease Control and Prevention released its first multi-year report on HIV infections in the U.S, finding that new infections remained stable at about 50,000 per year, but also noting that young, black, gay or bisexual men saw increasing infection rates over that time period — the only risk group to see an increase.

“More than 30 years into the HIV epidemic, about 50,000 people in this country still become infected each year. Not only do men who have sex with men continue to account for most new infections, young gay and bisexual men are the only group in which infections are increasing, and this increase is particularly concerning among young African American MSM ,” said CDC Director Thomas Frieden, M.D. “HIV infections can be prevented. By getting tested, reducing risky behaviors, and getting treatment, people can protect themselves and their loved ones.”

Here’s how the CDC characterized the study in a release:

According to the new estimates, there were 48,600 new HIV infections in the United States in 2006, 56,000 in 2007, 47,800 in 2008 and 48,100 in 2009. The multi-year incidence estimates allow for a reliable examination of trends over time. They reveal no statistically significant change in HIV incidence overall from 2006 to 2009, with an average of 50,000 for the four-year period. In 2009, the largest number of new infections was among white MSM (11,400), followed closely by black MSM (10,800). Hispanic MSM (6,000) and black women (5,400) were also heavily affected.

Statistics from the Michigan Department of Community Health’s quarterly level analysis for July 2011 show that about 53 percent of the HIV cases in the state are in the risk category of men who have sex with men (49 percent) or men who have sex with men and are intravenous drug users (four percent). Black men make up 42 percent of the cases found in men statewide, while white men make up 30 percent of the cases. Black women represent 17 percent of all the cases of women in the state while white women represent four percent. Overall, 78 percent of the cases in Michigan were identified in men, while 22 percent were identified in women.

“While we’re encouraged that prevention efforts have helped avoid overall increases in HIV infections in the United States, and have significantly reduced new infections from the peak in the mid-1980s, we have plateaued at an unacceptably high level,” said Kevin Fenton, M.D., director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention. “Without intensified HIV prevention efforts, we are likely to face an era of rising infection rates and higher health care costs for a preventable condition that already affects more than one million people in this country.”

In July 2010, President Barack Obama released the country’s first ever National HIV/AIDS Strategy. The program outlined ambitious goals, including reduction of new cases by 25 percent by 2015, but the plan included no increases in federal funding for prevention efforts.

“This data shows us the importance of targeting HIV prevention efforts. With this in mind, we need to commend the Michigan Department of Community Health’s usage of their CDC cooperative agreement HIV prevention dollars. MDCH has used these funds to support highly targeted counseling and testing efforts as well as effective prevention interventions to men who have sex with men, specifically those of whom are African American. This is becoming more important as we contemplate the upcoming recission of more than 20 percent of these funds from the CDC in the next year and up to 33 percent of these dollars within five years,” says Mark Peterson, a spokesperson for the Michigan Positive Action Coaltion, MI-POZ. “With no local or state support for these programs, the only prevention services we have available are through these shrinking dollars. We encourage MDCH to continue to target these funds to support the hardest hit populations in our epidemic. We can no longer afford to divert funds away from men who have sex with men, especially African American men who have sex with men.”

In addition, the AIDS Drug Assistance Program, which helps low income people infected with HIV access life saving anti-retroviral medications and medications to fight opportunistic diseases and side effects of the medications, is suffering because of the economy. With unemployment high, more people are turning to programs such as ADAP for assistance, putting a strain on the system which has in turn resulted in 8,871 people in 13 states awaiting access to medications, according to the ADAP Advocacy Association.

The CDC release further dissected the numbers, noting the impact on the men who have sex with men communities:

Men who have sex with men remain the group most heavily affected by new HIV infections. While CDC estimates that MSM represent only 2 percent of the U.S. population, they accounted for the majority (61 percent; 29,300) of all new HIV infections in 2009. Young MSM (ages 13 to 29) were most severely affected, representing more than one quarter of all new HIV infections nationally (27 percent; 12,900 in 2009).

Young MSM of all races are heavily affected. By race/risk young, black MSM were the only group to experience a statistically significant increase in new infections over the four-year time period studied. CDC estimates that new HIV infections among young, black MSM increased 48 percent during that period (from 4,400 HIV infections in 2006 to 6,500 infections in 2009).

Though the reasons are not yet clear, studies suggest that several factors may be driving this trend: higher proportions of young, black MSM are unaware of their infection than MSM of other racial/ethnic groups; stigma of HIV and homosexuality, which can hinder utilization of HIV prevention services; limited access to health care, HIV testing and treatment; increased likelihood of having older sexual partners (who are more likely to be HIV infected), compared to MSM of other racial/ethnic groups; higher rates of some sexually transmitted diseases among young black men, which can facilitate HIV transmission; and under-estimating personal risk for HIV.

“We are deeply concerned by the alarming rise in new HIV infections in young, black gay and bisexual men and the continued impact of HIV among young gay and bisexual men of all races,” said Jonathan Mermin, M.D., director of CDC’s Division of HIV/AIDS Prevention. “We cannot allow the health of a new generation of gay men to be lost to a preventable disease. It’s time to renew the focus on HIV among gay men and confront the homophobia and stigma that all too often accompany this disease.”

Peterson concurred with Mermin.

“We have just finished 8 years of federal policy which forcibly limited federally funded HIV prevention efforts from being able to respond comprehensively for HIV in men who who have sex with men, regardless of how they identify. We dealt with homophobic policies that did not allow us to use federal funds to provide the most effective interventions we could for these men. Our demographics of the epidemic clearly show what happens when you disenfranchise groups of people. The people, we as a government chose not to protect were men who have sex with men, especially those who are also African American,” the AIDS activist said. “We simply have to see this disease by its epidemiological demographics in Michigan and realize that racism, homophobia and gender bias in HIV health care and prevention are what is responsible for the disparate health profile. There is no greater health disparity faced in our state than that which is being faced by African American men who have sex with men, in regards to HIV acquisition.”

Rod McCullom, a blogger and journalist based in Chicago who writes frequently about HIV and black men, was much more forceful with his response to the CDC finding.

“This is an outrage. Black men who have sex with men — especially younger ones — continue to be the hardest hit by the HIV/AIDS epidemic. Black MSM are suffering the highest infection rates, have seen the highest increases and also the least likely to know they are infected. When will the data trend in a positive direction?

“What’s important to keep in mind is that the data does not exist in a vacuum. The black community is hit hardest by health disparities — less likely to be insured and less likely to get tested. And once black men or women test positive, they are more likely to need Medicaid, ADAP or other social services.

“It seems to me that the new data is just a symptom. We need to remain vigilant about prevention, but we also need to link black men to testing, to health care, to doctors and prevention. And that is becoming increasingly difficult in this challenging economic climate when conservatives see a ‘bulls eye’ target on health care reform, HIV/AIDS funding and ADAP.

“And of course we have to address stigma, discrimination and homophobia. Those are what are keeping many black and Latino MSM away from testing and away from care. It’s all hand in hand. The CDC’s new data should be a wake up call.”

While national LGBT groups were conspicuously silent on the CDC study, Emily Dievendorf, policy director for Equality Michigan, spoke out about the study and how it reflects the reality on the ground in Michigan.

“The recent data drives home once again that the self-imposed code of silence surrounding HIV will always do more damage than good,” she said. “Unfortunately, as the stigma tends to be stronger in our communities of color, the silence is pervasive and devastating. Young black MSM are experiencing alarming rates of new HIV infections while the infection rates in other communities are stabilizing. This is yet another clear illustration that the interests and challenges of the gay community and communities of color are not mutually exclusive. Our gay and transgender brothers and sisters are not defined by any color line. Health resources, education and testing need to be broadly available and encouraged by every part of our HIV affected communities. This is no time to perpetuate destructive divisions. As we know, acceptance within a community and coalition building between communities can also be significantly lifesaving and preventative.”

Peterson said his group would continue to push lawmakers and health officials to address this issue.

“This should be a wake up call that clearly shows us that if we continue to pretend like our policies haven’t been racist and homophobic, we can expect this disturbing trend in case demographics to only get worse,” he said.