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AIDS in U.S. revised upward Researchers say epidemic worse than was thought
BY THOMAS H. MAUGH II Los Angeles Times

    Federal officials have been underestimating the number of new AIDS infections in the United States by 40 percent every year for more than a decade, a finding that indicates the U.S. epidemic is much worse than was thought, researchers said Saturday.
    Using sophisticated testing to identify new infections, the Centers for Disease Control and Prevention concluded that there are about 56,300 new infections each year — not the 40,000 figure that has been gospel for so long.
    The new numbers do not mean that the epidemic is growing in this country, just that researchers have been able to provide more accurate estimates, said Dr. Kevin Fenton, director of the CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention. He said the number of new infections has remained relatively constant since the late 1990s.
    Still, the higher estimates produced a jarring reminder that the United States, while castigating prevention efforts in the rest of the world, has not been able to get a firm grip on its own problems.
    The new numbers “reveal that the U.S. epidemic is — and has been — worse than previously estimated and serve as a wake-up call for all Americans,” said Richard Wolitski, acting director of the division of HIV/AIDS prevention at the national center.
‘SCATHING INDICTMENT’
    Michael Weinstein, president of the AIDS Healthcare Foundation, called the new figures “a scathing indictment of how profoundly U.S. and CDC HIV prevention efforts have failed. ... There is absolutely no good news here. Without an accurate picture of the epidemic, vastly underestimated for the last 10 years, we have missed countless opportunities to intervene with effective public health strategies.”
    While the epidemic has remained stable for most of this decade, the new figures confirm that the brunt of the epidemic is being borne by gay men and young blacks and Hispanics. There have been small declines among heterosexuals and injection drug users.
    Gay men accounted for 53 percent of all new infections in 2006, the most recent year for which data are available. Infection rates among blacks were seven times as high as among whites, while the rate among Hispanics was nearly three times as high.
    Fenton said blacks are affected disproportionately more than any other racial and ethnic group in the country. In fact, he said, gay and bisexual black men “are one of the most severely impacted groups in the world.”
    He attributed the increase in this group to poverty, lack of access to health care, substance abuse, incarceration and the increase in other sexually transmitted diseases.
    “If you are a young, gay black man, the likelihood that you will encounter HIV is staggeringly high, even if your personal behavior is no more risky than people in other communities,” said Mark McLaurin, a board member of the Community HIV/AIDS Mobilization Project.
    The new data “confirm that AIDS in America is a black disease, and has been neglected for far too long,” said Phill Wilson, founder and chief executive of the Black AIDS Institute in Los Angeles.
1.1 MILLION AIDS CASES
    The CDC said that about 1 million to 1.1 million Americans are HIVpositive.
    But epidemiologist and AIDS expert Philip Alcabes of Hunter College of the City University of New York noted that the increased incidence indicates that, “There are roughly 225,000 more people living with HIV in the U.S. than previously suspected. … The previous estimate was 1 million to 1.1 million.”
    A CDC spokesman rejected his contention, however, saying that the old prevalence figure remains accurate.
    More than 15,000 Americans die of AIDS each year.
    The new data will be unveiled formally Sunday at the International AIDS Conference in Mexico City and published later this week in the Journal of the American Medical Association.
    The CDC has been criticized heavily for not releasing the new numbers sooner. Fenton conceded that they were available last November, but the agency chose to delay releasing them until they were accepted for publication.
    Dr. Julie Gerberding, director of the CDC, said that the paper had been revised heavily and improved during the peer-review process and that she has much more confidence in the findings because of the process.
    Some critics suspect the results were delayed in an effort to avoid embarrassing the Bush administration, which has shrunk CDC’s prevention budget by 19 percent in current dollars since 2002, according to Rep. Henry Waxman, D-Calif.
    “This administration continues to insist on funding ineffective abstinence only programs that are failing to equip our children with the skills and knowledge necessary to protect themselves,” said Rep. Barbara Lee, D-Calif.
CALLS FOR ACTION
    The new estimates are certain to bring calls for increasing spending to combat the epidemic. Even at the old estimate of 40,000 new infections per year, nongovernment organizations were calling for the U.S. to spend at least another $300 million per year for prevention in addition to the existing $700 million targeted at halting new infections.
    Since the AIDS epidemic began in 1981, the actual incidence in the United States — and indeed, in the world — has been a matter of controversy. The problem has been that researchers have historically used “by guess and by golly” techniques to extrapolate overall numbers from limited data.
    In the case of the world numbers, better data have led to a recent downward revision, a 40 percent decline to about 2.5 million new infections each year and a total of about 33 million people living with the virus.
    In the past, U.S. data came primarily by extrapolating HIV infections from the number of newly diagnosed AIDS cases. But as better treatments have lowered the number of people progressing to full-blown AIDS, those estimates have become more tenuous, experts said.
    The new numbers rely on newer testing methods that allow technicians to determine whether an HIV infection occurred in the last fi ve months or is an older, long-term infection. More states also have begun reporting newly diagnosed HIV infections as well new AIDS cases.
    Using the new estimates for 2006, the team also re-analyzed the historical data. They concluded that the number of new infections peaked at about 150,000 per year in the mid-1980s, then declined to about 50,000 per year in the early 1990s.

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Michael Weinstein, president of the AIDS Healthcare Foundation, called the new figures “a scathing indictment of how profoundly U.S. and CDC HIV prevention efforts have failed. ... There is absolutely no good news here. Without an accurate picture of the epidemic, vastly underestimated for the last 10 years, we have missed countless opportunities to intervene with effective public health strategies.”