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CDC’s HIV numbers reflect new reporting data

by Bob Roehr

Dr. Robert Janssen.
Dr. Robert Janssen.   (Source:Bob Roehr)

Names-based reporting of HIV diagnoses totaled 52,878 in the United States in 2006, according to data released by the Centers for Disease Control and Prevention on March 24.

At first glance that was significantly higher than the 35,537 diagnoses reported in 2005, but once one sorted through the technical explanations of what was counted and where, there was no increase at all.

The confusion comes from the fact that the CDC has always required the reporting of AIDS diagnoses by name, but not HIV diagnoses. Initially that made little difference because of rapid disease progression and death, but the introduction of powerful antiretroviral therapies in the mid-1990s changed the natural course of disease.

Some states sought to protect patient confidentiality by developing alternatives to names-based reporting for HIV. However, the CDC demonstrated that those alternatives could lead to duplication when people test several times or move, so it began to require names-based reporting. It takes several years for a state system to become established and report "clean" data.

The big jump in diagnoses in 2006 came from adding for the first time figures from seven newly reporting jurisdictions - California, Delaware, Illinois, Maine, Oregon, Rhode Island, and Washington, D.C.

"Data show that from 2003 to 2006, the estimated number of HIV/AIDS cases in the 33 states and five areas with long-standing confidential name-based HIV reporting remained stable (in 2003, 36,102 HIV diagnoses; in 2006, 36,817 diagnoses)," said Dr. Robert Janssen, director of the CDC HIV prevention programs.

"The higher number of reported HIV diagnoses in 2006 compared to 2005 is due to the fact that this table includes data from states that have newly implemented confidential name-based HIV reporting as of 2006, including highly populous states like California, Illinois, and Washington. HIV cases from these states have not been included in CDC surveillance reports in the past," Janssen said.

If the data from just the states that reported in both 2005 and 2006 is compared, the total number of new HIV diagnoses actually declined by about 2 percent. Five states did not have names-based reporting of HIV in place in 2006 and their data was not included in the national totals. They are Hawaii, Maryland, Massachusetts, Montana, and Vermont.

Among adolescents and adults, 75 percent of the HIV diagnoses were in males and 25 percent were in females. There were 566 reported cases in children. The epidemic disproportionately affects people of color and more than 60 percent of those living with AIDS contracted the disease through male-to-male sexual contact.

AIDS Action was critical of the CDC report.

"The newly released 2006 numbers of 52,878 reported HIV infection cases (45 states) and 39,002 reported AIDS cases (50 states) continues the CDC's pattern of underreporting numbers by not including all states in their count, and doing so in a manner that is confusing and makes year-to-year comparisons difficult," the agency said in a statement posted on its Web site.

AIDS Action also noted that the CDC's latest data, "showing level reporting by states with mature HIV reporting systems, and the addition of over 18,000 HIV cases from just six states, magnifies the need for the next president to create a national AIDS strategy with measurable outcomes, timelines, and adequate funding for prevention, treatment, and research."

Democratic presidential candidate Senator Hillary Clinton issued a statement last week in which she proposed doubling the HIV/AIDS research budget in the National Institutes of Health to $5.2 billion annually. She also noted that her health care plan would ensure that "Americans living with HIV/AIDS have access to care."

Senator Barack Obama, also a Democratic presidential candidate, has pledged to promote HIV prevention domestically and abroad.
A search on presumptive Republican presidential nominee John McCain's Web site under health issues found nothing on HIV/AIDS.

HIV diagnosis does not necessarily reflect recent infection. In fact the vast majority of those diagnoses occur when the patient shows up at an emergency room with an opportunistic infection and a low CD4 count, generally below 200. The infection occurred several years, perhaps more than a decade earlier.

The CDC is pushing increased testing for HIV so that more people will learn if they are carrying the virus and begin therapy before too much damage is done to their immune system.

Just over a year ago, the CDC launched a program of heightened prevention outreach to the African American community. The program has not gone well, however, with revolving leadership, poor communications with the community, and no new funding for anything beyond testing.

"This seems like yet another grand vision outlined in a glossy document that is, in fact, ill-equipped to make any real dent in new infections," said Kenyon Farrow, spokesman for the Community HIV/AIDS Mobilization Project.

HIV prevention advocates are calling for the U.S. to adopt a national AIDS strategy with measurable goals, rather than the status quo of programs fragmented between various government agencies. It is something that the U.S. government requires of other nations that it assists in the fight against AIDS.

Michael Wood is a contributor and Editorial Assistant for EDGE Publications.


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