Medical Institute Criticizes U.S. Efforts to Curb AIDS

U.S. efforts to monitor and slow the spread of HIV domestically were strongly criticized Wednesday by the prestigious Institute of Medicine.

The country’s HIV rate has remained “unacceptably high,” for far too long, the institute said.

For more than a decade, the Centers for Disease Control and Prevention has estimated that the same numbers of people--about 40,000--have contracted HIV annually. The institute, the nation’s highest independent medical science body, questioned the validity of those numbers, and of the CDC’s HIV surveillance system.

Even if the numbers are accurate, the report said, such a plateau would constitute public health failure. It said some poor countries have made strides in rolling back their epidemics.

The report, commissioned by the CDC, considered many factors potentially responsible for failure to reduce rates of new infections, including lack of a clear strategy for HIV control, weak federal leadership and inappropriate allocation of resources.

But the numbers are the primary concern. No disease prevention effort can be judged successful unless the number of people newly infected declines as a result of an intervention. The institute said in strong terms that it doubts the reliability of the CDC’s estimates of how many Americans are acquiring HIV each year.

“One of our concerns is getting accurate data to see if we have a handle on how serious the epidemic is,” Dr. Michael Merson, dean of the Yale School of Public Health, said in an interview. Merson was one of 16 experts involved in preparing the institute’s report. “One of the key recommendations in the report is that CDC create a surveillance system that can provide accurate estimates of the extent of the epidemic.”

Since 1986, the CDC has said that the same numbers of Americans were getting infected with HIV each year. That number isn’t based on hard data, nor could it easily be, because most people who are infected don’t realize they are HIV-positive until they, or their sex partners, become ill. And for reasons of confidentiality, many states do not require that physicians report HIV diagnoses. Even fewer report HIV cases by name, the most reliable way to track the incidence of any disease.