HIV cases undercounted for a decade

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Times Staff Writer

Federal officials have been underestimating the number of new HIV infections in the United States by 40% every year for more than a decade, a finding that indicates the U.S. epidemic is much worse than 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 were a jarring reminder that the United States, while castigating prevention efforts in much 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.

“With more people living with HIV than ever before, there are more opportunities for transmission,” and the need for prevention has never been greater, he said.

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,” he said.

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 African Americans and Latinos. There have been small declines among heterosexuals and injectable-drug users.


Gay men accounted for 53% of new infections in 2006, the most recent year for which data are available. The infection rate among blacks was seven times that among whites, and the rate among Latinos was nearly three times as high.

Fenton said blacks are more disproportionately affected than any other racial or 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 healthcare, substance abuse, incarceration and a rise 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.

The CDC said that about 1 million to 1.1 million Americans are currently HIV-positive.

But epidemiologist and AIDS expert Philip Alcabes of Hunter College of the City University of New York contends that the new numbers indicate there are about 225,000 more HIV cases in the U.S. than the CDC estimates.


A CDC spokesman rejected his contention, however, saying that the total number of infections is calculated using a different method, and its figure remains accurate.

More than 15,000 Americans die of AIDS each year.

The new data will be formally unveiled today at the International AIDS Conference in Mexico City and published later this week in the Journal of the American Medical Assn.

The CDC has been widely criticized for not releasing the new numbers sooner. Fenton acknowledged that the figures had been available since November, but he said the agency delayed releasing them until they had been accepted for publication.

Dr. Julie Gerberding, director of the CDC, said the paper had been heavily revised during the peer-review process and that she had much more confidence in the findings as a result.

Some critics suspect the results were delayed to avoid embarrassing the Bush administration, which has shrunk the CDC’s prevention budget by 19% in current dollars since 2002, according to Rep. Henry A. Waxman (D-Beverly Hills).

“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,” Rep. Barbara Lee (D-Oakland) said.


The new estimates are certain to bring calls for increased spending to combat the epidemic. Even at the old estimate of 40,000 new infections per year, nongovernmental organizations were calling for the United States, which spends $700 million annually on prevention efforts, to boost that figure by at least $300 million.

On Wednesday, President Bush approved $39 billion to fight AIDS around the world, nearly triple the $15 billion spent over the previous five years.

“The United States can be proud of . . . its remarkable commitment to the global HIV/AIDS epidemic,” said Dr. Daniel R. Kuritzkes, director of AIDS research at Brigham and Women’s Hospital in Boston. “These new figures from CDC demonstrate that the domestic epidemic needs a similar response.”

Since the AIDS epidemic began in 1981, the actual incidence in the United States -- and globally -- has been a matter of controversy. The problem was that researchers used “by guess and by golly” techniques to extrapolate overall HIV numbers from limited data.

In the case of the world numbers, better data led to a recent downward revision, a 40% 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. figures for HIV were extrapolated 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 iffy, experts said.


The new numbers rely on newer testing methods that allow technicians to determine whether an HIV infection occurred in the last five months or is an older infection. More states have also begun reporting newly diagnosed HIV infections as well as new AIDS cases.

“These data, which are based on new laboratory technology developed by the CDC, provide the clearest picture to date of the U.S. HIV epidemic, and unfortunately, we are far from winning the battle against this preventable disease,” the CDC’s Gerberding said.

Using the new estimates for 2006, researchers also reanalyzed 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.

By the end of that decade, the numbers had climbed back up to the current level of about 56,000 and have remained fairly constant ever since, they found.