What to do, what to do....For starters, how about if we close homosexual
bars and bathhouses, "GLBT" youth hang-out centers, end needle exchange
programs, and end the promotion of homosexuality in schools?
Estimate of AIDS Cases In U.S. Rises
New Test Places the Rate Of Infection 50 Percent Higher
By David Brown
Washington Post Staff Writer
Saturday, December 1, 2007; A01
New government estimates of the number of Americans who become infected with
the AIDS virus each year are 50 percent higher than previous calculations
suggested, sources said yesterday.
For more than a decade, epidemiologists at the Centers for Disease Control
and Prevention have pegged the number of new HIV infections each year at
40,000. They now believe it is between 55,000 and 60,000.
The higher estimate is the product of a new method of testing blood samples
that can identify those who were infected within the previous five months.
With a way to distinguish recent infections from long-standing ones,
epidemiologists can then estimate how many new infections are appearing
nationwide each month or year.
The higher estimate is based on data from 19 states and large cities that
have been extrapolated to the nation as a whole.
The CDC has not announced the new estimate, but two people in direct contact
with the scientists preparing it confirmed it yesterday.
What is uncertain is whether the American HIV epidemic is growing or is
simply larger than anyone thought. It will take two more years of using the
more accurate method of estimation to spot a trend and answer that question.
"The likelihood is that this bigger number represents a clearer picture of
what has been there for the past few years. But we won't know for sure for a
while," said Walt Senterfitt, an epidemiologist who is the chairman of the
Community HIV/AIDS Mobilization Project (CHAMP), a New York-based activist
There is evidence, however, that at least some of the higher number may
reflect an uptick in infections in recent years. Information from 33 states
with the most precise form of reporting showed a 13 percent increase in HIV
infections in homosexual men from 2001 to 2005.
Ironically, the news comes less than two weeks after UNAIDS, the United
Nations agency responsible for charting the course of the global epidemic,
drastically reduced its estimate of the number of people living with the
disease worldwide from 40 million to 33 million. The reason was the same:
Crude methods of counting were replaced by better ones.
"People in the United States are under the impression that this is more of
an international than a domestic issue," said Rowena Johnston, vice
president for research at amfAR, an AIDS research foundation. "Yet these new
CDC numbers are telling us that not only does this continue to be a serious
problem, it is actually a larger one than we suspected."
A study describing the new U.S. estimate is under review at a scientific
journal, Thomas W. Skinner, a CDC spokesman, said last night.
"We have to wait until this paper comes out, until it has gone through peer
review, before we know what the new estimates look like," he said.
Rumors have circulated for weeks in newsletters and blogs that CDC, the
federal government's principal epidemiology agency, was preparing a dramatic
upward revision of HIV incidence. The Washington Blade, a gay-oriented
newspaper, reported rumors of the new estimates two weeks ago.
The CDC has reported the figure of 40,000 new infections each year for more
than a decade, citing it as evidence that the epidemic in this country is
stable. But while widely quoted, that number has never been adequately
explained or justified, in the eyes of many epidemiologists.
"There was skepticism about the validity of how that estimate was reached,"
said Rochelle Walensky, an infectious diseases physician and mathematical
modeler at Harvard Medical School.
Some activists also were skeptical about it.
"It just doesn't seem plausible to me that it would be the same year after
year," said Mark Harrington, executive director of Treatment Action Group,
an AIDS activist think tank in New York.
Few doubt, however, that accurately counting new HIV infections is unusually
difficult. About one-quarter of people infected with the virus do not know
they are. The infection is largely "silent" for a decade in most people, and
a substantial number go for testing only as they develop the symptoms of
AIDS, the late stage of the illness.
Only recently has CDC put intense pressure on state and city health
departments to report by name everyone who tests positive for HIV.
Previously, health departments had to report only the people who had
progressed to AIDS.
Counting only AIDS cases was an acceptable substitute for counting new
infections in the era when AIDS treatment did not significantly prolong
life. But with the arrival of combinations of potent antiretroviral drugs in
1995, AIDS patients began living years longer, making the estimates
increasingly less accurate.
The new system in which health departments record individuals who have just
tested positive for the first time will eventually provide a much clearer
picture of the epidemic. However, some people oppose it, arguing that it
will keep the potentially infected from coming in to be tested.
"There are so many barriers to testing and reporting," Harrington said. "We
are grasping in the dark, as far as I am concerned, about the real size and
shape of the epidemic."
The 19 states and cities that contributed the data for the new estimate
include New York City, New York, New Jersey, Connecticut, Texas, Florida,
and several Southern and Midwestern states.
The new method of estimating HIV incidence makes use of the observation that
a person who is recently infected with HIV and whose immune system has just
begun to make antibodies against the virus shows a weaker reaction in the
standard AIDS blood test than those whose immune systems have been making
antibodies for years.
By altering the test-tube conditions, scientists can identify those who
react weakly -- and with them, the percentage of a batch of HIV tests that
come from people newly infected.
The method is called the STAHRS method, for serological testing algorithm
for recent HIV seroconversion.
© 2007 The Washington Post Company
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