New HIV Cases Remain Steady Over a Decade

AIDS advocates and researchers reacted with concern to CDC's Wednesday report on new HIV infections in the United States during 2006-09. While incidence overall plateaued, averaging 50,000 infections for each of the years, it increased among young men who have sex with men, particularly among young black/African-American MSM, who had a 48 percent increase in new infections. In the 1980s, HIV incidence peaked at 130,000 infections annually.

"It means I don't see an AIDS policy, and I don't see anyone in charge," said Larry Kramer, veteran AIDS activist and playwright. "It's so dispiriting that it's hard to find something to say about it. How many times can you yell 'Help!' without ever getting anywhere?"

The incidence data are "a great concern," said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases. But he and the director of CDC's National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Dr. Kevin Fenton, took issue with Kramer's interpretation.

"The CDC is absolutely not resting," Fenton said. "It was a major accomplishment to drop infections from 130,000 to 50,000, and we're dealing with an epidemic that is dynamic." Incidence is at an "unacceptably high level," he said. However, given the growing number of people with HIV/AIDS, if current prevention efforts are not intensified, "we're likely to face an era of rising infections," Fenton said.

Fauci and Fenton also pointed to new test-and-treat strategies to diagnose and treat HIV infections earlier, and thus to improve outcomes and drive down transmission rates. In a study, early treatment initiation made people with HIV at least 96 percent less likely to infect their heterosexual partners.

Philip Alcabes, a public health epidemiologist at Hunter College in Manhattan, said, "It's not clear that prevention is a failure. The average adult's chances of encountering HIV infection -- 0.02 percent a year -- are rather low. It's not reasonable to expect that a sexually transmitted virus will disappear in America, or anywhere else. But I agree with Larry Kramer that there has been a dearth of new policy ideas."

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