HIV Outbreak Identified Among Black Male College Students in North Carolina; Probably Not Limited to State, Study Says

Public health officials have identified an HIV outbreak among black male college students in North Carolina, with the number of newly diagnosed cases suddenly increasing over the previous four years, according to a study presented on Tuesday at the 11th Conference on Retroviruses and Opportunistic Infections, the AP/Raleigh News & Observer reports (Haney, AP/Raleigh News & Observer, 2/10). University of North Carolina-Chapel Hill researchers analyzed state HIV surveillance records for new diagnoses of HIV infection occurring between Jan. 1, 2001, and May 1, 2003, in males younger than age 30 living in 34 North Carolina counties. Researchers compared reported risk behavior and demographic information for newly diagnosed male college attendees with newly diagnosed non-college males (Study abstract, 2/10). The study began after the state Department of Health and Human Services identified two men attending different colleges in the same city who had recently become infected. Both of the men had high HIV viral loads but no antibodies to the virus, which is an indication of recent infection because the body usually produces antibodies about two weeks following infection, the Washington Post reports (Brown, Washington Post, 2/11). Since November 2002, North Carolina has used a polymerase chain reaction, or PCR, test to detect early-stage HIV infections, according to the New York Times (Altman, New York Times, 2/11). Health department officials interviewed the two men, asking for the names of their sexual partners within the previous year (Washington Post, 2/11). Researchers found six HIV cases among male college students ages 18 to 30 in 2000; 19 cases in 2001; 29 in 2002 and 30 in 2003. Of the 84 total new cases during that period, 73, or 88%, were among black men, and 11, or 13%, were among white men, the Times reports.

Further Findings
Researchers interviewed the men and found that in the year prior to their diagnoses, 4% said they had sex only with women, 58% said that they had sex only with men and 33% said that they had sex with both men and women, according to the Times (New York Times, 2/11). The researchers said that the cases "represent an outbreak with a distinct beginning and not simply a steady state of HIV transmission" because of the sharp increase in the number of new HIV cases "in just a few years," according to the Post. Lisa Hightow, lead researcher of the study, said, "We believe that this may not be unique to college students or to North Carolina but speaks more to transmission of HIV among young black men in the Southeastern states" (Washington Post, 2/11). Dr. Peter Leone, a study co-author, said that because 40% of the college men with HIV in the study reported having sex with women, "a substantial number of heterosexual college women are at a significant unrecognized risk for HIV infection." Harold Jaffe, director of the CDC's National Center for HIV, STD and TB Prevention, said that an important concern is "men who live on 'the down low' -- men who describe themselves as heterosexual and yet have same-sex partners and don't disclose that to their heterosexual partners" (Mitchell, Reuters Health, 2/10). Leone said that part of the problem is safer-sex message "fatigue," adding, "They've grown up hearing this thing. It's old stuff to them. They just ignore it." He said, "We have a very marginalized group. They don't identify with the message targeted to gay white men" (AP/Raleigh News & Observer, 2/10). Discovery of the outbreak occurred in time for health authorities to ask North Carolina's colleges to include HIV/AIDS prevention messages in their fall 2003 orientation classes, according to the Post. "We can't say that it's over yet," Hightow said of the outbreak (Washington Post, 2/11).

New York City
Another study presented at the conference showed that nearly 4% of men between the ages of 40 and 49 living in New York City are HIV-positive, Reuters Health reports. Dr. Denis Nash of the New York City Department of Health and Mental Hygiene HIV Surveillance and Epidemiology Program and colleagues examined data collected after the city began reporting HIV cases in 2000. The city previously reported AIDS cases only, according to Reuters Health. The statistics were based on data available as of Dec. 31, 2001 (Mitchell, Reuters Health, 2/10). The study shows that 6,662 New York City residents were newly diagnosed with HIV in 2001, 27% of whom "already had AIDS," Nash said, according to the Wall Street Journal. The study also showed that blacks in the city face a five-times greater risk of HIV, compared with whites, and Hispanics face a 2.5-times greater risk than whites (Chase, Wall Street Journal, 2/11). Dr. Lucia Torian, head of the city health department's HIV epidemiology program, said that an additional test run by the department found that 21% of the newly reported HIV cases had occurred less than six months before testing, Long Island Newsday reports. She said, "[O]ur new cases of HIV are more likely to be women, more likely to be black and more likely to be in the category of heterosexual or 'no discernable risk,'" adding, "This is a prescription for a resurgent, explosive HIV epidemic. Have we seen it yet? No. Could we? Definitely" (Garrett, Long Island Newsday, 2/11).

Syphilis
A sharp increase in the number of new syphilis cases among gay men in San Francisco has not yielded a similar increase in HIV cases, according to another study presented at the conference, the San Francisco Chronicle reports (Russell, San Francisco Chronicle, 2/11). Researchers examined trends in HIV incidence among men who have sex with men in two HIV testing populations and rates of primary and secondary syphilis among an estimated 50,782 MSM in the city from 1998 through 2002 (Study abstract, 2/10). The study, which was presented by Kate Buchacz of CDC and conducted by researchers from CDC and the San Francisco Department of Public Health, demonstrated that although the number of syphilis cases reported in San Francisco increased from 40 a year to more than 600 a year between 1998 and 2003, HIV prevalence among gay male patients being treated for syphilis was "holding steady or even declining," according to the Chronicle. Willi McFarland, chief AIDS epidemiologist with the city's public health department, said, "We may have reached another turning point -- and for the better." However, Jeffrey Klausner, director of sexually transmitted disease control for the city public health department, said that he is not "ready to call a turn in the course of the epidemic," according to the Chronicle. He said, "I'd say we've reached a plateau. I'd have to wait and see if we have a downward trend" (San Francisco Chronicle, 2/11).

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