Why the U.S. Has Not Stemmed HIV

The 40,000 new HIV infections that the United States has recorded annually since 1990 are an embarrassing indictment, a success, or both, depending on one's perspective. Five years ago, CDC launched efforts to halve new infections, but the figure remains unchanged.

Government inaction has caused "needless mortality," Chris Collins writes in a new Open Society Institute report. The lack of prevention funds is the most irksome dimension of continuing infections to Grant Colfax, a San Francisco Department of Public Health physician.

However, the number of new US infections has remained stable despite the fact that, with the advent of effective antiretroviral therapies, HIV mortality has plummeted and prevalence has been increasing -- a situation that would normally fuel incidence. One reason it has not is that HIV-positive people today are more likely to know they are infected and take measures to prevent transmission.

David R. Holtgrave, professor at the Johns Hopkins Bloomberg School of Public Health, and colleagues estimate new infections could be halved if the 5 million highest-risk Americans received proven interventions: HIV counseling and testing, free condoms, one-on-one or group counseling, and needle exchange. However, CDC would have to spend $415 million more than its current $720 million prevention budget to accomplish this.

Testing is a crucial intervention: Each year, 11 percent of the unaware HIV-infected transmit the virus, compared with 2 percent of those who know they are infected. About one-quarter of US infected persons do not know it.

In a CDC survey of 10,000 men who have sex with men published last month, 47 percent had engaged in unprotected anal sex; 98 percent had received free condoms; and only 15 percent and 8 percent, respectively, had ever participated in one-on-one or peer-group counseling. Organizations say it is increasingly difficult to get government funding for MSM-related efforts.

Of the 17 percent of new HIV infections CDC estimates come from contaminated needles, studies suggest 65 percent could be prevented if drug users had access to clean needles. US law prohibits federal funding for this intervention, though 150 needle exchange programs operate nationwide.

Back to other news for August 16, 2006

Search the Newsroom archive