The Recent CDC Studies on New Infections Confused Everyone -- and Showed, Once Again, the Lack of Reliable Incidence Data
April 4, 2008
The 2006 HIV/AIDS Surveillance Report released by the Centers for Disease Control and Prevention last week caused confusion and frantic press releases. It's no wonder: The report stated that newly reported infections in the U.S. rose dramatically from 35,537 in 2005 to 52,878 in 2006.
The rise was cause for concern -- and not. On the one hand, the numbers rose because California, Delaware, Illinois, Maine and Washington switched over to a names-based reporting system -- the only system the CDC tracks. On the other hand, in the 33 states and five territories that have used the CDC-approved confidential names-based reporting system since at least 2003, newly diagnosed infections have remained relatively stable, though there has been a slight increase in certain subgroups.
Technically, the new numbers don't indicate a rise in newly reported infections or diagnoses, as the Director of the Division of HIV/AIDS Prevention for the CDC Robert Janssen, M.D. said in a statement and Dear Colleague letter issued on March 28 and meant to address the confusion. But then again, this report blows apart the widely cited CDC figure of 40,000 new infections per year, a statistic that hasn't been updated since 2001, and was derived using an indirect method based on now outdated surveillance data.
The confusion over the 2006 Surveillance report was so great that the Federal AIDS Policy Partnership (FAPP) has scheduled a special meeting on Monday, April 14 to clarify the report's results. The scramble to grasp the data also overshadowed another, smaller more troubling report the CDC released on March 11: HIV/AIDS Surveillance in Men Who Have Sex with Men (MSM) shows a more than a 65 percent increase in the number of newly reported HIV cases among MSM ages 13 to 24 from 2001 to 2005 , and an even starker 74 percent increase in the number of new cases for blacks in that cohort.
One reason the 2006 Surveillance Report created chaos on AIDS listservs and organization releases is that some people confused it with recent news stories that the CDC is expected to announce a new national estimate of how many Americans are infected with HIV each year.
That estimate,based on better technological data, will probably be released this summer, and is expected to be much higher than dusty statistic that there are 40,000 new HIV infections a year. That number was last revised in 2001, and was always meant to be a "back of the envelope" estimate. But the new estimate may not be much more accurate. "Even if the number comes out saying there are 50,000 infections a year, this will just be a new benchmark instead of the old one. We need at least two years to see what the trend is," said Walt Senterfitt, an epidemiologist who works for Community HIV/AIDS Mobilization Project.
The adjusted data won't automatically affect funding, but as those involved with the 2006 Ryan White CARE Act Reauthorization process know all too well, if the data shows a huge shift among regions, this will probably affect the way the pie is divided within states during the 2009 reauthorization.
Although this week's newly released data is a bizarre patchwork of numbers, two things are clear. One: We still don't have close-to-accurate data about yearly new infections. "What we've had are suboptimal annual incidence rates," said Judy Auerbach, deputy executive director of science and public policy for the San Francisco AIDS Foundation. "We need to know who and where people are affected. Are we doing the right things? Are we reaching the right people? It matters what that number is." Two: HIV infections are not going down. "Even if the data in the Surveillance Report ultimately shows incidence is flat rather than going up, this still means shows we haven't put enough money in prevention to bring it down," Senterfitt said. "That funding is reduced every year is a crisis and an anomaly."
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This article was provided by Housing Works. It is a part of the publication Housing Works AIDS Issues Update. Visit Housing Works' website to find out more about their activities, publications and services.