September 11, 2008
The analysis from Subpopulation Estimates From the HIV Incidence Surveillance System -- United States, 2006 provides additional detail to the main points of the landmark paper Estimation of HIV Incidence in the United States that reported HIV incidence in the United States is higher than was previously known. Overall, the new analysis reinforces the severity of the epidemic in gay and bisexual men of all races and ethnicities, as well as African American and Hispanic and Latino men and women. The new analysis also provides data for subgroups within those specific populations. The differences among and between those populations will enable CDC to better target its resources.
This analysis confirms that MSM of all races continue to be severely affected by this epidemic, accounting for a majority (53%) of the new infections. This analysis further shows that the age group in which the most HIV infections occurred in MSM varied among racial and ethnic groups. For example, among black and Hispanic/Latino MSM, most new infections occurred in young MSM between the ages of 13 and 29. In white MSM, most new infections occurred between the ages of 30 and 39.
These differences are important because they suggest that different interventions are appropriate for different age and racial/ethnic groups.
Overall, the MSM groups with the most new HIV infections were black MSM between the ages of 13 and 29, followed by white MSM between the ages of 30-39 and white MSM between the ages of 40-49. The high numbers of new HIV infections in young, black MSM are of great concern because the number of new infections was approximately twice that of young white and Hispanic/Latino MSM of the same ages (between 13 and 29 years).
This new analysis confirms that blacks experienced a disproportionate number of HV infections. Forty-six percent of new HIV infections occurred in blacks, even though blacks comprise only 12% of the US population. The majority (65%) of new infections in blacks occurred in men. Among black men, 63% of new infections occurred through male-to-male sexual contact. Thirty five percent of new infections in blacks occurred in women. Of those, eighty-three percent of the infections occurred through high-risk heterosexual contact. The disparity in new infections was especially pronounced among women, with the incidence rate in black women being almost 15 times higher than that of white women.
The new analysis also confirmed that Hispanics and Latinos experienced a disproportionate number of new HIV infections. Eighteen percent of new HIV infections occurred in Hispanics and Latinos, even though they comprise 15% of the US population. The majority (76%) of new HIV infections among Hispanics and Latinos were in men and of those, 72% were in MSM. Twenty-four percent of new infections among Hispanics and Latinos were in women. Eighty-three percent of those infections occurred through high-risk heterosexual contact. As with African Americans, the disparity with regard to new HIV infections was especially pronounced among women, with Hispanic and Latina women having an HIV incidence rate that was almost 4 times higher than that of white women.
American Indians, Alaska Natives, Asians, and Pacific Islanders combined represented 2.6% of new HIV infections. These data were not included in this analysis because the numbers were too small to produce reliable subgroup estimates. CDC continues to gather surveillance data on these populations in order to monitor the HIV epidemic.
This new analysis provides a deeper understanding of the impact of HIV infection among specific populations, which will allow CDC and its partners to target and evaluate prevention efforts with more precision than ever. This enhanced clarity shows us that we need to be looking more critically at the intersections of gender, race/ethnicity, age, and risk in order to know where prevention efforts are needed most.
For example, we know that the majority of new infections in men of all races and ethnicities occur in MSM. Further, we now know that the age distribution of new infections by age among MSM varied across racial and ethnic groups. In addition, the racial disparity was most pronounced among women. All this information adds clarity to which populations are at the highest risk of HIV and in greatest need of more precisely targeted prevention efforts.
While these data give us a clearer picture of what needs to be done at the national level, the epidemic is not the same in every city and state. So, it is critically important that local jurisdictions compare the national results to those from their own surveillance systems so that they can know how best to target local resources.
Although states that receive funding for HIV incidence surveillance will be able to calculate incidence estimates for their jurisdiction, for those states without incidence surveillance, comprehensive name-based surveillance of HIV diagnoses will provide the best data regarding the distribution of HIV infection.
These new data are a wake-up call: We need to do more to ensure that effective prevention reaches those who need it, particularly MSM and black and Hispanic/Latino men and women. We all have to do more to ensure that HIV infection doesn't become a rite of passage for young gay and bisexual men. We also have to do more to ensure that communities of color in this country will not continue to be disproportionately affected by HIV. In short, the HIV epidemic is not over in this country. It continues to take a devastating toll.
As a nation, we must recognize the epidemic for the crisis that it is and match our response to the severity of the problem. We know that prevention works, when applied correctly and appropriately, but too many people at risk of HIV infection do not have access to HIV prevention programs that been proven successful.
Communities must mobilize and re-energize efforts for those at-risk in the U.S. We need to work strategically to reduce stigma, expand access to HIV testing, and implement the prevention strategies that we know are effective at a scale that matches the epidemic.