Despite a 50 percent increase in the number of newly reported domestic HIV cases from 2005 to 2006, leaders at the Centers for Disease Control & Prevention insist the country is not experiencing a spike in the actual number of people infected or diagnosed with the disease each year.
In 2006, at least 52,878 Americans were newly reported as having HIV, compared to 35,537 who were first reported in 2005, according to the CDC’s annual HIV/AIDS surveillance report released in March.
At the end of 2006, some 509,681 people were reported living with HIV/AIDS in the 33 states and five U.S. dependent areas covered by the report. From 2003 to 2006, cases increased among men who have sex with men, while cases attributed to high-risk heterosexual sex held steady.
Amidst intense criticism that the new numbers reflect the failure of the public health system to implement effective HIV-prevention strategies, CDC researchers were emphatic that the higher number of HIV cases reported “do not represent an increase in the epidemic.”
“The 2006 surveillance report does not show an increase in HIV/AIDS diagnoses,” said Robert Janssen, director of the CDC’s division of HIV/AIDS prevention. “The higher number of reported HIV diagnoses in 2006 is due to the fact that this [figure] includes data from states that have newly implemented confidential name-based HIV reporting as of 2006, including highly populous states like California, Illinois and Washington.
“HIV cases from these states have not been included in CDC surveillance reports in the past,” Janssen said.
But some AIDS activists believe the CDC has been sitting on the higher numbers for months, particularly since the Washington Blade, an affiliate of Southern Voice, first reported on the alarming increase last November.
Critics also accuse the federal health agency of downplaying the fact that the 52,878 people newly reported as having HIV in 2006 is significantly higher than the CDC’s longstanding estimate of 40,000 new HIV diagnoses each year.
“The numbers are far higher than what’s previously been reported,” said Michael Weinstein, president of the AIDS Healthcare Foundation in Los Angeles. “This means many more infections now and as far as the eye can see. The CDC has essentially hidden this information.”
The convoluted semantics that govern the CDC’s data collection, along with the inconsistent way state health departments gather HIV statistics and send them to the CDC, create a complicated and incomplete picture of the HIV epidemic in the U.S.
The 52,878 people newly reported as having HIV in 2006 is greater than the estimate of 40,000 new diagnoses annually, but the two figures “have nothing to do with each other,” Janssen said. Researchers have long known that someone diagnosed with HIV in 2006 did not necessarily contract the disease that same year, and so increases in diagnoses rates do not automatically mean increases in HIV infections.
Similarly, AIDS experts must understand that all HIV cases reported by a state during a given year do not necessarily mean those HIV cases were diagnosed in that same year, Janssen said. For example, in the 2006 HIV/AIDS surveillance report, the 6,581 HIV cases California reported for 2006 included HIV cases diagnosed in several previous years, since this is the first year California has reported its HIV numbers to be included in the national tally.
“The reported cases could’ve been diagnosed any time in the past,” Janssen said. “When a new state comes on with a new [reporting] system, because they never reported HIV before, they may begin with a large backlog.”
The CDC only recently tied HIV reporting to the amount of money states receive to fight HIV, meaning new numbers are beginning to come in as more states report HIV cases in compliance with CDC standards. In 2005, the CDC’s HIV/AIDS surveillance report included data from 38 states and territories, compared to the 50 states and areas that contributed data to the 2006 surveillance report.
In 2001, using results from studies involving gay and bisexual men, along with HIV data from about 31 states that already had confidential name-based reporting, the CDC formalized a longstanding estimate of 40,000 new HIV diagnoses each year. Some data from the 2006 HIV/AIDS surveillance report suggests the rate of HIV diagnoses remains stable, hovering around 35-36,000 cases for the past four years.
“The main thing is that things look stable,” said Janssen, who added that the CDC is in the process of updating its estimate of annual HIV diagnoses, but not because of the increase in reported HIV cases.
“The estimate we’re working on right now is still under review,” Janssen said.
But Weinstein of the AIDS Healthcare Foundation accused the CDC of playing semantic shell games to gloss over rising numbers that represent a “catastrophe.” The sharp increase in the number of newly reported HIV cases from 2005 to 2006 should prompt a paradigm shift in how researchers view the disease’s domestic impact, Weinstein said.
“What are the implications of [the new numbers] in terms of human cost, financial cost and in terms of having an effective prevention campaign?” Weinstein said.
Not having clear numbers is frustrating for people trying to map out HIV/AIDS policies, but it is also nothing new, said Melanie Sovine, who has worked in the HIV field for 28 years and currently serves as executive director of AIDS Survival Project in Atlanta.
“We have never known how many of this and how many of that, or who and why,” Sovine said. “Epidemiological reporting has never been anything more than a snapshot or picture. It will never be a perfect picture, but we can get it closer.”
Georgia, which was one of the last states to conform to CDC’s confidential name-based system for reporting HIV cases, ranked eighth in the number of HIV cases reported in 2006, according to the surveillance report. The full scope of the HIV/AIDS in Georgia is still unavailable due to the lag in reporting numbers, and it will be years until data trickles in from states to give CDC the most accurate picture of the epidemic in America, said Whitney Engeran, director of the public health division at AIDS Healthcare Foundation.
“We just don’t know where this will end,” Engeran said. “We could be seeing more and more numbers coming in from the CDC as more states come online, and, of course, that means more and more people being infected.”
The shift toward tracking HIV cases — as opposed to people diagnosed with AIDS, which is the number some states used to send the CDC — is an attempt to better tailor prevention efforts based on “who’s getting infected currently,” said Raymond Martins, chief medical officer at the Whitman Walker Clinic in Washington, D.C.
“I think every number we ever look at is probably lower than what is actually there,” Martin said. “As we get better surveillance and testing, the numbers are going to creep higher than what we predict. Should we sound a five-alarm based on this increase? I wouldn’t based on these numbers alone.”
Sovine agreed.
“I think there is an increase,” she said. “We can’t move too soon into absolute alarm. We just don’t know yet.”
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