Lots of bloggers follow HIV/AIDS, although we haven't. Maybe because it's no longer an automatic death sentence, it has fallen off the public radar screen, but not because it isn't a huge public health problem. Just how big a problem seems to be a matter of some sensitivity for the Bush administration:
Since the fall of last year, rumors have been circulating that the Centers for Disease Control and Prevention (CDC) will release revised statistics indicating that the number of people with new HIV infectionsliving with HIVin the United States is actually higher than previously reported. Some say the number could be as much as 50 percent higher. But, nearly three-quarters of a year later, there is still no indication of when we might see a new report documenting the likely number of HIV infections occurring each year in America. (POZ)
This was news to me, although apparently it's not a deep secret. AIDS organizations have known about this for a long time. The tardy estimates are related to a new CDC study now in the publication process. It indicates that the current estimate of 40,000 Americans living with HIV infection should really be as high as 58,000 to 63,000, that is, 50% higher. The study was supposed to be published early this year. Now it's already July and it hasn't appeared. In any other administration, Republican or Democrat, this might easily have been chalked up to the slow rate of scientific publication. But this isn't just any administration. This is the Bush administration whose penchant for suppressing science it finds inconvenient (employing compliant bureaucrats like CDC Director Julie Gerberding) is becoming the stuff of legend. So CDC doesn't get the benefit of the doubt, here. Not any more:
Conspiracy rumors were further fueled by an undeniable record of underfunding. A recent analysis by Johns Hopkins University shows that, adjusted for inflation, the buying power of the CDC's domestic HIV prevention budget declined 19 percent between fiscal 2002 and 2007. Still, President George W. Bush's budget request to Congress for fiscal 2009 seeks a $1 million reduction for domestic HIV prevention activities at the CDC. (David Ernesto Munar, vice president at the AIDS Foundation of Chicago and chairman of the board of the National Association of People with AIDS, quoted at POZ)
So while it's true we haven't been paying proper attention, it also seems to be true that the Bush administration hasn't wanted us or anyone else to notice, either. But perhaps I've got it all wrong. It isn't about AIDS or HIV. One look at the budget tells me it's about Freedom for the Iraqi People. So that's, that.
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I think CDC wanted to spin the higher number as a "victory" for opt-out testing and confidential HIV testing, even though the opt-out policy and much of the confidential testing in big states are too new to have effected this and finding existing, long-term infections (most of what opt-out would find in the short run if it really works) isn't necessarily a good marker of recent trends. They also may have wanted to use it to highlight the "success" of their targeted behavioral surveillance programs, which resulted from Congressional questioning about the paucity of evelaution data for prevention in the US. People inside CDC had been trying for years to implement this. Many less wealthy countries still have better sentinel surveillance than the US. CDC also has been building models based on HIV testing
Tha primary author of the Hopkins study used to oversee prevention-related activities at CDC. He's also been a very well-reasoned critic of CDC's tilt toward large scale HIV testing, which has been poorly thought through in terms of targeting and who bears the burden of the cost. CDC has fallen back on methods for addressing highly infectious communicable diseases to fight a quirkier disease and it's doubtful that there will be a big impact. getting acute infections is difficult even where the infrastructure is built around doing so (e.g., North Carolina's STI system). The most successful HIV prevention intervention in the world have relied on multi-sectoral prevention activities (e.g., Thailand's 100% condom campaign) rather than testing, which is inefficient on many levels, especially in a fragmented health care system like our's.
It is the same the world over. I am being gross, but true here. "What happens between the sheets, stays between the sheets". I doubt that anyone is entirely truthful about their own sexual activity, nor are they entirely truthful about their HIV status. At best HIV and VD numbers are a guesstimate. Having a government that is proactive in the areas of HIV prevention (ie. in your face advertisements and programs), and in providing life saving medication, helps a great deal.
Bush is certainly aware of his low popularity and recognizes that sometimes the best way to get something he wants to get done is to oppose it (CDC, EPA) and pretending to be anti-science, and for something he does not want, like offshore oil driling, he supports it (Big Oil makes more money with imported oil, and artificially tighted supplies). Don't be conned. Science has been corrupted and politicized by corporate government and corporate interests. If scientists want to make a living, they have to serve one or both of these interests. Doesn't mean they do not still do good science, but they have to wag the tail at the hot political issues of the day, like AGW.
pft: Since you are neither a scientist nor live in the US, you seem to be pretty certain about some things you don't seem to know much about. Tinfoil hat time, methinks.
Those numbers probably represent new infections per year, not people living with HIV.
The CDC used to publish a yearly statistical summary of HIV prevalence and incidence but stopped in, I think, 2003 or 2004, probably due to reduced funding.
David: I think you are right. Thanks for the correction.
CDC has released a notice about the change in their estimate. It will reflect the use of STARHS on a subset of surveillance samples. This will be discussed in a NEJM paper to be published in early August (no pre-print available), probably to coincide with the Int'l AIDS Meeting in Mexico City. These assys have some problems with false-positives (non-recent infections that appear to be recent by the assay) which I assume will be addressed.
Rich: Thanks for the update. Do you think this notice is related to the NAPWA statement?
Per the Dear Colleague letter of July 22 from CDC's Richard Wolitski:
"The manuscript containing the estimates has been accepted for publication by the Journal of the American Medical Association (JAMA) and is scheduled to be released on August 3, 2008. To prepare for the upcoming release of new HIV incidence estimates, CDC has developed a fact sheet on HIV/AIDS surveillance, available at http://www.cdc.gov/hiv/topics/surveillance/resources/factsheets/surveil…."
It seems important to still follow HIV/AIDS rates in the United States. Even though it is no longer an immediate death sentence, the entirely preventable disease can still cause endless heartache and pain in a new generation. If it is true that prevalence rates are underestimated and are actually 50% higher than currently reported, this is even more reason to pay attention to AIDS and continue to educate the population at large about the risks. When funding is being cut, this is the time to increase awareness and demand government suport, so the whole saga doesn't start over right from the beginning.