Sunday, August 03, 2008

CDC reports spike in HIV in all populations, higher incidence than had been expected

The Centers for Disease Control has reported a larger than expected increase in the incidence of HIV infection. A study published in JAMA, the Journal of the American Medical Association, showed 56,300 new HIV infections occurred in the United States in 2006, instead of 40000.

In the past fifteen years or so, the CDC has emphasized reporting of HIV infection rather than reporting “cases of AIDS” based on opportunistic infections or malignancies (like Kaposi’s Sarcoma, which is considered “multi-focal”) or multiple symptoms of what used to be called “ARC”. For a time in the early and mid 1980s, these cases counts were expanding geometrically, doubling every six months, before starting to level off later in the 80s.

Between 53%-57% occurred because of sexual activity in gay men, but this percentage is substantially lower for this population than it was in the United States in the early to mid 80s. According to CNN, 60% if all cases occur in the African American community. Heterosexual contact, usually (but not always) male-to-female, accounts for 31%, but has rapidly become a very dangerous problem for women in some communities. In Africa (where it is a catastrophic pandemic), most transmission seems to be heterosexual and is bidirectional, probably because of the previous existence of other STD's to facilitate transmission. A typical recent Lancet story is discussed in Medical News Today here.

Protection greatly reduces the risk of transmission but is not “perfect.” The ability of companies to provide protection information online was actually an issue in the COPA trial (follow my postings on this other blog, particularly in late 2006).

The link to the CDC report is here. The abstract for the JAMA article is here. A paid subscription is required to see the full text.

In the 1980s, AIDS assistance programs run by volunteers and non-profits like the Gay Men’s Health Crisis (New York), the Oak Lawn Counseling Center (Dallas), and Whitman Walker Clinic (Washington) often used many volunteer “buddies”, a program in which I participated in Dallas. The need for this seemed to diminish in the 1990s (partly because better medications enabled Persons with AIDS to remain active and often remain at work) and tended to shift to specific other volunteer areas like meals (Food and Friends). Now, eldercare and Alzheimers, for demographic reasons, is becoming an issue for many adults who did not have their own children, and the psychological aspects of eldercare are quite different (and long-lasting and more demanding in some ways) from buddy programs of the 80s.

There was an earlier story about an earlier CDC report on this blog June 27, 2008.

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