[Editor's note:] David Munar of the Chicago AIDS Foundation and Prevention Justice wrote this guest post after attending the 2007 HIV Prevention Conference in Atlanta.
No matter the spin, CDC’s not-well-protected secret is all bad news.
As widely reported in the Washington Blade, the Washington Post, and other media outlets, the official estimate for annual HIV infections in the U.S. is being raised in 2008. Ironically, UNAIDS recently lowered its global estimate for people living with HIV/AIDS, from 40 million to 33 million.
Virtually every hallway conversation at the 2007 HIV Prevention Conference in Atlanta—attended by 3,000 researchers, HIV prevention practitioners, public health officials, and AIDS advocates—buzzed with gossip and speculation about the unreleased figures and what the hold-up could mean.
Here’s a collection of gathered intelligence, observations, discussions, and opinions.
What we think we know …
• From press reports, some 55,000 to 60,000 HIV infections occurred in the U.S. in 2005, a 35 percent to 50 percent increase over the longstanding estimate of 40,000 annual HIV transmissions.
• CDC researchers may include regional break-downs in their analysis.
• CDC expects to release the new 2005 estimates in early 2008 and another data set and analysis, reviewing 2006 data, in mid-2008. Data from 2007 and trends analysis is slated for release in 2009.
• From official briefings, new laboratory analysis conducted on HIV-positive blood samples in 19 jurisdictions (distinguishing recent infections from longstanding ones) served as the primary data source for the new national estimates.
• Less clear is whether the increase is merely a result of more sophisticated methods or signs of climbing rates of transmission (or conceivably both).
• On this delicate point, officials seem keen to describe their more sophisticated methods (begging the question: “Is this a deliberate attempt to assuage public alarm at the nation’s failure to control HIV?”).
• Conclusive findings about the factors contributing to adjusted estimates will not be available until 2009 when three years’ worth of data (collected with new methods) is available for comparison. Coincidentally, a new administration takes the reigns of the federal government in 2009.
What’s with the delay?
Despite the media frenzy, CDC officials maintain that the announcement is pending “external peer review and publication,” necessary for verification of the employed methodology and findings. Ensuring that the data is entirely accurate remains CDC’s highest priority, asserted Dr. Kevin Fenton, CDC’s HIV prevention chief, during an ad-hoc meeting held with AIDS advocates.
I inquired: “Why not release the data in a more expedited fashion, publishing findings in CDC’s own Morbidity & Mortality Weekly Report?”
“Well, do you want accurate data?” Dr. Fenton retorted, rhetorically. Pressed on the matter, he explained that CDC’s MMWR is an internal “communications organ” and its content are not subject to external peer-review—merely internal review. Additionally, he said the findings are too sensitive to forego the peer-review process needed to ensure scientific integrity.
Asked about the issue, independent researchers concurred that the public will be better served by subjecting these polemic findings to a rigorous peer-review process. Nonetheless, some scientists questioned why the peer-review process started so late in 2007, almost guaranteeing the findings would not be ready in time for the 2007 National HIV Prevention Conference, the nation’s premier scientific gathering on strategies to slow HIV infections.
Contributing to the frustration, CDC officials have been speculating about the timing of this release since the last National HIV Prevention Conference in 2005. It's ongoing delay means HIV prevention stakeholders are operating in the dark. Moreover, the federal budget-setting process for fiscal 2009 will not be informed by the new data. While President Bush's FY09 budget request to Congress is not made public until February 2008, it is widely believed to include no new funding (or even cuts) for HIV prevention activities, despite the alarming new data pending peer-review.
What does it all means?
1. The HIV epidemic in the U.S. is worse than previously thought. Whether a result of better methods or upward trends, the findings should raise the public’s alarm that not enough is being done to slow HIV transmissions in the U.S.
2. Federal inaction is largely to blame. CDC’s own 2001 HIV Prevention Strategic Plan, which set the important goal of reducing new HIV infections to a level of 20,000 per year by 2005 (a 50 percent reduction), quietly expired two year ago without any progress. A decade of flat funding, inadequate money for HIV prevention (and care) from the start, and poor investments for the scarce resources that have been made available—such as failure to fund needle exchange, comprehensive sexuality education, and other proven interventions—are largely (but not entirely) to blame. We also need to figure out what other psychosocial and structural factors (i.e. stigma, homophobia, racism) contribute to high rates of HIV transmission in the U.S. and what can be done about them.
3. This is an indictment of failed federal public health policies. Quite simply, failure to invest in proven interventions (and at adequate amounts) fails to produce desired results. This is why a comprehensive national AIDS strategy with measurable goals and objectives—and the accountability mechanisms to sustain and measure progress—is so desperately needed. Join hundreds of individuals and organizations in calling for a national AIDS strategy at www.nationalaidsstrategy.org.
4. The new HIV incidence data will have ripple effects. New incidence data calls into question other data sets such as HIV prevalence figures, i.e. the estimated number of people living with HIV in the U.S. The most recent figures for the end of 2003, estimate between 1 million and 1.1 million people living with HIV/AIDS in the U.S. Researchers may well re-evaluate these estimates as well as the number of HIV-positive people not in HIV medical care and those who do not know their HIV status.
Keeping it in perspective …
Renowned HIV prevention researcher and advocate, David Holtgrave PhD, reminded rally participants that, whether the new figures are 60,000 or 40,001, they are unacceptably high and an outrage. The U.S. can and must do better!