On Wed, 3 Dec 2008 13:45:58 -0800 (PST), kujebak
Post by kujebakPost by Bill Z.Post by kujebakPost by Bill Z.Normal transmission of the HIV virus between individuals is
entirely dependent on a specific type of sexual contact which is
predominant among homosexual men.
Would you care to revise that statement? It is the "entirely" part
that is wrong. The probability of infection per sex act is highest
for one particular sexual practice, but it is not zero for other
ones, including ones common among heterosexuals.
It's bad form to send out messages that suggest something is
completely safe when it isn't.
That was not my point. My point was that normal sex
among homosexual men is far more risky, with respect
to HIV transmission, than normal sex (including oral sex)
among heterosexuals, to the tune of something like 20%
for the former compared to one tenth of one percent for
the latter. What is *your* point? That HIV is not just a pro-
blem of homosexual lifestyle? A disease that spreads
in the human population predominantly by anal intercourse?
How could it not be?
My point was that what you wrote, regardless of what you probably
meant, was wrong. If you weren't a jerk (as you turned out to be)
you would have merely posted a correction: your use of the word
"entirely" meant that the risk for any other type of sexual activity
was zero and that simply isn't the case.
You claimed to have some health care experience. If so, you should
have realized that posting misleading information that unknowledgable
members of the public might see is not a good idea, particularly
when you state such experience up front.
If you weren't so bigoted (you obviously are) you would have realized
what I was saying - it had nothing to do with "lifestyles" real or
imagined.
There is nothing "misleading" in what I said. I merely cut
through decades of willful misinformation piled upon this
subject. Your refusal to deal with facts underlying this and
other topics - even today, it is not easy to look up actual
HIV/AIDS statistics, which are obscured in public health
papers and scientific publications under tons of other irrele-
vant data, and almost never presented in the mainstream
media, but they are there for anyone to see, who actually
cares to look - and your quick retreat behind ideological
labels clearly indicates where *you* are coming from ;-)
June 27, 2008 / 57(25);681-686
Trends in HIV/AIDS Diagnoses Among Men Who Have Sex with Men --- 33
States, 2001--2006
In 2008, CDC conducted an analysis of trends in diagnoses of human
immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS)
among men who have sex with men (MSM) in the 33 states* that have had
confidential, name-based HIV case reporting since at least 2001. This
report summarizes the results of that analysis, which indicated that
the number of HIV/AIDS diagnoses among MSM overall during 2001--2006
increased 8.6% (estimated annual percentage change [EAPC] = 1.5).
During 2001--2006, an estimated 214,379 persons had HIV/AIDS diagnosed
in the 33 states. Of these diagnoses, 46% were in MSM, and 4% were in
MSM who engaged in illicit injection-drug use (IDU) (i.e., MSM and
IDU). To reduce the impact of HIV/AIDS in the United States, HIV
prevention services that aim to reduce the risk for acquiring and
transmitting infection among MSM and link infected MSM to treatment
must be expanded.
In this report, HIV/AIDS refers to three categories of diagnoses
collectively: 1) a diagnosis of HIV infection (not AIDS), 2) a
diagnosis of HIV infection with subsequent AIDS diagnosis, and 3)
concurrent diagnoses of HIV infection and AIDS. Reporting cases of HIV
infection (not AIDS) and AIDS is now legally mandated in all U.S.
states, the District of Columbia, and five U.S. territories. The CDC
case definition for HIV infection (not AIDS) requires a positive test
result from an assay approved by the Food and Drug Administration that
demonstrates evidence of HIV infection; the case definition for AIDS
requires meeting the HIV infection (not AIDS) case definition, plus
diagnosis of at least one AIDS-defining illness or a CD4+ T-lymphocyte
count of <200 cells/µL. Using the HIV/AIDS Reporting System (HARS),
case report data were collected by local and state health department
staff members and then transmitted to CDC devoid of patient names. The
findings in this report are based on HIV/AIDS diagnoses made during
2001--2006 and reported to CDC as of June 30, 2007 (1).
Numbers of diagnoses were adjusted for reporting delays and for
redistribution of cases with missing risk factor information, using a
standard method that has been described previously (2). This method
does not include statistical adjustments for diagnosed but unreported
cases or for cases yet to be diagnosed. To facilitate comparisons
between the estimated number of diagnoses occurring in 2001 and the
number occurring in 2006, 95% confidence intervals (CIs) were
calculated. To examine trends, EAPCs with corresponding CIs were
calculated. EAPC measures the differences between adjacent years under
examination and then averages these inter-year differences. In this
report, transmission categories¤ are discrete (e.g., "MSM" is distinct
from "MSM and IDU" and "IDU" is distinct from "MSM and IDU").
Accordingly, MSM who were also injection-drug users (MSM and IDU) were
excluded from analysis of MSM.
Of 214,379 HIV/AIDS diagnoses in 33 states during 2001--2006, a total
of 97,577 (46%) were among MSM. Decreases in diagnoses were observed
in all transmission categories except MSM (excluding MSM and IDU)
(Figure 1). Among males, MSM accounted for 97,577 (63%) of cases. Men
aged 25--44 years accounted for 64% of cases among MSM (Table). Among
MSM, the number of diagnoses increased from 16,081 (CI =
15,784--16,377) in 2001 to 17,465 (CI = 16,938--17,992) in 2006; (EAPC
= 1.5) (Figure 1).
From 2001 to 2006, a 12.4% (EAPC = 1.9) increase in the number of
HIV/AIDS diagnoses among all black MSM was observed; however, an
increase of 93.1% (EAPC = 14.9) was observed among black MSM aged
13--24 years (Figure 2). During 2001--2006, approximately twice as
many (7,658) diagnoses occurred in black MSM aged 13--24 years as in
their white counterparts (3,221). The largest proportionate increase
(255.6% [EAPC = 30.8]) was among Asian/Pacific Islander MSM aged
13--24 years. Among MSM aged 13--24 years, statistically significant
increases in diagnoses as measured by EAPC were observed in all
racial/ethnic populations except American Indian/Alaska Natives. Among
MSM of all ages, statistically significant increases as measured by
EAPC were observed in blacks, Hispanics, and Asian/Pacific Islanders.¦
Reported by: A Mitsch, MPH, X Hu, MS, K McDavid Harrison, PhD, T
Durant, PhD, Div of HIV/AIDS Prevention, National Center for HIV/AIDS,
Viral Hepatitis, STD, and TB Prevention, CDC.
Editorial Note:
During 2001--2006, male-to-male sex remained the largest HIV
transmission category in the United States and the only one associated
with an increasing number of HIV/AIDS diagnoses. In this analysis,
statistically significant decreases in HIV/AIDS diagnoses were
observed for all other transmission categories (i.e., among persons
likely to have been infected through high-risk heterosexual contact,
IDU, MSM and IDU, and other routes). Among MSM aged 13--24 years,
statistically significant increases in diagnoses were observed in
nearly all racial/ethnic populations. These findings underscore the
need for continued effective testing and risk reduction interventions
for MSM, particularly those aged <25 years.
The data in this report indicate when persons were diagnosed with HIV
infection, rather than when they became infected. This is an important
distinction because a person might have been infected with HIV for
years before receiving a diagnosis of HIV infection. Determining when
persons who have been diagnosed were actually infected is difficult.
Although HIV diagnosis data can provide some indication of underlying
trends in HIV infection, this approach has limitations. A greater
number of tests for HIV infection among MSM might partially explain
the observed increase in HIV/AIDS diagnoses. However, available data
suggest that these increases cannot be explained by increases in
testing alone; the increase could be attributed to more targeted
testing, increasing incidence, or some combination of these.**
To improve the nation's ability to track new HIV infections, CDC has
established a new system for measuring incident HIV infections at the
population level. A novel laboratory method will be combined with
standard case surveillance procedures and statistical estimations to
provide a better means of estimating national HIV incidence from the
number of persons who are newly diagnosed with HIV (3). This system
will be able to distinguish between recent and long-standing HIV-1
infection on a population level. Estimates from the new system are
expected to be available in 2008. The new system will provide a better
tool for measuring progress in the prevention of HIV infection than
data based on HIV/AIDS diagnoses alone, such as those described in
this report. Nevertheless, diagnosis data will continue to play an
important role in monitoring the HIV epidemic, particularly among
adolescents and young adults who, because of their age, are unlikely
to have been infected many years before diagnosis. Additionally,
HIV/AIDS diagnosis data will continue to provide useful information
for evaluating efforts to increase HIV testing and will allow programs
that do not conduct HIV incidence surveillance to monitor the HIV
epidemic in their local area.
The findings in this report are subject to at least four limitations.
First, the 33-state case surveillance data are not representative of
all HIV-positive persons in the United States. However, the
racial/ethnic disparities described in this report are similar to
those observed in AIDS cases from all 50 states (4). Second, since
1993, the proportion of HIV/AIDS cases reported to CDC without an
identified risk factor for HIV infection has been increasing. In 2006,
no risk factor was reported for 25% of HIV (not AIDS) adult and
adolescent cases reported to CDC (4). This results in an increasing
proportion of cases that are assigned to transmission categories
(including male-to-male sexual contact) not based on interview with
patients, but rather via statistical adjustment. Risk factor
information often is missing because patients decline to disclose
behaviors that might place them at risk for HIV transmission or are
unaware of their sex partners' high-risk behavior. Third, methods for
reporting delay adjustments have greatest uncertainty for the most
recent years' estimates of HIV/AIDS diagnoses; therefore, recent
trends should be interpreted with caution. Finally, a backlog of cases
diagnosed earlier than recorded in the data might have exaggerated the
number of diagnoses in the first 2--3 years after name-based HIV (not
AIDS) case reporting was implemented (5). For example, retrospective
ascertainment of name-based HIV case reports might have resulted in a
substantial number of cases that were recorded as diagnosed during
2001--2002 but were actually diagnosed earlier. New York's
implementation of name-based HIV reporting in June 2000 might have
magnified the effect of this backlog on the 33-state trend analysis
because New York data represented 21% of all HIV/AIDS diagnoses during
2001--2006. After exclusion of New York from this analysis, however,
an even larger statistically significant increase in HIV/AIDS
diagnoses among MSM was observed during 2001--2006 (EAPC = 3.1 [CI =
2.4--3.9]).
To reduce transmission of HIV among MSM of all races/ethnicities,
prevention strategies should be strengthened, improved, and
implemented more broadly. Testing is important in preventing HIV
transmission because it provides knowledge of one's infection status;
after persons become aware that they are HIV positive, most reduce
their high-risk sexual behavior (6). In addition, an estimated 25% of
HIV-infected persons have not received a diagnosis of HIV infection
(7). These persons represent a challenge in terms of HIV prevention
and case ascertainment. Moreover, testing is the first step to linking
persons infected with HIV to medical care. CDC recommends at least
annual testing for sexually active MSM and an "opt-out" approach for
screening of all patients aged 13--64 years in clinical settings (8).
Ulcerative and nonulcerative sexually transmitted diseases (STDs) such
as syphilis and gonorrhea facilitate HIV transmission from infected
MSM and acquisition of HIV by noninfected MSM; therefore, screening
for STDs in private and public clinical settings is an important
component of HIV prevention in MSM (9). STD and HIV prevention efforts
should be as fully integrated as possible. Furthermore, associations
have been observed between abuse of illicit and legal drugs such as
methamphetamine and alcohol, respectively, and high-risk behavior
among MSM. Screening for substance abuse in private and public
clinical settings is an important tool for reducing HIV
transmission. Strengthened collaborations between STD, HIV, viral
hepatitis, and substance abuse programs should result in more
effective HIV prevention efforts.
CDC assists in the creation, development, and dissemination of
behavioral interventions for the MSM population. Recently, in
collaboration with the state health department and local organizations
in North Carolina, CDC implemented a successful intervention for young
black MSM (10). This intervention has resulted in decreases in
high-risk sexual behavior and the number of sex partners with whom
such behavior occurred. CDC recommends that state and local health
departments allocate HIV prevention resources to ensure that program
operations reflect the current state of the HIV/AIDS epidemic in the
geographic areas for which each health department is responsible. In
support of CDC's strategic goal of reducing the number of new HIV
infections in the United States,¤¤ the proportion of MSM who adopt
behaviors that reduce risk for HIV transmission must increase.
References
1. CDC. HIV/AIDS Reporting System (HARS) user manual. Atlanta, GA:
US Department of Health and Human Services, CDC; 2000.
2. Green TA. Using surveillance data to monitor trends in the AIDS
epidemic. Stat Med 1998;17:143--54.
3. Lee LM, McKenna MT. Monitoring the incidence of HIV infection in
the United States. Public Health Rep 2007;122(Suppl 1):72--9.
4. CDC. HIV/AIDS surveillance report, 2006. Vol. 18. Atlanta, GA:
US Department of Health and Human Services, CDC; 2008:12. Available at
http://www.cdc.gov/hiv/topics/surveillance/resources/reports.
5. Torian L, Bennani1 Y, Wethers J, Schwendemann J, Nash D. Use of
the serologic testing algorithm for recent HIV seroconversion to
assess specificity of routine surveillance to detection of incident vs
prevalent HIV: evaluation of the first 2 years of named HIV reporting,
New York City, June 1, 2000 to June 30, 2002. 11th Conference on
Retroviruses and Opportunistic Infections, 2004. Session 135 poster
abstract. Available at
http://www.retroconference.org/2004/cd/abstract/964.htm.
6. Marks G, Crepaz N, Senterfitt JW, Janssen RS. Meta-analysis of
high-risk sexual behavior in persons aware and unaware they are
infected with HIV in the United States: implications for HIV
prevention programs. J Aquir Immune Defic Syndr 2005;39:446--53.
7. Glynn M, Rhodes P. Estimated HIV prevalence in the United States
at the end of 2003 [Abstract T1-B1101]. Programs and abstracts of the
2005 National HIV Prevention Conference; June 12--15, 2005; Atlanta,
GA. Available at
http://www.aegis.com/conferences/nhivpc/2005/t1-b1101.html.
8. CDC. Revised recommendations for HIV testing of adults,
adolescents, and pregnant women in health-care settings. MMWR
2006;55(No. RR-14).
9. Fleming DT, Wasserheit JN. From epidemiological synergy to
public health policy and practice: the contribution of other sexually
transmitted diseases to sexual transmission of HIV infection. Sex
Transm Infect 1999;75:3--17.
10. Jones KT, Gray P, Whiteside YO, et al. Evaluation of an HIV
prevention intervention adapted for black men who have sex with men.
Am J Public Health 2008;98:1043--50.