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New HIV Infections Down for U.S. Black Women, Still Rising for Young Gay Men

HIV incidence continues to climb for young men who have sex with men (MSM) -- the group with the highest incidence -- showing a 22% increase between 2008 and 2010, according to new data from the Centers for Disease Control and Prevention (CDC). The rate fell by 21% among African-American women, however, representing the first-ever significant decline.

On December 19, 2012, the CDC released its latest HIV Surveillance Supplemental Report, along with an accompanying fact sheet, describing estimates of HIV incidence among adults and adolescents in the U.S.

The report provides new data for 2010, as well as updated estimates for 2007-2009. Although the overall HIV infection rate has held relatively steady at about 50,000 cases per year since the mid-1990s, there have been some shifts in which populations are most heavily affected.

Key Findings

• Overall, an estimated 47,500 people were newly infected with HIV in 2010.
• The estimate was the same for 2008, a bit higher in 2007 at 53,200, and slightly lower in 2009 at 45,000.
• 44% of new infections occurred among African Americans (20,900 cases) -- an incidence rate nearly 8 times higher than that of whites -- but their overall incidence remained stable from 2008 to 2010.
• Whites accounted for 31% of all new HIV infections in 2010 (14,900 cases), with 85% of them among gay/bisexual men, with no significant change from 2008 to 2010.
• Hispanics accounted for 21% of all new infections in 2010 (9800 cases), again with no significant change during 2008-2010.
• Asians accounted for 2% of new infections (950 cases), while American Indians/ Alaska Natives and Native Hawaiians/Pacific Islanders each accounted for less than 1% (210 and 70 cases, respectively).
• People aged 25-34 made up 31% of new infections (14,500 cases), followed by the 13-24 age group (26% or 12,200 cases), the 35-44 group (24% or 11,300 cases), the 45-54 group (15% or 7100 cases), and those age 55 or older (5% or 2500 cases) -- all with stable incidence.
• Nearly two-thirds (63%) of all new HIV infections in 2010 occurred among gay/bisexual men (29,800 cases), with a 12% increase from 2008 to 2010.
• White gay/bisexual men continued to have the largest absolute number of new HIV infections (11,200 cases).
• Black MSM have the highest incidence rate, however, and their absolute number is catching up (10,600 cases), despite making up a much smaller proportion of the population.
• Incidence rose by 22% during 2008-2010 for young MSM age 13-24 years -- the only group with a statistically significant increase (8800 cases in 2010).
• Young black gay/bisexual men have the highest incidence of any group, accounting for 55% of all infections among young MSM (4800 cases in 2010).
• Injection drug users accounted for 8% of new infections in 2010 (3900 cases), with no significant change in incidence during 2008-2010.
• Heterosexuals without a history of injection drug use accounted for 25% of new infections in 2010 (12,100 cases), 66% of them among women.
• HIV incidence among women fell by 21% overall, largely due to a drop in heterosexual transmission.
• African-American women accounted for 13% of all new infections in 2010 (6100 cases), but saw a 21% decrease between 2008 and 2010; this is the first CDC incidence report to show a statistically significant decline.
• Nevertheless, black women have an incidence rate 20 times higher than that of white women, a greater disparity than previously estimated.

More research on effective prevention approaches are needed, especially for young gay men of color. Studies have shown that black MSM have significantly higher odds of becoming infected despite not engaging in more high-risk sex or drug use. The CDC implicates higher prevalence (meaning a higher likelihood of encountering partners with HIV), lower rates of HIV testing (resulting in more people who do not know they are positive and are not on antiretroviral treatment), higher rates of other sexually transmitted diseases (which facilitate HIV transmission and acquisition), stigma and homophobia, and lack of insurance and limited access to care.

Speaking of the promising decrease in incidence among black women, Kevin Fenton, outgoing director of the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, told The Root that "a number of factors are beginning to bear fruit," including scaling up efforts to encourage women to get tested. "The data reflect not only our efforts but also that the community is clearly taking the message and taking steps they need to avoid to avoid HIV," Fenton continued. "We're seeing black women taking control."

In a "Dear Colleague" letter and blog post, Jonathan Mermin, director of the CDC's Division of HIV/AIDS Prevention, said these findings validate the federal government's "high impact prevention" approach, which aims to direct HIV prevention funding where it can have the greatest impact -- that is, by focusing on the groups at highest risk.

12/27/12

Reference

J Prejean, A Hernandez, R Son, et al, CDC. Estimated HIV incidence in the United States, 2007--2010. HIV Surveillance Supplemental Report 17(4). December 2012.

Other Sources

CDC. New HIV Infections in the United States. Fact sheet. December 2012.

J Mermin. CDC Releases Data on New Cases of HIV. U.S. Dept. of Health and Human Services AIDS.gov Blog Update. December 19, 2012.

J Mermin. Estimates of HIV Incidence in the United States, 2007-2010. CDC e-HAP Direct Updates. December 19, 2012.

J Desmond-Harris. New HIV Infections Down Among Black Women. The Root. December 19. 2012.