At least there's some good news on this front
ATLANTA, Nov. 17 -- The rate of newly reported HIV cases among blacks has been dropping by about 5 percent a year since 2001, the government said Thursday, but blacks are still eight times as likely as whites to be diagnosed with the AIDS virus. "The racial disparities remain severe," said Lisa Lee, an epidemiologist at the Centers for Disease Control and Prevention. The falling rate among blacks seems to be tied to overlapping drops in diagnoses among injection drug users and heterosexuals, CDC researchers said.
The study was based on 2001-04 data from 33 states that have name-based reporting systems for HIV. Health officials do not know which diagnoses represent new infections and which ones were infections people had for years but had just discovered. The CDC found that annual number of diagnoses in the 33 states decreased slightly, from 41,207 cases in 2001 to 38,685 in 2004. The rate fell from 22.8 cases per 100,000 people in 2001 to 20.7 per 100,000 in 2004. The decline was more pronounced among blacks: The rate dropped from 88.7 per 100,000 in 2001 to 76.3 in 2004. Among whites, the rate rose slightly from 8.7 to 9.0.
At least part of the decline among blacks appears to be tied to a 9 percent annual decline in diagnoses among injection drug users, who can contract the virus from contaminated needles. More than half of the drug users were black, Lee said. The decline is also linked to a 4 percent decline in diagnoses among heterosexuals. About 69 percent of the heterosexuals diagnosed with HIV were black.
But not all the news is (relatively) good, unfortunately.
Diagnoses among men who have sex with men remained stable from 2001 to 2003 but climbed 8 percent between 2003 and 2004. That was true for men of all races, CDC officials said. They said they could not explain the recent increase....
Trends in Reportable Sexually Transmitted Diseases in the United States, 2004
Division of STD Prevention
Centers for Disease Control and Prevention
Sexually transmitted diseases (STDs) remain a major public health challenge in the United States. While substantial progress has been made in preventing, diagnosing, and treating certain STDs in recent years, CDC estimates that 19 million new infections occur each year, almost half of them among young people ages 15 to 24. In addition to the physical and psychological consequences of STDs, these diseases also exact a tremendous economic toll. Direct medical costs associated with STDs in the United States are estimated at $13 billion annually.
This document summarizes 2004 national data on trends in notifiable STDs — chlamydia, gonorrhea, and syphilis — that are published in CDC's report, Sexually Transmitted Disease Surveillance 2004 (available at www.CDC.gov/STD/stats). [...]
Increasing cases of P&S syphilis among MSM are believed to be largely responsible for the overall increases in the national syphilis rate observed since 2000. Until very recently, CDC has not collected data by risk group. However, the male-to-female ratio for P&S syphilis has risen steadily between 2000 and 2004 (from 1.5 to 5.9), suggesting increased syphilis transmission among MSM. This increase occurred among all racial and ethnic groups. Additionally, CDC estimates that MSM comprised 64 percent of P&S syphilis cases in 2004, up from 5 percent in 1999.
In 2004, the P&S syphilis rate among blacks increased for the first time in more than a decade — 16.9 percent from 2003 to 2004 (from 7.7 to 9.0), with the most significant increases among black men. Between 2003 and 2004, the syphilis rate among black males increased 22.6 percent (from 11.5 to 14.1), while the rate among black women rose 2.4 percent (from 4.2 to 4.3). In addition, the male-to-female ratio for blacks rose from 2.7 in 2003 to 3.3 in 2004, suggesting increases among black MSM....
"[CDC officials] said they could not explain the recent increase..."
Hmm. Yes. Quite.
Well, you know, coupled with the increase in other STDs, I'm guessing that it means that perhaps, just perhaps, condom use among "men who have sex with men" is undergoing some steep declines. (Yes, yes, I know, it's the sort of thing that researchers when they haven't examined an issue. But still.) Now why that is happening, that might be worth examining.
It would, you know, be fascinating to see a breakdown of certain kinds of overlap, if they could get good information on this. For example, according to a recent article I saw (and cannot now find), MSM are doing a certain amount of self selection -- people are tired of condoms, but also don't want to feel even a little responsible for someone else, so many men who are HIV-positive are trying to have sex only with other positive men, and negative men only with other negative men. Unfortunately for everyone, HIV isn't the only sexually transmitted disease in the world -- it's not even the only incurable STD -- but it's the only one everyone thinks about. And it makes you wonder how much of this disease increase is occurring, for example, in men who are already positive.
Alas, this is the type of data that would likely show heavy "social desirability bias" -- even assured of the confidentiality of the information, people are just not going to want to go on record as saying, "Yeah, I'm using condoms a lot less now, and I just don't care!"
Posted by iain at November 18, 2005 07:43 PM
