Date: Thu, 13 Jun 1996 18:49:49 -0400 From: "Flynn Mclean" Subject: CDC National AIDS Hotline Training Bulletin #170 ................................................................. CENTERS FOR DISEASE CONTROL AND PREVENTION HIV/AIDS PREVENTION CDC NATIONAL AIDS HOTLINE TRAINING BULLETIN ................................................................. February 13, 1996 #170 This is a statement from the Centers for Disease Control and Prevention (CDC) concerning a new National Cancer Institute study that refines estimates of HIV in the United States and reveals sobering trends for young Americans. While the rate of new AIDS cases reported among adults born before 1960 appears to be reaching a plateau, the rate among younger Americans continues to escalate, according to a study by Dr. Phillip Rosenberg of the National Cancer Institute, published in the November 24, 1995 issue of Science. These findings clearly demonstrate the dynamic nature of the epidemic and underscore the importance of targeted prevention efforts for young adults. According to the research, the number of AIDS cases reported each year (AIDS incidence) may now be reaching a plateau in white men born before 1960. But the disease is still increasing in other groups, including younger white men. Looking only at the running total--either the total number of people with AIDS or the total number of people estimated to be infected with HIV--masks the true impact of disease on young adults, minorities, and women. Using the National AIDS Database compiled by the Centers for Disease Control and Prevention (CDC), Rosenberg's study uses a statistical method called "back-calculation." Back-calculation examines the number of AIDS cases reported to CDC and calculates the number of HIV infections each year (HIV incidence) in specific populations that would produce those cases, given the long and variable lag time between HIV infection and AIDS. By reconstructing historical HIV incidence, Rosenberg is able to draw conclusions about past trends in infection among groups, as well as the total number of people infected with HIV (HIV prevalence). HIV Prevalence Highest Among Young and Minorities Rosenberg's estimate of overall HIV prevalence, consistent with estimated ranges from previous research, indicates that between 630,000 and 900,000 adults and adolescents in the United States were living with HIV as of January 1993. (The estimate was derived using statistical techniques that have been refined and expanded since previous estimates based on back-calculation.) Overall, HIV prevalence is highest among young adults in their late twenties and thirties and minorities. An estimated 3 percent of African-American men (100,000) and 1 percent of African-American women (37,000) in this age group were living with HIV infection. Approximately 1.7 percent of Hispanic males (52,000) and 0.5 percent of Hispanic females (13,000) in their late twenties and early thirties were estimated to be infected. The high prevalence among minorities--particularly African-American men--is a significant public health concern. The findings indicate that 1 of every 33 African-American men ages 27-39 in the United States may be infected. Successive Waves of Infection According to Rosenberg, perhaps the most important question in terms of where the epidemic is going is whether the HIV incidence rate among young adults has declined compared to the rate among people of the same age in the past. To analyze changes in infection rates over time, the study compares the estimated number of people infected per 100,000 individuals among white, African-American, and Hispanic men and women for the 1981-1986 and 1987-1992 periods. Comparing the two 6-year periods, the only evidence of a marked decline in infection rates over time is among white males. In every group during both time periods, there is a substantial increase in the rate of infection as individuals enter their late teens and earlier twenties, with rates peaking in the mid- to late-twenties. Need for Sustained Prevention Prevention efforts have helped stabilize infection rates overall and may have contributed to a decline in infection in older white males. But it is now clear that as each generation of young Americans comes of age, they face an AIDS epidemic not unlike the generation before. The danger is that we will become complacent, accept that at least 40,000 people will become infected each year, and that wave after wave of HIV infection will endanger our nation's youth. The study concludes that, "If HIV infection rates remain at the levels indicated, HIV must be considered an endemic infection affecting successive cohorts of young adults." The study emphasizes the need to intensify prevention efforts for young Americans. Sustained, targeted prevention for each group entering young adulthood is what will keep these waves from developing. Disclaimer: CDC Hotline Training Bulletins The information in the "CDC Hotline Training Bulletins" is provided by CDC and NIH for use by the CDC National AIDS Hotline in responding to general questions from the public about HIV and AIDS. The bulletins are not intended to be comprehensive discussions of the subject areas. Treatment and drug therapy options change as new research and clinical experiences broaden scientific knowledge. Therefore, persons seeking information on drug therapy should refer to the product information sheet included in all drug packages for the most current and accurate information about a particular drug, especially if the drug is new or infrequently used. HIV-infected individuals should consult their personal physician for specific concerns about their health. For persons desiring more information on a specific topic, public, medical, and university libraries can provide excellent references. The AIDS Clinical Trials Information Service (800-874-2572) can provide information about ongoing HIV/AIDS clinical trials; the HIV/AIDS Treatment Information Service (800-448-0440) can assist with information about the latest treatments for persons with HIV infection or AIDS.