New Study: 95% of HIV Positive Don’t Transmit HIV

Even though we’ve talked over the last year about the new HIV infections rate (incidence) in 2006, I haven’t given any thought to the issue of transmission–how many people actually transmit HIV to an HIV negative person every year? And what does the looking at the rate of transmission over the course of the epidemic tell us about what’s working or not working with prevention, testing, treatment or care efforts?

Well that’s why we have smarty pants like David Holtgrave, PhD at the Bloomberg School of Public Health at the John Hopkins University. His study, which JAIDS released online ahead of the publication date, looks precisely at HIV transmission rates over the course of the epidemic. They conclude that the highest rates of transmission occurred in the early years of the epidemic–in the early/mid 80s, and then began to drop off at several different points, particularly from 1985-1986 (31.4-17.4), and 1990-1991 (11.7-6.6). By 2006, the transmission rate declined to 5.0.

In other words, 95% of all people with HIV did not transmit the virus to people who are HIV negative.The study goes on to explain the possible causes for this drop in transmissions:

The general decline in HIV transmission rates over time could be considered a rough measure of prevention success, in that even as prevalence grew over time incidence did not grow proportionately. HIV diagnosis is known to significantly reduce HIV risk behavior, and in the past decade, there has been an increasing emphasis on prevention programs for persons living with
HIV that further reduce HIV risk behavior and 2006.

Another interesting thing they note is that AIDS drugs (anti-retrovirals) didn’t have a grand impact on transmission rates, as transmission was declining long before ARVs were on the market.

Could it be that marginalized communities with no access to treatment is where those transmission rates did not decrease or increased?

Could it be that the prison boom and/or Welfare Reform Act of 1996 (when prison construction peaked and we hit the 2 million prisoner mark for the first time) disrupted or changed sexual networks enough to create new HIV transmissions (and sexually transmitted infections in social networks where they had been stable?

Holtgrave doesn’t ask these questions, but notes that further research needs to happen to explain why ARVs do not seem to have significantly decreased transmission of HIV. But in a Q & A on Johns Hopkins’ website, he addresses the impact of housing stability on HIV risk, and also says what he would do if he was AIDS Czar in the Obama Administration:

I think it is critical to address unmet HIV prevention needs in the U.S. As I testified recently before Congress, my wish for a five-year plan would be for $1.3 billion in prevention funding per year. I might front-load that a bit, so maybe it’s $1.6 billion in the first year, and so on. Over that five-year period, I estimate that as a nation we could reduce transmission by half—but we’d need that substantial investment. And if we really saw a drop in new infections, that higher level of funding might sunset in several years, so we wouldn’t necessarily have to continue to fund it at $1.3 billion per year.

Let’s hope we’re as lucky to have this come to fruition.

UPDATE: The CDC has published a factsheet and podast on HIV Transmission Rates in the US, based on the release of this data.

World AIDS Day: We’re Still Living With AIDS

(originally written for the NGLTF Policy Institute)

December 1, 2008 8:40 am

Today, many of us will dust off those red ribbons, and “remember” to remember the people who we’ve lost, and who are currently living with HIV/AIDS.

Some of us may even donate money to an AIDS charity doing work in some far flung place. But red ribbons and prayer services that commemorate only hide the reality that here in America, we are still living with AIDS.

Despite major advances in treating the virus, the HIV/AIDS epidemic didn’t go anywhere and in fact, it seems to be getting worse for people in our community. At the International AIDS Conference, the Centers for Disease Control and Prevention (CDC) stunned the international AIDS community by announcing that the richest nation on earth had over 56,000 new infections in 2006. While this may not seem like a huge number, this revision also included a back-calculation revealing that, for the 15 years from 1991-2006, infection rates were approximately 25-50 percent higher than the long-held 40,000 annual estimate.

Not only have we been under-counting the growth of the epidemic, men who have sex with men (MSM — that public health category that includes gay and bisexual men, and transgender women) continue to bear the greatest increases in new infections. In 2006, 53 percent of all new infections were among MSM. More stunning, it found the number of new infections of black MSM ages 13-29 to be the highest of all MSM groups. Even though CDC officials are typically conservative in its public statements, CDC Behavioral Scientist Greg Millett has stated publicly that black MSM are the only group in the U.S. with HIV rates similar to Sub-Saharan African nations, despite similar or lower rates of risky sex or substance abuse than white MSM. While black MSM certainly bear the brunt of the virus, gay and bisexual men and transgender women of all races are disproportionately impacted by the virus.

Though many of us are celebrating a new administration, we are still living with HIV/AIDS policies that reflect the reactionary Reagan era, where politics, not public health science, dominates our approach to HIV prevention, treatment and care. We still fund abstinence-only sex education, ban federal funding for syringe exchange programs, and there’s no coordinated national AIDS strategy for the United States. This lack of concern for our lives shapes the ability of people with HIV to accessing quality services, but also makes many in our community more vulnerable to contracting the virus.

And the HIV negative still live with the virus — lovers, friends, relatives, are positive, have died, and the spectre of HIV still shapes our current sexual lives.

So instead of silently commemorating this World AIDS Day with a red ribbon, I urge of us to continue to fight the public policies that make us more vulnerable to contracting the disease or that prevent people who are positive from staying healthy. President-elect Barack Obama will be making key appointments in the coming weeks that will demonstrate whether his promises for policy change for the domestic HIV epidemic will put public health over politics. We have an opportunity to do something different. Let’s hold him to his word.

American Prospect: Best HIV/AIDS Reporting This Year!

It is hard to find good reporting on the domestic AIDS epidemic in the US that isn’t sensational, or focuses nearly entirely on individuals who contract HIV–as if it’s only their fault and that there are no policy decisions that are also complicit in driving the US epidemic. When was the last time you read a feature story that focused on the Centers for Disease Control & Prevention (CDC), National Institutes of Health (NIH), Congress, Health & Human Services or any of the other federal agencies responsible for AIDS treatment, care, prevention, and research?

Well, The American Prospect, the liberal monthly policy magazine published not one, but TWO stories on domestic HIV policy, and both do a really great job of reporting what’s going on in terms of national HIV policy.

Kai Wright, the best AIDS reporter in the biz, has a story on AIDS in the South that shows his strength as a writer, and his enormous ease with a very complex subject as he deals with virtually every angle of the issue from history to prisons, to homophobia to government funding. He writes:

What was once considered an urban, coastal epidemic — centered in gay havens like New York City, San Francisco, and Los Angeles — is now a surprisingly rural, Southern one. More than half of all new infections logged between 2001 and 2004 were found in the South. Those infections are far more likely to be found among Southerners who are black, low-income, and diagnosed with advanced conditions they do not have the resources to control.

What’s being done? Adam Green’s story focuses on the work by AIDS activists in the US to push the government to have for a coordinated National AIDS Strategy. In case you didn’t know, part of Bush’s much celebrated (and highly problematic) PEPFAR prorgam is that any country applying for PEPFAR dollars must have a national strategy for AIDS prevention, treatment & care. THE UNITED STATES HAS NO SUCH PLAN. In addition, the nation’s capital has an HIV prevalence rate worse than many countries in sub-Saharan Africa. Green writes:

Instead, the domestic response is built on a loosely connected network of local, state, and federal programs. Authors and activists often describe this existing HIV/AIDS programming as a safety net. But the metaphor is not quite apt. There’s only a tenuous connection between the organizations. There’s little strategic coordination and no clear goals. The result is that people who are at risk or infected don’t know where or how to access care. In 2002, an estimated half of people with HIV/AIDS were not receiving care.

For more information on the National AIDS Strategy visit their website. Also, in early August I will be in Mexico City with CHAMP at the International AIDS Conference blogging on issues pertinent to the domestic AIDS epidemic at the conference, so be sure to check us out at www.AIDS2008.com