Half of black gay men will be infected with HIV, CDC finds
Half of black men who are gay and a quarter of Latino gay men will be diagnosed with HIV in their lifetimes if current trends continue, according to a first-of-its-kind federal analysis released Tuesday.
The findings present a stark reminder of the threat still posed by the AIDS virus 35 years after the illness was first detected, despite progress in treatment and prevention.
“It was really a clarion call,” said Dawn Fukuda, director of the HIV/AIDS division at the Massachusetts Department of Public Health, who heard the report presented at the international Conference on Retroviruses and Opportunistic Infections in Boston. “These are numbers that are pretty astounding.”
The report from the Centers for Disease Control and Prevention is the first to project the lifetime risk of HIV infection state-by-state and among certain groups of people. Based on death data from 2009 through 2013, the CDC concluded that gay and bisexual men, African-Americans, and people who live in the South have the highest risk of infection.
It is well-known that blacks and Latinos have been hit disproportionately by the HIV epidemic and that gay men are most at risk. But the new data present the disparities in striking terms, intended to drive public policy discussions.
“We did this to help with communication,” said Kristen L. Hess of the CDC’s division of HIV/AIDS Prevention.
Overall, the lifetime risk of an HIV infection has dropped among all Americans. Today, it is 1 in 99. About a decade ago, the risk was 1 in 78. But, Hess said, “There are vast disparities that still exist.”
“It’s really important to say that these [projections] are not inevitable,” said Carl Sciortino, executive director of the AIDS Action Committee of Massachusetts, the largest AIDS service organization in New England. “This is a call to do things differently.”
Sciortino said his agency has been taking extra steps to reach those at risk, working with religious and community groups and posting ads on public transit and on gay dating websites.
Among other key findings in the CDC report:
■ Among men who have sex with men, the lifetime risk of HIV infection is 1 in 6. But the risk varies by race. For black men who have sex with men, the lifetime risk is 1 in 2, for Latinos 1 in 4, and for whites 1 in 11.
■ All African-American men have a lifetime risk of 1 in 20, compared with 1 in 132 for white men.
■ Among people who inject drugs, the risk is 1 in 23 for women and 1 in 36 for men. Women are more vulnerable because they may also be exposed through sex, and some studies have shown that when people share needles, “men go first,” said Dr. Susan P. Buchbinder, professor of medicine at the University of California San Francisco.
■ People in Washington, D.C., have the highest risk in the country, while people in North Dakota have the lowest. States with the highest risk are Maryland, Georgia, Florida, and Louisiana. Massachusetts ranks near the middle, with residents facing a lifetime risk of 1 in 121.
The geographic disparities reflect, with few exceptions, which states have expanded Medicaid, Sciortino noted. Where Medicaid provides services to the needy, the risk of infection goes down, he said.
Massachusetts is doing better than would be expected based on the makeup of its highly urbanized population, said Fukuda, of the state public health department.
“We still have work to do in Massachusetts,” she said. Still, the state has seen a 41 percent decline in new HIV infections since 2000. The rate plateaued for several years, but preliminary data for 2014 suggest the number has declined again, she said. Fewer than 30 new infections in 2014 were attributed to injecting-drug use, despite the epidemic of heroin use.
The state is about to a launch a prevention effort in cooperation with community health centers, hospitals, and community organizations, Fukuda said. The program will seek to identify people at risk for contracting HIV and encourage them to start on a medication that, if taken as prescribed, prevents infection in 90 percent of users. Insurance and Medicaid pay for the medication, and the state will provide assistance with copays in an effort to remove all barriers.
Fukuda found a recurrent theme at the annual infectious disease conference, which continues through Thursday: “More than anything, across the country, we need to focus on at-risk vulnerable populations.”
Dr. Kenneth H. Mayer, medical research director and cochairman of the Fenway Institute in Boston, saw a similar theme in what he called “good news-bad news” reports Tuesday. “We’ve definitely made a lot of progress,” he said, “but we still have a long way to go.”
Mayer pointed to a study by Kaiser Permanente, a large California health system. The study found a dramatic improvement in life expectancy among people with HIV — but also noted that blacks are still dying at earlier ages than whites.
The Kaiser Permanente study compared 25,000 of its patients who had HIV and 250,000 who did not from 1996 to 2011. In 1996, HIV-infected people could expect to live on average only to age 39. By 2011, that had increased to age 73. But blacks with HIV could expect to live only to 65.
From 2008 to 2011, the difference in life expectancy between those with HIV and those who were not infected was 13 years. But for those who started treatment early, the gap was only eight years, and among infected people who don’t have hepatitis, don’t use drugs or alcohol, and don’t smoke, the life-expectancy gap was five to seven years.
Those data suggest how to further reduce deaths, with vaccines for hepatitis B, treatment for hepatitis C, and stepped up efforts to address tobacco and other addictions, Mayer said.
But even as life expectancy rises, he said, “There’s a fair number of people who, over the course of a lifetime, face considerable risk.”