CDC Updates HIV Statistics, Confusion Ensues
The Washington Post published an article yesterday on the apparent positive impact of AIDS prevention and education. The article is based on new updated numbers released by the CDC that actually revise upwards historical incidence counts over the past 30 years due to new estimation methods. Sunday's article was accompanied by a series of graphics that seem to paint a picture contradictory to the headline. According to the graphics, HIV infections in men who have sex with men have been increasing steadily since 1993 or so. Over the same time period, incidence rates have been steady among heterosexuals, and decreasing for intravenous drug users. Again, over the same time period, it appears that infection rates when divided up by whites, blacks and Hispanics have more or less stayed the same, with the whites showing the most pronounced upward trend over the past 15 years.
I find it disturbing that the message being broadcast by the media is that "we're gaining ground on HIV" when in fact it appears we're losing, especially among gay and bisexual men and African Americans. I'm also disappointed by the snapshots that the graphics supply. From the data presented, it is impossible to determine the change in incidence rate for, say, white men who sleep with men versus black men who sleep with men. One could guess that the uptick in incidence among gay and bi-sexual men correlates to the uptick in incidence among blacks, but correlation doesn't equal causality. I tracked the data back to the source, and looked to see if I could find the raw data on the CDC website, so I could create my own graphics of interest. Alas, no such data is currently available.
Based on the data available, I feel an appropriate headline for an article on this data release would be, "Gay's Have Forgotten The Past, Need Reminders Of The Horrors Of HIV/AIDS."
It's far too easy for an arm-chair statistician to look at a few numbers and graphics from the CDC and produce faulty analysis. Our community deserves better reporting, representation and information than this.
4 comments:
"Remember the past" doesn't work to scare young guys away from unprotected sex because it's NOT the past any more. Getting HIV/AIDS is still very bad news, but it's not as dire as it used to be.
We found out in the 80s that it's possible to persuade gay men to use condoms temporarily, to get through a crisis, but I think it's unreasonable to expect a permanent change in behavior. Eventually, the drive is too strong to resist, the need to penetrate or be penetrated. The whole point of sex is that physical intimacy, which can't be achieved with a condom on your dick.
Yeah, that WP article is confusing. I think that it is true that AIDS prevention is having an effect but they don't provide any information to support that and in fact what they do provide seems to contradict that statement.
The JAMA article (reference below) and CDC fact sheet (link below) actually do a great job at highlighting the racial and sexual disparities that are such a large part of this disease. I was glad to see the JAMA researchers controlled for increased testing of MSM (because MSM having higher rates of being tested for HIV, if they didn't control for this fact, there would be testing bias that skewed the data).
I think the missing point from the WP is: Despite there being more people living with HIV/AIDS, incidence rates have remained stable. This is a good thing and probably does reflect the benefits of prevention programs. Because if more people are around with the disease, you would expect incidence to increase. Thanks too all the safe sex educators out there, whether it is your job or you are acting as a friend, you are doing a great job!!!
The JAMA article is really dense but I think it might be interesting for those interested to read the abstract and then read the WP article. There were so many different stories that could have been written based on this story..... what article would you have written???
Finally, thanks for your post. Back in the mid 90s when I was a pre-med college student my dream job was to be the health writer for Spin magazine. Then Spin stopped that section of the magazine and I went to medical school. I am glad to see your post and hope to read more health related articles in forums (inc. TNG) that are accessible to many. Hell, maybe you will inspire more gays to go into medicine (as Spin did for me), which would be a good thing, in my opinion.
JAMA article: Hall, I. Estimation of HIV Incidence in the United States. JAMA. 2008;300(5):520-529.).
CDC Fact Sheet: http://www.cdc.gov/hiv/topics/surveillance/resources/factsheets/incidence.htm
Thanks, Anon, for your comment. The Washington Blade published a good article today on the same data and came up with vastly different conclusions:
U.S. efforts to fight HIV assailed: CDC data a ‘scathing indictment’ of prevention tactics
We're always interested in providing more coverage on lots of different topics of interest to queer folk. Please feel free to submit a post on any health issue you feel needs some attention.
Hi, again.
I think the Blade's article is interesting. I think calling the current state a "scathing indictment" of prevention tactics is a little off base. Especially when they point to the stable or declining infections in IVDU, women, and heteros. That is something to be proud of.
Plus, the hard thing with measuring the success of wide spread preventative programs is that you have no good controls.... what would the infection rates be without the current prevention programs?
Regardless, I think the point that (most) everyone can agree upon is that additional prevention efforts should be pursued, especially for racial and sexual minorities. We have a lot of ground to cover.
Thanks.
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