MICHEL MARTIN, host:
I'm Michel Martin and this is Tell Me More from NPR News. Yesterday, the International AIDS Conference opened in Mexico City. We'll have two reports from there. In a minute, we'll talk about HIV/AIDS and African-Americans. Is AIDS becoming a black disease?
But first, we're going to look at the spread of the disease in the U.S. across all communities. There are more new cases of HIV infections in the U.S. than previously known. A new report by the Centers for Disease Control and Prevention released over the weekend says the country had roughly 56,000 new infections in the year 2006, far more than the annual estimate of 40,000 that had been used for the past dozen years. But the increase is not believed to be due to a worsening of the epidemic but rather better testing.
Joining us to talk about this is Dr. Kevin Fenton. He is director of the CDC's National Center for HIV/AIDS. He's in Mexico City for the conference. Welcome, Dr. Fenton. Thanks for talking to us.
Dr. KEVIN FENTON (Director, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention): Thank you very much.
MARTIN: Talk to us about this new system for determining the HIV infection rate. How is it that there's such a wide variance between what we thought and what we now know?
Dr. FENTON: Well, what we need to bear in mind is that we're now using breakthrough technology and this technology is providing us with a much clearer picture of new infections which are occurring in the United States, while previous estimates, which were done in the 1990s, used much less sophisticated methods. And really, it is the improvement in the methodology and our ability to apply new laboratory techniques to new surveillance systems and to do different analyses which has enabled us to have this clearer picture today.
MARTIN: As I understand it, one of the things you can learn with the new testing is when someone became infected as long - as well as the fact that they simply are infected. Why is that important?
Dr. FENTON: You know, that's absolutely correct, and this is where the breakthrough technology really gives us that added advantage. The new technology can determine whether an individual has been infected within the last five months. Now this is very different to what we had before where people - we only could count new HIV diagnoses, and that could be for someone who was infected for five months, or, you know, 10 months or two years. So really, we are able to look at the leading edge of the epidemic in the U.S. today and therefore better able to refine our prevention methods and to evaluate our efforts, as well.
MARTIN: How should we interpret this figure, though, this number? It's 40 percent higher than the estimate that we had previously been using. So I'm assuming that that's a shock to many people in the field, or maybe it isn't. I mean, what are the implications of understanding that the disease is, in fact, more prevalent than we had thought?
Dr. FENTON: Well, yeah. Even when we had been estimating incidents at about 40,000, we were never entirely confident of that because of the imprecise methods that we're using. These new methods are an increase, but we're getting a clearer picture. But it is important, bear in mind, that incidents have been relatively stable since the late 1990s. We've been seeing approximately 56,000 new HIV infections occurring each year. Now the implications for this are that we're not getting ahead of the curve. So we're holding the epidemic at bay, but we need to look at ways in which we can enhance our efforts to further effect reductions in the new incidents estimate.
MARTIN: And what populations - or are there some groups that need particular attention? We're going to talk in just a minute about the issue of HIV/AIDS in the black community. What does the report tell us about - are there any particular populations that perhaps need more attention than they have been getting, according to the figures that CDC just reported?
Dr. FENTON: Absolutely. Now, you know, these data really confirm what we knew from other data sources that we had. And the data confirmed that the most severe impact is among gay-bisexual men of all races and among minority communities in the U.S., especially the African-American community and to a lesser extent, the Hispanic community. But the data also points to ways in which we all need to be using them as a wakeup call to focus on our prevention efforts moving forward.
You know, gay-bisexual men were the only group in this analysis that had consistent increases in HIV incidents since the 1990s. Other groups, such as injecting drug users, heterosexuals, had been either stable or declining in the United States. So again, we're really getting better information to focus our efforts.
MARTIN: Does it suggest that the initial emphasis on men who have sex with men, gay-bisexual men of all races is somehow sort of falling off? Does it suggest that the education efforts - there was tremendous outreach and public education efforts directed at this group - does it suggest that they're not getting those efforts anymore, that they're not hearing it anymore?
Dr. FENTON: I think there are multiple factors which really place men who have sex with men at greater risk, whether it is effectiveness of prevention efforts, whether it's our ability to target a younger generation of MSM who are becoming sexually active and being exposed to HIV, or looking at some other factors such as prevention burn-out or safer-sex fatigue. And of course, remember, within this community, there is higher levels of substance abuse, some higher illness - sexually transmitted diseases, all of which can facilitate the transmission of HIV.
MARTIN: And finally, this whole question of the infection rate among African-Americans, seven times that of whites, almost three times as high as Hispanics, a group that was also disproportionately affected. Why do you think that is?
Dr. FENTON: Well, it's important to remember that race itself is not a risk factor for acquiring or transmitting HIV. These high rates do not reflect the color of an individual's skin. But the realities of the lives of many people of color in the United States may well be facilitating HIV transmission, whether poverty, stigma, misperceptions of risks, high rates of STDs, and, of course, high incarceration rates. Studies have all shown that these social determinants of HIV transmission are a key driving factor in the community and really point to where we need to be focusing our prevention efforts, in addition to individual efforts to prevent the disease moving forward.
MARTIN: Dr. Kevin Fenton is the director of the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. He joined us from Mexico City where the HIV/AIDS International Conference is underway. Thank you so much for being with us, Dr. Fenton.
Dr. FENTON: Thank you.
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