Rates of HIV/AIDS diagnoses steady in the U.S

Dec 1 2004

Rates of HIV/AIDS diagnoses in the United States stayed steady for the years 2000-2003, but sharp racial disparities remain, according to an analysis of data from 32 states, the Centers for Disease Control and Prevention announced today.

Rates of HIV/AIDS diagnosis—the number of new diagnoses of HIV per 100,000 population regardless of whether infection has progressed to AIDS—among non-Hispanic African-Americans in the United States were significantly higher than among other racial and ethnic groups. The rate of HIV/AIDS diagnosis among African-American females in 2003 (53 cases per 100,000 population) was more than 18 times higher than among white women and almost five times higher than among Latina women. In addition, African-American women accounted for 69 percent of female HIV diagnoses during 2000-2003.

“The number of women of color in the United States that continue to be affected by this devastating disease is quite sobering,” said Secretary of Health and Human Services Tommy G. Thompson. ”We will not become complacent in our efforts to aggressively fight this disease which continues to rob too many people of the quality of life they deserve.”

Overall, 125,800 people were diagnosed with HIV/AIDS in the 32 states that conducted confidential, name-based reporting from 2000 through 2003. More than half of diagnoses (51 percent) were among African Americans, although they account for only 13 percent of the population of the 32 states. Thirty-two percent of diagnoses were among whites and 15 percent were among Latinos. Asians/Pacific Islanders and American Indians each accounted for 1 percent of diagnoses during the 4-year period.

Men of color were also disproportionately represented among rates of new HIV diagnoses. In 2003, the highest rate of HIV/AIDS diagnosis was among African-American males (103.4 per 100,000 population), a rate almost seven times that of white men and nearly three times the rate among Latino men. Men who have sex with men (MSM) continued to account for the largest proportion of diagnoses—44 percent of all HIV diagnoses during the four-year period, and 61 percent of diagnoses among men.

“Nearly a quarter of a century has passed since HIV/AIDS was first recognized and it’s simply unacceptable that so many people continue to be infected by this virus,” said CDC Director Dr. Julie Gerberding. “We are making progress in our fight but many challenges lie ahead.”

New Data on HIV Testing Trends Released
CDC today also issued new data on HIV testing trends in the U.S. from two national surveys conducted in 2002 with more than 100,000 people. The National Health Interview Survey (NHIS) showed that 10 percent of adults reported HIV testing in the previous year. The Behavioral Risk Factor Surveillance System (BRFSS) reported that about 12 percent of adults were tested in the previous 12 months. The overall proportion of Americans who report being tested during the prior year has remained roughly stable since 1992.

“Our efforts are paying off. People who should be getting tested are coming forward and learning their status,’’ said Dr. Gerberding. “It’s important that people know their status because modern medical care and treatments are helping people who are infected with HIV live healthy and productive lives.”

Greater use of the rapid HIV tests approved in 2002 is expected to continue to increase the number of persons who get tested. The tests can provide preliminary results in less than a half-hour and can be used outside of clinical settings, making it possible to reach people at risk in a wide variety of settings. To date, CDC has:

• Purchased and distributed 500,000 rapid test kits to local health departments and community-based organizations
• Started pilot projects in seven cities to use the rapid tests in non-clinical settings, and
• Trained more than 1,000 people to perform the rapid test and to provide counseling and testing

Testing rates were higher among groups for whom HIV testing is recommended by CDC than among the general population. Nearly one-fourth of people at increased behavioral risk for HIV were tested in the previous year – 21 percent in the NHIS and 27 percent in the BRFSS. About half of pregnant women – 48 percent in NHIS and 54 percent in BRFSS – reported being tested in the previous year.

Increased access to voluntary counseling and testing is an essential part of reducing new HIV infections in the U.S. CDC estimates that between 850,000 and 950,000 Americans are now living with HIV, and that one-fourth are unaware of their infection. An estimated 40,000 new HIV infections continue to occur in the U.S. each year.

CDC currently funds prevention programs for African-American and Latina women that emphasize better links between prevention and treatment services, education about how to best protect against HIV transmission, and effective programs for reducing risky behaviors. CDC also provides funds to 104 community-based organizations for HIV/AIDS prevention. More than 15% of these programs focus on girls and women; 84% serve African-American girls and women and 72% serve Hispanic girls and women.

The 32 states included in the analysis have conducted confidential, name-based HIV/AIDS case reporting for at least four years . These states represented 49% of the nation’s AIDS cases during the 2000-2003 period. The data may not be nationally representative since California, New York, and several other states with high numbers of AIDS cases were not included. However, national AIDS statistics suggest the racial and ethnic disparities seen in this analysis are occurring nationwide.

In 2003, to help reduce barriers to early HIV diagnosis, CDC launched Advancing HIV Prevention (AHP), an initiative designed to increase knowledge of HIV status among at-risk and infected individuals. AHP is one component of CDC’s work with communities, public health partners, and health care providers across the nation to help at-risk individuals reduce their risk, to help HIV-infected individuals take steps to protect their own health and avoid infecting others, to develop new behavioral and biomedical approaches to prevent infection, and to diagnose and treat STDs, which can increase the risk of HIV transmission.

Telebriefing Transcript
New Data on HIV/AIDS Diagnoses, Numbers of People Tested for HIV
December 1, 2004

DR. VALDISERRI: Good afternoon, everyone. I'm Dr. Ronald Valdiserri, the deputy director of the National Center for HIV, STD and TB prevention, here at the Centers for Disease Control and Prevention.

Thank you for joining me this World AIDS Day.

On this call, I will discuss new CDC surveillance data on the latest trends in HIV diagnoses in 32 U.S. states with confidential name-based HIV and AIDS reporting.

Chief among these trends are persistent racial and ethnic disparities, and the continuing impact of the epidemic among men who have sex with men. I will also discuss the latest CDC data on HIV testing in the United States, and at the end of the call I'd be glad to take your questions.

The new CDC data on both diagnoses and testing are published in the December 3rd issue of the Morbidity and Mortality Weekly Report.

That the embargo on these data lifted at the start of this telebriefing, and let me add that after the telebriefing, if you want any additional information or if you have additional follow-up questions, please feel free to contact our Office of Communications. I'm going to give you their phone number. It's [404] 639-8895. Once again that number if [404] 639-8895.

Now before we focus on the new U.S. HIV/AIDS data, I'd like to take a moment to discuss the importance of today's World AIDS observance. There are more people living with HIV in the world than ever before, an estimated 39 million, and almost half of these are women.

Appropriately, this World AIDS Day focuses on the growing impact of HIV on women and girls around the globe.

Data released by UNAIDS last week indicated that the number of women living with HIV has grown in every region of the world over the past two years, with the steepest increase in East Asia, that was a 56 percent increase, and in Eastern European and in Central Asia, that was a 48 percent increase.

As demonstrated by the data that CDC will be releasing today, the impact of HIV among women in the United States, particularly racial and ethnic minority women, is also quite severe. Let's turn to those data now.

CDC conducted an analysis of data on new HIV diagnoses with or without AIDS in 32 states that conducted confidential name-based reporting of HIV/AIDS cases between the years 2000 and 2003.

I will refer to these as HIV/AIDS diagnoses throughout this presentation.

The number of states with mature, integrated HIV and AIDS surveillance systems continues to grow, and this year's analysis includes three additional states, Texas, Alaska and Kansas, that were not included in last year's data.

Our analysis found that the overall rate of HIV/AIDS diagnoses in these 32 states, that is, the number of new diagnoses per 100,000 population, was stable from 2000 to 2003, increasing only slightly from 19.5 diagnoses per 100,000 to 19.7 per 100,000.

However, the analysis revealed that sharp racial and ethnic disparities persist.

Of these 125,800 people newly-diagnosed with HIV/AIDS in these states, between 2000 and 2003, 51 percent were African Americans, even though African Americans represented just 13 percent of the population in these 32 states.

By comparison, 32 percent of the diagnoses were among whites, and 15 percent were among Latinos, who represented 72 percent and 11 percent, respectively, of the population in these states.

American Indians, Alaska natives, and Asian-Pacific islanders each accounted for roughly one percent.

Throughout the study period, that is, between 2000 and 2003, rates of HIV/AIDS diagnoses were significantly higher among African Americans than among other racial and ethnic groups.

In 2003, the highest rate of HIV/AIDS diagnosis was among African American males, 103.4 cases per 100,000 population.

This rate was almost seven times that of white males and nearly three times that of Latino males.

Racial disparities were even greater among females. The rate of HIV/AIDS diagnoses among African American females in 2003 was 53 cases per 100,000 population. This rate was 18--that's one eight--18 times higher than the rate among white females, which was 2.9 per 100,000, and almost five times higher than the rate among Latinas, which was 10.9 per 100,000.

At this point, I do need to stress that HIV/AIDS diagnoses are not the same as new HIV infections, and in fact, trends in HIV/AIDS diagnoses reflect the combined effect of any trends that might be taking place in new infections, as well as trends in HIV testing.

Now, let's take a look at the trends over this four-year period. The number, as I said earlier, the number of actual diagnoses changed very little among females, but did increase five percent among males. The overall five percent increase among males is believed to be largely due to previously reported increases among men who have sex with men or MSM. The annual number of diagnoses among MSM increased 11 percent over the four-year period. But the largest increase occurred from 2001 to 2002.

Overall, MSM accounted for the largest proportion of HIV/AIDS diagnoses, 44 percent of diagnoses, followed by high-risk heterosexual contact, at 34 percent, and injection drug use, at 16 percent.

The continued impact on MSM and the striking racial disparities among both men and women remind us of the continued challenges we face to combating the epidemic here in the United States.

A combination of prevention strategies are required to address the unique challenges in each population at risk for HIV. It is also critical to ensure that high-risk populations have access to HIV counseling and testing services, because testing services provide an important gateway to both prevention, services, and ongoing treatment and care.

Yet, as the testing data released today indicate, there are substantial gaps. According to two national surveys of more than 100,000 people in 2002, roughly one in 10 adults--that's 10 percent figure from the National Health Interview Survey and 12 percent obtained from the Behavioral Risk Factor Surveillance System--roughly one in 10 adults reported being tested for HIV in the previous 12 months. These proportions have remained roughly stable since 1992.

Now, we are encouraged that testing rates were higher among groups for whom CDC recommends testing. However, there is still the need for substantial improvement.

Among people who were at increased behavioral risk for HIV, nearly one-fourth had been tested in the previous year; 21 percent in the National Health Interviews Survey, and 27 percent in the Behavioral Risk Factor Surveillance Survey.

Among pregnant women, about half reported having been tested in the previous year, 48 and 53 percent in the two surveys, respectively.

CDC recommends that health care providers routinely provide HIV counseling and testing to all pregnant women, and that they routinely offer testing to individuals in settings with high rates of HIV, as well as those at increased risk for HIV infection. We estimate that one in four Americans living with HIV do not know that they are infected. That's as many as 280,000 persons.

Obviously, the individuals who don't know that they're infected are not receiving medical care, life prolonging HIV treatments, and prevention services. And without knowing it, they may be transmitting virus to others.

CDC is working to increase knowledge of HIV status through the advancing HIV prevention initiative, which was launched in 2003. Through this initiative, we are working to reduce barriers to early HIV diagnosis. The use of rapid tests is key to the success of these efforts.

Rapid tests can provide preliminary results in less than half an hour, and can be used outside of clinical settings, making it possible to reach at-risk people in a wide variety of settings and situations.

As part of our effort, CDC has purchased and distributed 500,000 rapid test kits to local health departments and community-based organizations. We have initiated demonstration projects in seven U.S. cities to pilot the use of rapid tests in non-clinical settings, including venues as diverse as homeless shelters, drug treatment programs, and social events. And we have trained more than 1,000 people in the performance of rapid testing and the counseling that goes along with rapid testing.

The Advancing HIV Prevention initiative is one important component of CDC's comprehensive program efforts to reach infected and at-risk populations with the prevention services and support needed to reduce the impact of HIV, and ultimately to reduce transmission of the virus in this country.

CDC works closely with communities, public health partners, and health care providers across the nation to support or provide a full range of prevention approaches, including risk reduction programs tailored to the needs of minority women, men who have sex with men and other populations at high risk for infection, STD screening and treatment, which can reduce the risk of HIV transmission and research into female-controlled prevention strategies.

Our efforts include over $300 million annually to state and local health departments to conduct HIV prevention programs for populations at highest risk and an additional $49 million directly to community-based organizations which was awarded this past summer, and 82 percent of this resource going toward funded programs that serve communities of color.

Clearly, key challenges remain, and we must expand the use of proven strategies while we continue to search for new and more effective approaches for populations that remain at high risk.

I thank you for your attention and would be glad to answer any questions that you might have.

MODERATOR: Thank you. At this time, if you would like to ask a question, please press star one on your touch-tone phone. You will be prompted to record your name. To withdraw your question, please press star two. One moment, please, for our first question.

Steve Sternberg, with USA Today, you may ask your question.

QUESTIONER: Hi, Dr. Valdiserri.

DR. VALDISERRI: Hey, Steve.

QUESTIONER: There's probably no better index of the success of prevention strategies than the data that you've discussed today. What does it tell us about the specific gaps in programs and how do you propose the close them?

DR. VALDISERRI: Thanks for that question, Steve.

I, first, would like to point out that the data itself is not as complete as we would like to see it. Obviously, we're talking about only 32 states in the union, and this particular sample does not include New York and California. So it's not a complete picture of what's happening across the United States. Now, we are heartened that we are in a situation now where all states in the U.S. have HIV reporting, and over time we will continue to add to the numbers and get a more complete picture. So I want to start out by saying that the picture itself is not complete.

But having said that, I think what this points out, I think there are at least two major issues that we need to emphasize through these data.

First of all, the persistence of disparities among racial and ethic groups, particularly African Americans and Hispanics. This is telling us, and telling all of us involved in HIV prevention efforts, that we need to focus our attention in these areas.

I think also the fact that although it's less of an increase, the fact that we do see a continued increase in HIV/AIDS diagnoses among men who have sex with men, and when we pair that up with the information that CDC also released earlier this week about trends in national rates of syphilis, which are up again for the third year in a row after about a decade's worth of decline, and I might add that we believe that the majority of those increased cases are occurring among men who have sex with men, it points out that we need to pay close attention to this population and that we have to, as a society, continue to invest resources in developing interventions that reflect the realities of where we are in 2004.

MODERATOR: John Cohen, with Science Magazine, you may ask your question.

QUESTIONER: The rate in non-Hispanic black women decreased 6 percent. And I'm wondering whether the California, New York and Illinois AIDS data that are available give any indication as to whether that decrease is nationwide or whether it's an aberration. How do you make sense of that given the 19 times higher rate of HIV/AIDS in black women?

DR. VALDISERRI: It's very difficult to say. Overall, the decrease in women was not a significant change. As you point out, the decrease in African-American women was a significant change.

As you know, with most data points, we like to have more points before we can opine as to exactly what's happening. So, at this point in time, I don't know that we can interpret that, given the fact that we don't have multiple data points and also given that, as you point out, not every state is involved, at this point in time, in providing this information to us.

MODERATOR: Pat Zwillick with WebMD News, you may ask your question.

QUESTIONER: Hi, Dr. Valdiserri.

So we have the rates per 100,000 population. What is the new infection rate, I guess the incidence, the new infection incidence for the year it was reported, 2003, how many new infections in the United States?

DR. VALDISERRI: Well, as I said earlier, what we're reporting on today are HIV/AIDS diagnoses--

QUESTIONER: Of course. I'm wondering about the other number.

DR. VALDISERRI: --some of which are new infections, some of which are not.

The reality is that we are still stating an estimated 40,000 new HIV infections annually in the United States, but, in addition to that estimate, over the past 4 years, the Agency has been working toward implementing a surveillance system that will actually give us better estimates of HIV incidents. That system is not fully operational at this point in time, but it will take advantage of the detuned assay, pairing a more sensitive with a less sensitive Eliza Test on positive specimens to determine whether we're seeing new or old infection.

So the short answer is that we still use the national estimate of approximately 40,000 new HIV infections annually. That is an estimate. We hope in the next year or so the have an updated, much improved estimate of incidence.

MODERATOR: Phil Tasker, with the Miami Herald, you may ask your question.

QUESTIONER: Hello. Isn't it true that the rates among men who have sex with men had been dropping earlier? And, if so, why are they up now?

DR. VALDISERRI: No, that's not true. I mean, last year at this time we reported on 29 states, obviously, a different time frame. It was from 1999 to 20002. And, again, it was a report looking at trends in HIV/AIDS diagnoses. And what we saw there was a significant increase of 17 percent in HIV/AIDS diagnoses.

I mean, the difficulty is that we cannot say, with complete certainty, that this represents an increase in new infections. We continue to remain concerned about it because of other data that we look at. For instance, I mentioned earlier, for a third year in a row, we're seeing increases in primary and secondary syphilis in the United States after a decade of decline. Most of those cases are related to male-to-male sex.

We also have numerous reports from across the United States of increases in high-risk behavior among men who have sex with men. So we still remain concerned about the possibility of a resurgence among MSM. We cannot definitively rule that in or rule that out because of the incompleteness of the data.

But, to answer your question, no, we also reported last year at this time a 17-percent increase in HIV/AIDS diagnoses among men who have sex with men.

One final footnote, what you might be referring to is that over time, when we look at reported AIDS cases, over time we see a larger share of AIDS cases, of cumulative AIDS cases, an increasing share resulting from heterosexual transmission. So I mean that trend, over time, is changing.

But in terms of mouth-to-mouth sexual activity, it is still the most frequently reported risk factor for men who have HIV or AIDS, and as I mentioned in the press statement, it accounted for 44 percent of all of these new HIV/AIDS diagnoses in this study period.

MODERATOR: Daniel Yee with the Associated Press, you may ask your question.

QUESTION: Thanks for doing this. Can you talk about this report in context of the CDC initiative in 2001 to try to cut the number of new HIV infections in half by 2005, and the reason why I'm asking is because you're still using the 40,000-person estimate.

And the other thing that I was wondering was also, back then, I guess it was announced that like 800,000 to 900,000 people lived with HIV and with the 40,000 new infections, so the one million mark still has not been breached yet?

DR. VALDISERRI: All right. Let me start with your last question. We still estimate that in the United States there are between 850- and 950,000 persons living with HIV, whether they have AIDS or not, and we still estimate that a quarter, as many as a quarter of those people don't know that they're infected with HIV and we still use the estimate of 40,000 new HIV infections every year.

So overall, nationally, the epidemic has been, quote, relatively stable, end quote. But I think what this report shows us is that there are pockets of persistent challenge, particularly in terms of racial and ethnic disparities and some of the new challenges we're facing are among men who have sex with men.

In terms of the HIV initiative, Advancing HIV Prevention, one of the major factors behind that initiative was the fact that we have a substantial proportion of people who are affected and don't know it, and so that hasn't changed. I mean, we are making some inroads but we've got a ways to go as the testing data pointed out.

So I think that what I would say is that it underscores the importance of expanding opportunities for early diagnosis for HIV infection, and CDC has a number of programs, both in public settings and also in nongovernmental organizations to address that issue.

I might also add that if you look at the MMWR on testing, you will see that the people who responded to these two national surveys, that the majority, over 60 percent, still reported that most of them got their HIV testing in doctors offices or hospitals.

So that's why CDC has also been trying to reach out to medical and nursing associations to implement routine testing in, as I mention, in situation of high prevalence and for high-risk individuals.

I think the other thing that these data show are that, again, we have more and more people living with HIV, whether they have AIDS or not, than ever before, and this relates to the importance of expanding the prevention efforts that target people living with HIV.

So I think that what we're seeing is that the direction that we're headed in, trying to increase opportunities for early diagnosis, trying to improve prevention efforts for people living with HIV, those activities are very much supported by these data.

Now clearly, we want to continue and are continuing to fund programs that reach out to people who are at high risk and not infected, to keep them from becoming infected, but we have a ways to go before we reach the mark of reducing new infections by half in the United States.

MODERATOR: Bill Monier with WAND-TV, you may ask your question.

QUESTION: Hi, Doctor. WAND is in Decatur, Illinois, and there's talk locally that methamphetamine users have a higher rate of AIDS because of the use of the illegal drug often leads to unprotected sex. Is that true? Are you finding that at all?

DR. VALDISERRI: There's tremendous concern about methamphetamine use, especially in the gay and bisexual community and there have been several studies that have shown strong associations with methamphetamine use, unsafe sexual activity, and some of the syphilis outbreaks among MSM in the United States, and we are actually starting to see some reports linking methamphetamine use to HIV as well.

Now we don't have that information nationally. I can think of at least one study from the West Coast that showed that association.

But, certainly, there's tremendous concern, especially in various communities of gay and bisexual men, where this drug has crept in, if you will, into the communities and folks don't understand how dangerous it is and how pernicious it is, and in fact CDC has been working very closely with the National Association of State and Territorial AIDS directors and the National Coalition of STD directors, to increase awareness of the unhealthy synergy between this drug use and STDs including syphilis and HIV. But we don't have data on a national level but we do know in certain communities it has clearly been linked with unsafe sexual practices, with syphilis outbreaks, and there's at least one study I'm aware of, that I've read, that links it to increased rates of HIV in a particular community.

MODERATOR: Dan Harris with ABC News, you may ask your question.

QUESTION: Hi. Thanks for doing this. Forgive me for asking you to go over some of the basic statistics but a lot of them flew by me pretty quickly and I just want to make sure we've got 'em correct.

Essentially what you're saying is that in the 32 states that you, the CDC, monitor, HIV and AIDS diagnoses have remained stable but the rates among men who have sex with men have increased, and so have the rates among black women.

Is that an accurate but brief summary?

DR. VALDISERRI: The diagnoses, HIV/AIDS diagnoses among MSM have--let's start from the main message. Overall, the rate of HIV/AIDS diagnoses for all populations in these 32 states was relatively stable. What we have seen was that rates of HIV diagnoses increased for males and especially for men who have sex with men.

But we also pointed out that there remain persistent disparities in rates among various racial and ethnic groups.

For instance, African Americans, non-Hispanic blacks who live in these 32 states account for 13 percent of the population in the states but 51 percent of all the HIV/AIDS diagnoses were among African Americans.

We also noted that in 2003, the highest rate of HIV/AIDS diagnosis was for African American males, that that rate was nearly seven times the rate for white males, and nearly three times the rate for Latino males, and that when we looked at the rate of HIV/AIDS diagnoses among African American females in 2003, that that rate was 18 times higher than the rate of HIV/AIDS diagnoses among white females, and almost five times higher the rate of HIV/AIDS diagnoses among Latinas in these 32 states.

MODERATOR: Judith Graham with the Chicago Tribune, you may ask your question.

QUESTION: This is Judy Graham of the Chicago Tribune. I wanted to ask if the disparities, the racial and ethnic disparities that are noted in this report have significantly increased from prior years. These disparities are not new, and so the question is, Are they growing? Thank you.

DR. VALDISERRI: I would say that they're persistent. We're not seeing an increase per se but there are persistent disparities that we note in terms of HIV/AIDS diagnoses, particularly for African Americans and Hispanics.

MODERATOR: John Lauerman with Bloomberg News, you may ask your question.

QUESTION: A couple of quick questions; thanks for taking my call. First of all, in the paper it says that rates among non-Hispanic black females were 19 times the rate among non-Hispanic white females. Which is right? Eighteen or nineteen? And then I've got another question, so please don't cut me off.

DR. VALDISERRI: Let me answer that one first. The rate in the paper is for all three years--four years, I'm sorry--from 2000 and 2003. The rate that I cited was for 2003.

QUESTION: Okay; that's great. And I wanted to also--can you provide us with any kind of comparison with earlier years. You say this is a persistent problem among--the disparities in, particularly among black women. Can you give us anything that would help us, you know, show--

DR. VALDISERRI: I might ask you to actually look at the article which does, for 2000 through 2003, cite the rates. I don't, unfortunately, I don't have the rates in front of me for past years. I think that again, I would repeat what I said earlier, that the racial disparity has been persistent.

I don't have evidence in front of me that it's increasing, but, again, if you look at the MMWR, we do have those for 2000 through 2003, and I suppose that it might be--I have some colleagues here from the Office of Communications. We have those data available, earlier years, if you call the number, if we have it available we'll provide it to you.

But I think the important message for your reading audience is that there are persistent disparities among racial and ethnic minorities.

MODERATOR: Duncan Osborne with Gay City News, you may ask your question.

QUESTION: Can you tease out the extent to which the increase you're seeing among men who have sex with men may be due to increased testing versus new infections?

DR. VALDISERRI: That's an extremely important observation, Duncan. Thank you for bringing it up. It gives me the opportunity, first of all, to remind everyone that as CDC and our partners in the community do improve efforts to reach out for early diagnosis, we would expect to find more positive individuals. And this phenomenon is very well-noted in other sexually transmissible diseases.

For instance, when CDC has been able to put more money into chlamydia testing for infertility prevention, we've seen rates of, chlamydia rates go up because more young women are being tested.

So the general comment is that as we are more successful in our efforts to reach out to these somewhere between 180- and 280,000 persons who are infected with HIV and don't know it, we would expect to see increased rates of HIV/AIDS diagnosis, which may not have anything to do with increasing rates of new infections.

Now having said that, I can't tease out in these data the interplay between HIV incidence and HIV testing behaviors.

Last year, I think you know that when CDC published the 17 percent increase among men who have sex with men, we actually went on record saying that we did not think that that increase was due to increased testing.

But we haven't made that statement this year.

What I would say is that we remain very concerned about the, when we look at the complete picture for various communities of men who have sex with men, when we look at--now, granted, the increase was not as large in this report as it was in last year's report, so that is somewhat encouraging.

But when we look at the trends in syphilis and what's happening elsewhere, I think that the bottom-line message has to be that we're very concerned. This is not a trend that we want to ignore. It's something that we need to look at very carefully, and more important, we need to make sure that the leadership in the gay community understands the importance of tracking this very carefully.

MODERATOR: Brenda Wilson with National Public Radio, you may ask your question.

QUESTION: Thank you, Dr. Valdiserri. My question is, I mean the states covered by the survey and looking at the disparities among the ethnic groups, has the CDC--did it in this study or an earlier one, sort of single out certain regions of the country where it is clear that infection rates, for example, in southern states, for example, like North Carolina, where there was a recent outbreak that affected African American women and African American men who have sex with men, when you kind of look specifically more at those areas, I mean, how does the picture that you come away from--what kind of a picture do you come away with, and wouldn't it be better if those are the areas that are being hardest hit, wouldn't it be better to focus on those areas?

DR. VALDISERRI: Let me make a few comments. First of all to clarify that the 32 states in this analysis were included because they have the data, the high-quality data that we need to make statements about trends. So, we would like to have a situation where we're able to include all the states in the union and eventually that will happen. But, at this point in time, that's not the case.

So, we'd like to have more complete data, but we don't.

Now, the--let me say that our surveillance report, our complete HIV/AIDS surveillance report has been put on the web today, and that--let me give you all the--this is not the exact address, but it's close enough that you can track it down. If you go to www.cdc.gov/hiv, and look for a surveillance header, that will take you into the 2003 Surveillance Report, which does provide information on a breakdown of both AIDS cases and also HIV/AIDS diagnoses by region or, for, you know, by the Northeast, by the Midwest, the South, and the West.

I can tell you that in that report, you'll find a statement that says in 2003, compared with 2002, the estimated number of AIDS cases--now, we're talking just about AIDS. Let me be clear here--that the estimated number of AIDS cases increased nine percent in the Northeast, six percent in the South, four percent in the Midwest, and decreased by three percent in the West.

So, there are some regional trend information that you can find in the complete surveillance report, which is available online at the address I gave you. If you have any trouble accessing it, call that number that I gave you earlier, and the competent staff in our communications office will direct you to the exact tables that look at regional trends.

MODERATOR: Tom Corwin with the Augusta Chronicles, you may ask your question.

MR. CORWIN: Hi. Thanks for taking my question. In talking to some African-American women who are HIV positive, they talked about running into some cultural barriers in terms of doing education and prevention. And this is in Georgia. I'm wondering if--sort of following up on the previous question--there are certain areas of the country that are more difficult to reach, and if there are, when you talk about culturally sensitive programs, if there are things that you're doing to overcome those barriers?

DR. VALDISERRI: Well, first of all, I think--let me say that the issue here perhaps is not so much one of difficulty, as it is that, although the principles of HIV prevention have not changed over time, it's very important that approaches change and evolve over time. And I think a lot of what is included when people talk about “difficulties” is the fact that we can't assume that a prevention program that was developed in 1989 for and by White middle-class gay men will be effective for African American women, for instance.

And, so, a lot of what CDC does, a substantial proportion of our HIV prevention budget, actually over $115 million, is spent in providing technical assistance to not just health departments, but also community-based organizations who are serving high-risk populations. And we also put a great amount of effort into trying to export proven, scientifically proven prevention approaches. For instance, I just attended an internal presentation that was held this morning in commemoration of World AIDS Day, where there were several scientifically evaluated prevention efforts targeting African American women. These are studies that have appeared in the scientific literature that have been shown to be effective at reducing risk behaviors and improving health-related behaviors. Then what we do at CDC is we take those studies, develop training packets and training modules to try to get those out to communities.

So, you are correct that there are complexities in HIV/AIDS prevention and that we, regardless of the community we're talking about--whether we're talking about Native American bisexual men or Latina women or African American female partners of injecting drug users, any permutation that you might consider we have to look carefully at what the issues are to make sure that the programs that are developed are--have the highest scientific credibility and also are culturally competent. And, therefore, will work at reducing risk behaviors.

MODERATOR: Steven Sternberg with USA Today. You may ask your question.

MR. STERNBERG: Hi. I'm sorry, a quick follow-up. The--Representative Waxman released a report today looking at the content of federally funded abstinence-only education programs. This is federal funding that is aimed at a different population I think than the high-risk populations you're discussing in your report today. But the spending has gone to 170, $170 million in fiscal 2005, more than twice the amount spent in 2001. And the report says that over 80 percent of the abstinence-only curricula contains false, misleading, or distorted information about reproductive health, and goes into some detail on this.

And I'm just wondering whether you would care--have you seen the report and whether you would care to comment?

DR. VALDISERRI: Steve, I honestly have not seen the report; and, therefore, I can't really comment on it. But I'll make a point of reading it sometime today.

MODERATOR: John Lauerman with Bloomberg News, you may ask your question.

MR. LAUERMAN: Yeah. Just to follow up on the same point. Does the CDC use abstinence only--is that part of the CDC's repertoire? Do you endorse abstinence only? Is that part of CDC's repertoire? Do you endorse Abstinence Only measures for prevention of HIV/AIDS?

DR. VALDISERRI: The CDC I think is very clear in its policies related to abstinence, and that is that we identify abstinence as the most effective means of preventing HIV and other sexually transmitted diseases. And so in our materials related to preventing the sexual transmission of HIV, and materials related to condom use, for instance, we are always very mindful of stressing the fact that abstinence is the most effective means of preventing transmission.

We, also, however, recognize that, for sexually active persons, persons who, for whatever reason, don't choose abstinence or are not able to be abstinent, depending upon the circumstances of their lives, then we go into a hierarchy of information about how to reduce risk. And so we talk about issues related to the importance of having a single partner and trying to make sure that that partner is free of HIV infection or other sexually transmissible diseases. Then, we move on to people who might not have a single partner, and we talk about, particularly for HIV, we talk about the importance of consistent and correct condom use related to preventing the transmission of HIV. So our approach to HIV prevention for sexually active populations is comprehensive.

Now, when one is talking about school-based programs that CDC funds, first of all, we make a very important point that local communities need to weigh in and determine the content of school-based curriculum related to HIV prevention and STD prevention. We think that's extremely important. And, again, for young people, we clearly make the point that there are many health advantages to delaying the onset of sexual activity not just preventing HIV, but also preventing other sexually transmissible diseases and unwanted pregnancies.

So we definitely lead with that message, but we also recognize that at some point most individuals will become sexually active, and so we talk about also the importance of a comprehensive approach, including scientifically correct information about means of reducing risk, including partner reduction, partner selection and consistent and correct condom use.

MODERATOR: At this time, we're showing no further questions.

DR. VALDISERRI: Thank you all very much for your interest. Let me just again repeat the number of our press office. It's 404-639-8895 if you have further questions or follow-up questions or require further material.

Thank you.