Published on 30 March 2019
- LIFETIME RISK OF HIV DIAGNOSIS BY STATE
- CALL TO ACTION: RESEARCH QUESTIONS REGARDING THE DISTRICT OF COLUMBIA HIV STATISTIC
- LIFETIME RISK OF HIV DIAGNOSIS BY TRANSMISSION GROUP
- LIFETIME RISK OF HIV DIAGNOSIS AMONG MSM BY RACE/ETHNICITY
- LIFETIME RISK OF HIV DIAGNOSIS BY RACE/ETHNICITY
- FOUR SCENARIOS OF THE POTENTIAL IMPACT OF EXPANDED HIV TESTING, TREATMENT AND PrEP IN THE UNITED STATES, 2015-2020
Today I found out that the lifetime risk of HIV infection published by Truvada, and referred to in an earlier blog of mine, originated with a 2016 Centers for Disease Control study which is public domain. Here is the overall report …
Link: “Supplemental Report: Estimated HIV Incidence and Prevalence in the United States, 2010-2016,” in “HIV Surveillance Report: Supplemental Report,” Vol. 24, No. 1, by Centers for Disease Control (CDC), National Center for HIV / AIDS, Viral Hepatitis, STD, and TB Prevention, Division of HIV / AIDS Prevention … https://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-supplemental-report-vol-24-1.pdf ..
Here are the CDC graphics …
LIFETIME RISK OF HIV DIAGNOSIS BY STATE
Image: “Lifetime Risk of HIV Diagnosis by State,” from Centers for Disease Control and Prevention. 2016 Conference on Retroviruses and Opportunistic Infections, published 2016; accessed 8 June 2017 … http://www.cdc.gov/nchhstp/newsroom/2016/croi-2016.html … public domain
Here is text for the lifetime risk of contracting HIV, by United States state …
CALL TO ACTION: RESEARCH QUESTIONS REGARDING THE DISTRICT OF COLUMBIA HIV STATISTIC
I note in particular the lifetime risk in the District of Columbia is 1 in 13 people. I have a question as to the cause. Here are my thoughts as to lines of inquiry …
- As the District of Columbia is a high density urban area, could it be that other high density urban areas in the United States are also among the highest risk?
- To answer this question, a researcher would have to pull out the relevant statistics for cities from those for rural areas, and see if there is a statistically significant difference between urban and rural areas.
- Alternatively, we could look at increasing population density in each of the above states, and see if it correlates with increasing risk.
- If the answer to this question turns out to be ‘yes’, then I ask that researchers look into whether the presence of an international airport or an international port of call in a city increases lifetime risk of infection.
- Could it be that the District of Columbia has experienced the first of regional ‘HIV blooms’, bell curve increases, and that we might expect the same in other areas? If so, when?
- To answer this question, we would need to see an annual graph on lifetime risk in the District of Columbia, optimally going back 10 years. If it were found, say, that a District of Columbia ‘bloom’ happened in the time interval from 2014-2016, a three-year time span, then that information would be very helpful in planning for education, prevention and treatment of HIV in other areas of the United States, for a three-year interval starting in 2019.
- As the CDC data are three years old, and if there was a ‘bloom’ in the District of Columbia from 2014-2016, then we might posit that there has been a similar bloom elsewhere in the United States in the three-year interval from 2016-2019. That might provide a basis for extrapolating to the true current situation in the United States, with regard to the pandemic. My thought is that the current situation might be much more intense than is surmised, and that this discrepancy might be due to the staleness of the CDC statistics and the quick rise in prevalence instanced by the steep slope of the epidemic bell curve (about which I have written in past years).
- Could it be that the District of Columbia high risk has to do with the presence of international visitors? If so, could this mean that AIDS lifetime risk in other countries has been underreported or underestimated?
- Another way to assess international visitor risk would be to test all military personnel who have been on away missions.
LIFETIME RISK OF HIV DIAGNOSIS BY TRANSMISSION GROUP
Image: “Lifetime Risk of HIV Diagnosis by Transmission Group,” from Centers for Disease Control and Prevention. 2016 Conference on Retroviruses and Opportunistic Infections, published 2016; accessed 8 June 2017 … http://www.cdc.gov/nchhstp/newsroom/2016/croi-2016.html … public domain
This image is pretty standard, and I feel pretty misleading. For MSM (men having sex with men) the lifetime risk is 1 in 6. For women who inject drugs, 1 in 23. For men who inject drugs, 1 in 36. For heterosexual women, 1 in 241. and for heterosexual men, 1 in 473.
My concerns regarding this table are several. I wonder, for instance, whether the MSM category ought to be rephrased and reanalyzed in terms of men and women who are recipients of rectal sex, and this statistic compared to that for men who are donors of rectal sex.
Also significant would be the extent to which HIV screening varies for the various groups in the table. My thought on this is that we might find that men and women who inject drugs are more frequently tested for HIV concomitant with drug detox protocols instituted through emergency treatment of drug overdoses.
Then with regard to the big difference in the risk for heterosexual women and heterosexual men, how is it that the risk for heterosexual women is so very much greater than that for heterosexual men? Is it that women are more likely to test for HIV than men?
Could it be that a statistically significant portion of men described as heterosexual are bisexual, and are testing separately, under alias, as MSM, so as to avoid social stigma and preserve the appearance of a straight marriage? For such a segment of undeclared bisexual men married to straight women, they might be dosing their wives with HIV prophylactics without their knowledge, or alternatively, their wives may be infected and untreated, largely, I feel, because the CDC risk factors do not include married, straight women.
The question is, how large might a putative, undeclared bisexual and married male segment of the population be? If that were known, then we might better plan for diagnosis and treatment in the coming decade.
LIFETIME RISK OF HIV DIAGNOSIS BY RACE/ETHNICITY
Image: “Lifetime Risk of HIV Diagnosis by Race/Ethnicity,” from Centers for Disease Control and Prevention. 2016 Conference on Retroviruses and Opportunistic Infections, published 2016; accessed 8 June 2017 … http://www.cdc.gov/nchhstp/newsroom/2016/croi-2016.html … public domain
This is a well-known set of statistics. The highest racial-ethnic category with regard to lifetime risk of HIV diagnosis is African American men: 1 in 20. Next are African American women: 1 in 48. Possibly socioeconomic disadvantage may negatively influence prevention and medical care in this group?
Then Hispanic men: 1 in 48 … and Hispanic women, 1 in 227. Guessing that, because of the influence of Catholicism, many Hispanic men may be married to Hispanic women, and because of the Church’s stance on homosexuality as an ‘objective disorder’ may not be willing to admit homosexual liaisons to their wives. The wives of such men might be at risk and unaware of it, and so, not testing. They might pass on due to AIDS-related issues, without being treated for these issues.
Then for White men, the risk is 1 in 132; whereas, for White women the risk is 1 in 880. Either White women are extremely lucky, in regard to their lifetime HIV risk, or else they decline to test, for reasons of social status. If the latter turns out to be so, then I feel the turning point, for white women, will be when the pandemic reaches such proportions in the United States that it is clear their friends and neighbors have it, and so it will be socially acceptable to test for and treat HIV infection.
LIFETIME RISK OF HIV DIAGNOSIS AMONG MSM BY RACE/ETHNICITY
Image: “Lifetime Risk of HIV Diagnosis among MSM by Race/Ethnicity,” from Centers for Disease Control and Prevention. 2016 Conference on Retroviruses and Opportunistic Infections, published 2016; accessed 8 June 2017 … http://www.cdc.gov/nchhstp/newsroom/2016/croi-2016.html … public domain
From this table, the lifetime risk for men having sex with men (MSM) is 50% … 1 in 2 people, for African American MSM. For Hispanic, MSM the risk is half that … 25%, or 1 in 4. For White MSM, the risk is 9%, or 1 in 11.
FOUR SCENARIOS OF THE POTENTIAL IMPACT OF EXPANDED HIV TESTING, TREATMENT AND PrEP IN THE UNITED STATES, 2015-2020
I like the below graph very much, as it shows how helpful testing and treatment would be in slowing the progress of the pandemic here in the United States. This slowing of the progress of the disease would, I feel, ease the effect of the pandemic on manpower, and on the U.S. economy. It would also make it easier to provide adequate education and medical care for HIV-infected patients. In terms of human suffering, as well, I feel that optimization of education, prevention, and treatment are of paramount importance.
As can be seen in the below graph, were this optimization to have occurred beginning in 2015, then in 2020 new infections would have been reduced from 265,330 to 80,270. That would have been a reduction of 70% … which is to say, a slowing of the rate of progress of the disease by 70%.
In future five-year intervals, we might expect the same statistic to apply. This, surely, is ample impetus for optimizing HIV education, prevention, and treatment as swiftly and thoroughly as possible.
Image: “Four Scenarios of the Potential Impact of Expanded HIV Testing, Treatment and PrEP in the United States, 2015-2020,” from Centers for Disease Control and Prevention. 2016 Conference on Retroviruses and Opportunistic Infections, published 2016; accessed 8 June 2017 … http://www.cdc.gov/nchhstp/newsroom/2016/croi-2016.html … public domain
This bar graph shows four scenarios of the potential impact of expanded HIV testing, treatment and pre-exposure prophylaxis (PrEP) use in the United States from 2015 to 2020.
The first bar shows that at current testing and treatment rates, there would be 265,330 new HIV infections in the U.S between 2015 and 2020.
The second bar shows that increasing the use of PrEP among high-risk populations (40 percent of men-who-have-sex-with-men; 10 percent of injecting drug users; and 10% of high-risk heterosexuals) could avert 48,221 new infections. This would mean that only 217,109 new HIV infections would occur in the U.S. from 2015 to 2020.
The third bar shows that increasing the number of people diagnosed with HIV who are on treatment to 85 percent, and ensuring that 60 percent achieve viral suppression would avert 88,908. Increasing PrEP use among high-risk populations at these higher treatment rates would avert an additional 31,988 new infections, reducing the total number of new HIV infections to 144,434.
The final bar shows that if we achieve the targets of the National HIV / AIDS Strategy (85 percent of people diagnosed are on treatment and 80 percent of those achieve viral suppression), we would avert 168,132 infections, with an additional 16,928 HIV infections prevented if PrEP was used as well, resulting in only 80,270 new HIV infections from 2015 to 2020.
Here is another pdf file on the same topic …
Link: “Lifetime Risk of a Diagnosis of HIV Infection in the United States,” by Kristen L. Hess, PhD, MPHa, Xiaohong Hu, MSb, Amy Lansky, PhD, MPHc, Jonathan Mermin, MDd, and H. Irene Hall, PhD, MPHe, published in final edited form as:
Ann Epidemiol. 2017 April ; 27(4): 238–243. doi:10.1016/j.annepidem.2017.02.003 … https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5524204/ ..
In love, light and joy,
I Am of the Stars
Link: “New HIV / AIDS Statistics from Truvada,” by Alice B. Clagett, published on 25 February 2019; updated on 25 April 2020 … https://wp.me/p2Rkym-bOa ..
For a complete list of my blogs and compendiums on HIV / AIDS see … Link: “Compendium: HIV / AIDS Pandemic,” by Alice B. Clagett, published on 2 March 2019; revised on 3 April 2020 … https://wp.me/p2Rkym-bPl ..
Except where otherwise noted, this work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
health, HIV, AIDS, CDC, Centers for Disease Control, community health, calls to action, societal expectations, social stigma, homosexuality,