Published on 4 November 2019
- MISLEADING NATURE OF CDC HIV DATA
- ‘INCIDENCE’ of HIV / AIDS
- ‘PREVALENCE’ or ‘LIFETIME RISK’ of HIV / AIDS
- How Family Wealth Planning for Future Generations Is Affected by HIV Prevalence
- How May We Instill Hope in Our Families, Even Though They May Have HIV?
- Careers Despite HIV
- Continuing to Work Despite Blindness
- RECENT CDC FIGURES ON HIV LIFETIME RISK
- Table 1. Lifetime Risk of HIV Diagnosis, by Sex, Race/Ethnicity, and Risk Group, United States
- Gender Inequality in Testing for HIV – AIDS
- Lifetime Risk for Black Men Who Have Sex with Men
- Table 2. Lifetime Risk of HIV Diagnosis, by State, United States
- Great Disparity in Lifetime Risk, State by State
- Possible Underreporting of Risk by States for Economic Reasons
- Risk in Large Cities
- Table 3. 10-Year Age-Conditional Risk (1 in n) of HIV Diagnosis Among HIV-Free Males and Females, Aged 20-50 Years, United States
- Young Men Who Have Sex with Men Are at Greater Risk of New HIV Diagnosis
- New HIV Diagnosis Risk for Young Men Who Have Sex with Men Varies Greatly by Race / Ethnicity
- New HIV Diagnosis Risk for People Who Inject Drugs is Much Less Than for Men Who Have Sex with Men
- New HIV Diagnosis Risk for Young Women Who Inject Drugs Is Twice as Great as for Young Men
- Can We Extrapolate That HIV Diagnosis Risk for Young Women is Twice as Great as That for Young Men?
- Importance of Gender Equality in HIV / AIDS Testing of Young People
MISLEADING NATURE OF CDC HIV DATA
Over the years I have written quite a few blogs on the HIV / AIDS global pandemic. Chicken that I am, I feel I have failed to convey my feeling that the Centers for Disease Control (CDC) is releasing data about the pandemic that greatly misrepresent the difficulties that lie before us as a nation. Perhaps this misrepresentation is intentional; perhaps it is political in nature … and perhaps not. Who can say?
The crux of the matter is that the data the CDC typically presents to the public have to do with disease ‘incidence’ rather than disease ‘prevalence’ or ‘lifetime risk’.
‘INCIDENCE’ of HIV / AIDS
As I understand it, disease ‘incidence’ has to do with how many new cases will be diagnosed next year, or the following year. These data are important to medical doctors, so that they can have sufficient medications on hand for the coming year.
‘PREVALENCE’ or ‘LIFETIME RISK’ of HIV / AIDS
‘Prevalence’, or ‘lifetime risk’ offers data on the likelihood that we and our families will contract HIV / AIDS during our lifetime. These are the data that I feel are hard to find in the CDC documents. Yet these are the data that help us plan for our families’ future.
How Family Wealth Planning for Future Generations Is Affected by HIV Prevalence
For instance, if our children, according to ‘lifetime risk’ data, are likely to contract HIV / AIDS in their lifetime, then we might ask: At what age are they likely to contract the disease?
If they contract it in early childhood, from what I have read, it is apparently likely they will die from it at a young age.
If they contract the disease at about the age of puberty, from what I have read, it is likely they will be unable to bear offspring that live more than a few years.
If our children contract the disease while their children are young, then apparently the risk is high that their young children will contract the disease from their parents through suckling milk, or transmission of bodily fluids while the family has bouts of cold or flu, or through childhood play.
Whether or not our children will contract the disease before they bear children is, I feel, very important to each family’s planning for the future. If there are no grandchildren, then that will make a big difference in the wealth that must be set aside for future generations. In addition, health care costs and the economic impact of sick leave downtime for our infected children and grandchildren is a wealth planning consideration.
How May We Instill Hope in Our Families, Even Though They May Have HIV?
If the lifetime risk of contracting HIV / AIDS is high, either because of lifestyle choices, or because of race or ethnicity, or because of the city or state or region of the United States in which we live, then now would be the time to plan with our children and grandchildren for a future that may involve infection.
Our families need to have some hope to live for, even though they may be infected.
I will say that, in my opinion, the CDC does a great job of glossing over the downside, and providing the upside of life with HIV / AIDS. So families can go to their site to learn that life with HIV is no big deal in the United States, any more.
By that is meant, I feel, that for those who are able to tolerate the drug regimens that have been developed, the prospect of a long and productive life is good. And that is something that might offer hope to our children: They may find that they, or their friends, contract the disease.
Careers Despite HIV. Maybe they may not be able to have families of their own, but they can look forward to fulfilling careers, and maybe good health for quite a long time.
Continuing to Work Despite Blindness. I note that, as of 2001 10-20% of people worldwide who had AIDS were becoming blind in one or both eyes …
Link: “HIV / AIDS and Blindness,” by P. G. Kestelyn and E. T. Cunningham, Jr, Bull World Health Organ 2001, 79(3), 208-213 … https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2566369/ ..
Thus, as a nation, we must retool as many industries as possible so that our eyesight-impaired HIV-positive children can continue on with their careers even should they have low vision.
RECENT CDC FIGURES ON HIV LIFETIME RISK
Today I found a pretty good pdf file offered by the CDC, that presents lifetime risk and also age-conditional risk by race and ethnicity, gender, and state. The data are from 2009-2013 …
Link: “Lifetime Risk of a Diagnosis of HIV Infection in the United States,” by Kristen L. Hess, PhD, MPH, Xiaohong Hu, MS, Amy Lansky, PhD, MPH, Jonathan Mermin, MD, and H. Irene Hall, PhD, MPH, HHS Public Access Author Manuscript, Ann. Epidemiol. 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/ ..
By clicking on the above pdf link you can download the document to your computer.
Of special note are the three tables at the end of the document.
Table 1. Lifetime Risk of HIV Diagnosis, by Sex, Race/Ethnicity, and Risk Group, United States
Gender Inequality in Testing for HIV / AIDS. I note the total lifetime risk for men is 1 in 68 people, and for women 1 in 253 people. I believe this has to do with gender inequality in testing for HIV / AIDS. I feel the perception in the medical community is that MSM men are at risk for HIV / AIDS, and so, I feel, doctors are more likely to test men than women.
As I have mentioned priorly, it could be that bisexual men who are dating or married to women and raising families are also at risk, and that their wives and families are at risk and fail to test for HIV – AIDS because they are uninformed about their boyfriends’ or husbands’ exposure to risk.
I would like to see equal gender testing for HIV / AIDS, especially among couples with children where the boyfriend or husband tests positive for HIV. Then the medical community might, a few years from now, reassess the total lifetime risk for women.
Lifetime Risk for Black Men Who Have Sex with Men. I note the lifetime risk of contracting HIV / AIDS is 1 in 2 men. The overall lifetime risk for men who have sex with men is 1 in 6 men. From this I feel that women who want to have families ought to ascertain, before becoming pregnant, whether the prospective fathers in fact prefer to have sex with men. I feel that societal expectations, especially amongst Christians, make it especially difficult for Christian men to disclose this bias to prospective wives.
Given this, I feel all women hoping to have children ask those men they want to be intimate with for HIV test results, keeping in mind that chastity for one month after the last sexual contact is necessary before tests such as Oraquick can provide relatively accurate results. The last I read in the fine print of the Oraquick package was that there was a 10 percent error in this type of saliva test. HIV blood tests, while more expensive, are a good deal more accurate; they are the best the medical community can offer presently.
Table 2. Lifetime Risk of HIV Diagnosis, by State, United States
From this table, I note a big range of risks, state by state, and in the District of Columbia.
Great Disparity in Lifetime Risk, State by State. For instance, the lifetime risk in Maryland is 1 in 56 people. But the risk in Montana is 1 in 674 people. The other states are in between these two extremes, with Georgia and Florida on the very risky side, and Idaho and North Dakota on the ‘unrisky’ side.
The first thought along these lines, for families who are concerned about HIV infection, might be (and I agree it seems logical) to relocate to a state that has less lifetime risk of infection.
Possible Underreporting of Risk by States for Economic Reasons. Amongst the states, I feel it likely that there may be HIV / AIDS ‘underreporting’, and that this may have to do with the tourist trade, or perceived need to attract new business to one’s home state. If this is true, I hope lifetime risk reporting will become more accurate in the next few years, as our states owe it to their residents to offer accurate figures, so that families can take steps for disease prevention and health care.
Risk in Large Cities. I note the lifetime risk of HIV / AIDS is 1 in 17 people in the District of Columbia, which is the heart of one of our large metropolitan areas. In past blogs, I have asked for a breakdown of lifetime risk for our large cities, as the very high risk in the District of Columbia may in fact indicate high risk in other large United States cities as well.
Table 3. 10-Year Age-Conditional Risk (1 in n) of HIV Diagnosis Among HIV-Free Males and Females, Aged 20-50 Years, United States
Young Men Who Have Sex with Men Are at Greater Risk of New HIV Diagnosis. From these data I see that overall, it is four times more likely that men who have sex with men, and who are 20 years of age will get a new diagnosis of HIV than will men who have sex with men, and who are 50 years of age.
New HIV Diagnosis Risk for Young Men Who Have Sex with Men Varies Greatly by Race / Ethnicity. For black men who have sex with men, the risk of new diagnosis of HIV is 1 in 4 at age 20 and 1 in 26 at age 50. For Hispanic men who have sex with men, the figures are 1 in 13 at age 20, and 1 in 40 at age 50. For White men who have sex with men, the figures are 1 in 39 at age 20 and 1 in 79 at age 50.
New HIV Diagnosis Risk for People Who Inject Drugs is Much Less Than for Men Who Have Sex with Men. Also, I see that people who inject drugs and are 20 years of age are somewhat less likely to get a new diagnosis of HIV than people who are 50 years of age; and that the overall new diagnosis risk for people who inject drugs is, across the age spectrum, very much less than for men who have sex with men.
New HIV Diagnosis Risk for Young Women Who Inject Drugs Is Twice as Great as for Young Men. Overall, for men who inject drugs the new diagnosis risk is 1 in 220 at age 20, and 1 in 167 at age 50. For women who inject drugs the new diagnosis risk is 1 in 108 at age 20 and 1 in 112 at age 50. That would mean that amongst people who inject drugs, women 20 years of age are about twice as likely to get a new HIV diagnosis as are men that age.
Can We Extrapolate That HIV Diagnosis Risk for Young Women is Twice as Great as That for Young Men? As both men and women who inject drugs know they are at risk, it seems to me fair to assume they are testing for HIV in a gender equal way. Thus the figures for new diagnosis risk for men and women who inject drugs might help provide an answer regarding the true new diagnosis risk for women who fail to test because they do not know their boyfriends or husbands are having sex with men.
We might go with the assumption that women who are dating or married to men who have sex with men have twice as much risk of new HIV diagnosis as the men. Amongst 20-year-old men having sex with men the new diagnosis risk is 1 in 15. Projecting from the drug injection risk, 20-year-old women who have sex with men who also have sex with men might be expected to have a new diagnosis risk of 1 in 8 (twice as risky as for the men).
I arrive at this estimate by creating a similar ratio, like this …
- New diagnosis risk at 20 for men versus women who inject drugs = 1/220 for men versus 1 in 109 for women (about twice as risky for women)
- Extrapolating new diagnosis risk at 20 for men versus women in relationships where the man has sex with men = 1 in 15 for men versus 1 in 8 (about twice as risky) for women
Importance of Gender Equality in HIV / AIDS Testing of Young People. The above estimate highlights how important gender equality in HIV / AIDS testing may be right now, as regards testing for young women.
From the above estimate we might also extrapolate the number of men who are not disclosing their bisexual lifestyle. If in fact it proves true that twice as many young women as young men, overall, are getting new HIV diagnoses, then it seems to me possible that as many as half of American men are engaging in sex with men as well as with their female sexual partners and wives.
What otherwise would account for young women having a higher incidence of new diagnoses than young men? I have read online that many young women have sex with two men by about age 20. If one of these two had HIV, and gave it to the young woman, then her new male partner would be at risk of infection as well. If this were to be so, then the risk for young women might be from young men who also have sex with men. And the risk for young men might be from having sex with either young men who have sex with men, or from having sex with young women who have done so. Do you not feel this to be true?
If so, then the feat that lies before the medical profession would be to find the most effective way of gathering information from young HIV positive men regarding their female sexual partners, and of persuading the men to allow their female sexual partners to test.
Blessings to all,
In love, light and joy,
Alice B. Clagett
I Am of the Stars
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