01/09/08

Largely in New York: new HIV is young, black and gay

New York likes to think of itself as ahead of the rest of the US on many fronts. It certainly is on the HIV front.

In most of the world, we’ve got precious little idea how many people get infected with HIV each year. Generally, we report HIV prevalence — the number of people who have HIV right now. Some of those people will have been infected last month, some will have been infected 10 years ago. It doesn’t tell us much about what’s happening right now. What we really want is information on HIV incidence — the number of people who got infected in the last year. Recently the US has been trying out new technologies that can distinguish between an old and a new infection. That tells us what proportion of the people tested this year were infected this year; then we have to add in a guesstimate for how many people were infected this year but didn’t get tested. CDC last month published national estimates of incidence for 2006. Now New York City has published its own estimates.

And yes, New York is ahead of the curve. Whites in the city are four times more likely to be newly infected with HIV than they are nationally, Hispanics three times more likely and blacks twice as likely. Overall, half of all new infections are among men who have sex with one another. In fact among white New Yorkers, nine out of 10 new infections are among men, most of them gay. Seven out of 10 of the blacks who got HIV in New York in 2006 were men, and over half of them picked up HIV in anal sex with another man. So much for the “feminising epidemic”.

Blacks of the “post-AIDS generation” — men under 30 who probably became sexually active after effective HIV drugs became the norm in 1996 — seemed particularly hard hit. Some 46% of black men who got infected in sex with another man were under 30, compared with just 24% of whites.

New York doesn’t have any systematic estimates of the number of people in each high risk category, which makes it hard to compare rates across risky behaviours (in this respect, it is definitely not ahead of the curve, falling way behind countries such as China, Indonesia and Nepal, all of which estimate how many drug injectors, sex workers, clients and high risk gay men there are in each district nationwide). But it does look as though a “good news” story might be the comparatively small numbers of new infections among drug injectors in New York City. Just 8% of all new infections were among injectors, a flagrant success for the city’s harm reduction policies.

In the No Shit Sherlock department, I just have to draw attention to this trenchant analysis from dbTechno: “The biggest issue with prevention methods thus far has to do with people who are infected with the AIDS virus infecting those who do not have HIV/AIDS.”

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This post was published on 01/09/08 in Men, women and others, Science, War on drugs.

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