Post a Comment On: Vigilance

At the Citizens for a Responible Curriculum's meeting this past weekend they handed out a flyer, a reprint of a Washington Times article with the headline HIV rate rises 8 percent among gay, bisexual men. Here's The Times' lead to the story:
HIV infections among homosexual and bisexual men in the United States rose 8 percent last year, after remaining relatively stable the three previous years, new federal data show.

The increase for the virus that causes AIDS compares with average annual declines of 4 percent among heterosexuals and 9 percent among intravenous-drug users from 2001 to 2004, according to a report in this week's issue of the Centers for Disease Control and Prevention's Morbidity & Mortality Weekly Report.
The story is about a monthly report that the Centers for Disease Control put out this week. Here are the first couple of paragraphs of the actual report:
In 2003, more than 1 million persons in the United States were estimated to be living with human immunodeficiency virus (HIV) infection (1). As a result of advances in treatment with highly active antiretroviral therapy (HAART) since 1996, persons infected with HIV are living longer than before and progression to acquired immunodeficiency syndrome (AIDS) has decreased. Consequently, AIDS surveillance no longer provides accurate population-based monitoring of the current HIV epidemic. Therefore, CDC recommends that all states and territories adopt confidential, name-based surveillance systems to report HIV infection (2). This report describes the characteristics of persons for whom HIV infection was diagnosed during 2001--2004 and reported to 33 state and local health departments with name-based HIV reporting. The findings indicate that the rate of HIV diagnosis in these states decreased among non-Hispanic blacks* from 2001 to 2004; however, the rate of HIV diagnosis among blacks remained disproportionately high. In 2004, the rate among blacks was 8.4 times higher than among whites. Improved knowledge of HIV status and access to care and prevention services is important to decrease the number of new HIV infections among those populations most affected.

Included in this analysis are HIV cases reported to CDC from 33 states† that have conducted name-based HIV/AIDS reporting for at least 4 years. The addition of New York, a state with high AIDS morbidity, has resulted in data for a greater percentage of U.S. cases of HIV infection. Cases of HIV/AIDS diagnosed during 2001--2004 and reported to CDC through June 2005 were analyzed. Cases included 1) diagnosis of HIV infection that had not progressed to AIDS, 2) diagnosis of HIV infection followed by a diagnosis of AIDS, and 3) concurrent diagnoses of AIDS and HIV infection (i.e., AIDS and HIV diagnoses in the same calendar month). Data from U.S. territories were not included. Trends in HIV/AIDS Diagnoses --- 33 States, 2001--2004
Do you notice that the CDC gets that far into the story without even mentioning the "gay and bisexual men" that are The Story at The Times? In fact, though the word "bisexual" does appear in this article (not in the way The Times used it), the words "gay" and "homosexual" don't appear at all. Labeling seems to be more important at The Times than at the CDC, where risks are associated with behaviors, not stereotypes.

The Washington Times is taking this, from the next to the last paragraph of the report, and putting it at the top -- here's the CDC's paragraph:

I wonder why it is that The Times chooses to focus on HIV among gays, and the CRC finds it such a great article that they hand it out to everyone who attends their meeting. There's lots of potential news in this report. For instance, it should be most significant that HIV is hitting Blacks especially hard, and it seems meaningful that rates among Blacks are dropping. I think the recommendation in the first paragraph, that states should adopt a name-based surveillance system for HIV patients, will send a shockwave through certain groups, there must be a privacy issue there that could make the news. The fact that HIV cases are decreasing in the US is obviously good news, even though the decrease in not statistically significant -- at least it isn't increasing.

Of course I'm teasing -- you know why they find this so fascinating. They see this as even more proof that gay people are disgusting. An increase in HIV rates for gay people contributes to the stereotype that Peter Sprigg described so well at the CRC's March meeting, that gay people are promiscuous, disease-carrying child molesters.

This report mentions that 25 percent of people with HIV don't know it. Maybe what's happening is that gay men are realizing the risk, and are getting better about being tested.

Here's a very important paragraph in the Editorial Notes of this CDC report:
Although a statistically significant increase occurred from 2003 to 2004 in the number of diagnosed infections among MSM, the overall annual average percentage change from 2001 to 2004 was not significant. Flat trends in diagnoses were observed among white, black, and Hispanic MSM. The small upturn in diagnoses in 2003--2004 occurred for all racial/ethnic MSM populations. Increases in HIV diagnoses during this period are more difficult to interpret because of increasing emphasis on the benefits of increased testing among persons at high risk. Whereas increases among MSM might reflect increases in HIV incidence, consistent with increases in syphilis and other risk behaviors, they might also reflect increases in HIV testing among MSM. Increasing HIV testing among MSM is critical in light of a study of MSM aged 15--29 years in six U.S. cities, which reported that the proportion of unrecognized HIV infection was as high as 77% (7).
The Times did quote part of a sentence from this paragraph, acknowledging that the observed increase may reflect an increase in HIV testing. The CDC report is positive about noting the "increasing emphasis on the benefits of increased testing" and that "increasing HIV testing among MSM is critical."

If more people are being tested, of course more cases are going to be reported.

Just for fun, I looked at Google news to see how the other newspapers are carrying this. Here are the headlines reporting this exact same story, taken in the order they appear on Google:
CDC: HIV rate decreasing in minorities: Provo Daily Herald, UT
Washington State HIV/AIDS Advocacy Groups To Protest CDC Names-Based Reporting Recommendation:Kaiser network.org, DC [see, I told you]
CDC's AIDS report may be misleading: Miami Herald, FL [they say the effect may be entirely due to more aggressive testing]
AIDS: No Time for Complacency: Student Operated Press, FL [focuses on bad numbers for minorities]
CDC: Nonwhites more likely to contract HIV : Gwinnett Daily Post, GA [now there's a surprise for you]
Populations at Risk of HIV Need Directed Prevention Messages ...: Kaiser network.org, DC
HIV/AIDS Programs Devastated by House Budget Vote: 247gay.com, CA [another big surprise]
CDC's Latest HIV Stats Show Need for Stepped Up Prevention Efforts ...: Infection Control Today, AZ
Overall US HIV Incidence Stable But Significant Racial Differences ...: Medical News Today
Isn't that interesting? Nobody else decided to focus on "gays and bisexual men."

Because it was the least important finding in the entire report.