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News About This HIV Thing, When We're Done Discussing the Governor's Cool Eyeglasses

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Is Sarah Palin's grandchild a boy or a girl? I wonder where she gets those eyeglasses? What's happening to Levi's Facebook page?

I was meaning to ask about something else....

Oh yeah. What's happening to the HIV epidemic in the United States?

The Centers for Disease Control and Prevention (CDC) released new estimates today, based on analysis of 33,802 HIV diagnoses in 2006 and 2007 across 22 states. These data were analyzed using a new method, euphoniously labeled the serological testing algorithm for recent HIV seroconversion (STARHS). STARHS allows researchers to estimate how many of these infections occurred recently, and thus how the HIV epidemic is changing across the major risk groups.

CDC unveiled its first official findings in the Journal of the American Medical Association last month. Today's report provides more detail, and underscores four things:

First, men who have sex with men bear the majority of new HIV infections in the United States. Gay and bisexual men account for slightly over half of the 56,000 new infections thought to occur every year. The number of new infections has been steadily climbing in these groups for 15 years now, even as the number of new infections has been stable or declining in other groups.

Second, our HIV prevention strategies are falling short, particularly among young men who have sex with men. We are really failing in communities of color. Among young men who have sex with men, African-Americans and Latinos now account for more than 2/3 of new infections. We are not executing what needs to be done.

Third, race/ethnic disparities among women are even larger. HIV incidence among African-American women is 14.7 times the rate among whites. HIV incidence among Hispanic/Latino women is 3.8 times the rate among whites.

Finally, our next president will inherit a demoralized and under-funded public health system that has not given HIV prevention the managerial skill, focused attention, and resources the subject deserves. For my own full take, click here.

In brief: CDC has faced astonishing organizational problems over the past seven years, which have prompted the exodus of noted scientists and officials from the country's flagship public health agency. In a recent federal employee morale survey, CDC ranked 189th out of 222 agencies.

Disputes about scientific integrity pose one set of problems. Funding cuts pose another. CDC's inflation-adjusted budget for domestic HIV prevention has declined by about 20 percent since 2001. David Holtgrave, former director of CDC's HIV prevention efforts, presented a widely-cited estimate that the agency must increase HIV prevention outlays to about $1.3 billion, to meet identified but unmet needs across the United States. The additional resources amount to about 0.04 percent of the federal budget. This is rounding-error within a $2.1 trillion healthcare system. Yet we can't seem to get it.

Things are no better within the alphabet soup of lesser-known federal public health agencies. Inflation-adjusted federal spending has declined for substance abuse treatment block grants and Ryan White services to persons living with AIDS. The hard-pressed agencies responsible for implementing these programs rank 219th and 191st, respectively, in employee morale.

I'm sorry to intrude on the campaign with such matters.

Now we can all go back to wondering about Todd Palin's cool snowmobile, and about that story with the pig and the pit bull. No wait, it was something about lipstick. I forget the details....

Postscript: Thanks to a distinguished reader, who noted a particularly stupid editing error in the original posting.

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