The number of US citizens living with HIV has surpassed one million for the first time, the Centers for Disease Control and Prevention (CDC) estimated on 13 June.
Dr Kate Glynn, an epidemiologist at the CDC said that their estimates, as of December 2003, were that between 1 039 000 and 1 185 000 Americans were infected with the virus. The ethnic breakdown is 47% black, 34% white, 17% Hispanic, with the balance composed of Asian and Native American populations. Black and Hispanic people compose roughly 13% and 14% of the total US population and are disproportionately affected by HIV.
The epidemic remains overwhelmingly male, at 74%. Men who have sex with men constitute the largest single risk factor for becoming infected (45%); high risk heterosexual behaviour was next on the list (27%); followed by injecting drug use (22%); and the dual risks of injection drug use and men having sex with men (5%).
Between 24% and 27% of those infections remain undiagnosed, said Ronald Valdiserri, deputy director of the National Center for HIV, STD, and TB Prevention at CDC. That is particularly true for young black men who have sex with men and ignorance continues to play a substantial role in the transmission of new infections.
Citing data from a five city study, Dr Valdiserri said, "Sixty seven per cent of the black men, 48% of the Hispanic men, and 18% of the white men were unaware of their infection before study participation."
CDC estimates that 40 000 new infections occur each year, a number that has remained unchanged for more than a decade. A 2001 strategic plan aimed to cut that number in half by the end of 2005. Dr Valdiserri acknowledged this: "It is clear that we have not achieved that goal." In light of increased HIV prevalence, he was "heartened by the fact that we haven't observed tremendous increases in incidence."
Federal funding for HIV prevention has remained flat over that period while many state governments have cut back their funding because of budgetary strains.
Terje Anderson, executive director of the National Association of People With AIDS, had mixed emotions about the statistics. He said, "Part of the reason for the increase is good news, those of us living with HIV/AIDS aren't dying at the high rates we were in earlier years."
But he believes that the US government is trying to fight the epidemic with one hand tied behind its back. He cited prohibitions on funding needle exchange programmes and restrictions on funding sexually explicit education and prevention messages as inhibiting those efforts.
Dr Valdiserri rejected that analysis: "Government alone is not going to end this epidemic. Government has to partner very closely and carefully with all of the parts of society to address these issues."