RAY SUAREZ: For the first times since AIDS was discovered more than 20 years ago, the number of Americans living with HIV infection has surpassed 1 million.
That's according to a new report from the Centers for Disease Control and Prevention released this week at the National HIV Prevention Conference in Atlanta. The study also found that one-quarter of those living with HIV are unaware of their infection; nearly half are African-American; and three-quarters of those infected are male.
To discuss what's behind these numbers, we're joined by, Dr. Ronald Valdiserri, deputy director of CDC's National Center for HIV, STD and TB Prevention; and Phill Wilson, executive director of the Black AIDS Institute.
RAY SUAREZ: Dr. Valdiserri, that number, 1 million, it's kind of staggering. What does that stat tell you? And is there both good news and bad news embedded in that number?
DR. RONALD VALDISERRI: Well, what it tells us is that because of the improvements in treatments for HIV, that Americans are living longer than ever before and that is certainly very good news.
However, when we think about the increase of people living longer combined with a relatively stable rate of new infections, what that translates into is more and more people living with HIV. And what that tells the public health community is that we need to really begin focusing our prevention efforts on people who are living with HIV to help them ensure they don't pass that virus on to their partners.
RAY SUAREZ: The report says about 40,000 new people are infected every year. What do we know about those new cases? Who are they? How do they contract the disease?
DR. RONALD VALDISERRI: That's our current estimate. And based on the best available information that we have right now, we know that African Americans are overrepresented in the overall burden of HIV infection in the United States. HIV is increasingly a disease of women, though men still account for most of the infections in the United States. And we know that male-to-male sex contact is still a very significant mode of transmission in the U.S.
RAY SUAREZ: Phill Wilson, that incidence, that higher incidence of African Americans, it's not a close call; it's ten times higher among black Americans than whites. How do you explain that?
PHILL WILSON: Well, I think there are a number of issues at play here. First of all, the African American is community is still suffering from the misconception that HIV is still a white disease and as a result, people don't believe it is a problem that they have to deal with. Secondly, there is not the kind of infrastructure and capacity needed to fight the disease in black communities.
RAY SUAREZ: Is there something about the way that it's being spread? Who is picking up the infection that makes this population particularly vulnerable?
PHILL WILSON: Well, there are three populations particularly vulnerable in the African American community: Men who have sex with men, women and young people. Among women with AIDS in America, black women represent over 60 percent of the new HIV/AIDS cases in this country.
Black gay men still represent over 30 percent of the new HIV/AIDS cases among gay men and over 50 percent of the new cases are young adults. And of that population, over 60 percent of them are black. So young people, gay people, women, poor people, are all particularly impacted by the disease.
RAY SUAREZ: Are there women who are contracting HIV from male partners who, without their knowledge, are having sex with other men?
PHILL WILSON: Well, that is an issue that we have been dealing with for sometime now. There is not sufficient data to tell us how big of a problem that is in driving the epidemic among women. The causes of the epidemic among black women tend to be drug use and increasingly heterosexual contact.
RAY SUAREZ: Dr. Valdiserri, you mentioned at the beginning the fact that people are living successfully and living longer with HIV these days. Has that in any way contributed to the abandonment by some people of the vigilance, the safe sex practices that had been preached to people so heavily in the '80s and '90s?
DR. RONALD VALDISERRI: Yes, there is certainly substantial evidence that complacency about HIV/AIDS, some of which is due to the fact that it's no longer the immediate death sentence that it once was, that some of that complacency is in fact contributing to individuals not being as safe as they might be.
I think it's important to point out, though, that improved treatments are not the cause of the situation. It's the perception, unfortunately, of the American public at large, and also people who are at risk for HIV, that this is no longer a serious health problem in the United States. And conferences like the one we just concluded in Atlanta are very important opportunities to get the word out to remind all of America that HIV/AIDS remains a very, very serious health problem.
RAY SUAREZ: Well, it's interesting that you say that because while, on the one hand, you say that the word isn't out there in quite the same way, that there is not this perception that contracting HIV is a death sentence, is there anybody 20-plus years on who doesn't realize that a certain set of practices can lead to an infection that creates havoc in your life?
DR. RONALD VALDISERRI: Well certainly young people today know more about HIV than they did in the early '90s, but I think it's very important to make a distinction between having a basic knowledge about HIV/AIDS, and having the skills and attitudes and beliefs that one needs to practice safer behaviors.
It is true that people need to have accurate information. But accurate information alone is not going to result in safer behaviors -- so many, for instance, so many of the studies are showing that among African American gay and bisexual men who are infected with HIV, they don't perceive that they were at risk for HIV.
Now do they know what the virus is and do they know how it was transmitted? Yes. But what we have to do is a better job of making sure that our programs help people identify their own individual risks so that they can take action to protect themselves and protect their partners.
RAY SUAREZ: Well, Phill Wilson, the report indicates that a tremendous percentage of bisexual and gay African Americans are already infected, and that many of the transmitters didn't know they were infected. So what's the public health prescription at that point? Do you start prescribing to all gay and bisexual men that they at least get tested and know their status?
PHILL WILSON: I definitely advocate that people know their HIV status. Knowing your status can save your life. But I also think that we also need to focus on the fact that we know that HIV is spreading in this population and yet we are investing fewer dollars today on prevention than we were last year or the year before. So while we have more people living for a longer period of time and a greater need of targeted prevention, we have fewer resources to address the problem.
RAY SUAREZ: Do you think that this report accurately captured the status of the community that you are advocating for?
PHILL WILSON: I think that the report does accurately characterize the scope of the epidemic among black men who have sex with men. What is alarming is that these numbers are unprecedented anywhere on the planet, that when you look at the hardest hit parts of sub-Saharan Africa, you don't see numbers that are equal to the numbers that we are finding among young black gay men in America.
RAY SUAREZ: So what's the prescription, Dr. Valdiserri, from your point of view? What are the action points going forward from here?
DR. RONALD VALDISERRI: Well, I think what Phill said makes a lot of sense. It's important, though that we remind everyone that there is no single solution to this problem and that when we're talking about stopping the epidemic, we have to employ a comprehensive approach using a variety of approaches. Certainly, getting people to learn their serostatus, to find out whether or not they're infected is extremely important.
You started off this segment by the very sobering statistic that a about a quarter of the million people infected with HIV in the United States don't even know that they're infected. Certainly this is not good from a medical point of view because it means they're not accessing lifesaving treatment.
But it's also a very serious problem from a public health point of view because, likely, many of these individuals are spreading the virus unknowingly. They don't know that they're infected; they're not taking steps to prevent the spread of the virus. So certainly early diagnosis is important.
It's not the only action that we need to take. We need to invest in efforts to work with people once they're diagnosed, to provide them information and support to maintain safer behaviors. And we have to continue to work with very high risk groups who are not infected to make sure that they don't become so.
RAY SUAREZ: Dr. Valdiserri, Phill Wilson, gentlemen, thank you both.