AIDS Death Declines Overall in NYC and the US,

But Improvements are Less for African-Americans, Women, Hispanics, Heterosexuals and Injection Drug Users

Overall declines in AIDS deaths and the incidence of AIDS were reported at the Retrovirus Conference. However, the real story is the disparity in the numbers between minorities (African-Americans, Hispanics and women) and non-minority populations. Also, there is a wide gap between exposure categories of men who have sex with men compared to injecting drug users and heterosexual contact.

Dr. Kevin DeCock, of the Center for Disease Control and Prevention, reported that there was an overall 44% decline in AIDS deaths and a 12% decline in AIDS incidence in the first 6 months of 1997 compared to the first 6 months of 1996. During 1996, AIDS incidence declined overall 6% and AIDS deaths 23%, compared to 1995 statistics.

However, Dr. DeCock reported from 1995 to 1996, AIDS incidence continued to increase among non-Hispanic black men by 19% and among non-Hispanic black women by 12% from heterosexual exposures. While the overall AIDS deaths decreased among whites by 32% from 1995 to 1996, African Americans only decreased 13% and Hispanics decreased 20%. The decrease for male and female injection drug users is 17% and 10%, respectively. For males and females contracting HIV through heterosexual contact, the decrease is 8% for both. The figures for AIDS incidence reflect similar patterns with whites decreasing by 13%, while African-Americans had no decline at all and Hispanics had a decline of only 5%. These numbers may mean that minorities, injection drug users, women, and heterosexuals have more limited or inadequate access to treatment, treatment education and/or adherence initiatives.

M. Chaisson from the New York City Department of Health reported similar patterns. She reported a 33% overall decline in AIDS deaths for the first half of 1997 compared to the second half of 1996. Again, there is a disparity. There was a 41% decline for white men, compared to a 29% decline for black men, a 30% decline for black women, 34% decline for Hispanic men and 37% decline for Hispanic women. Deaths for men having sex with men fell by 40% but for injection drug users by 30%. Encouragingly, the 30% decline for black women followed a 16% decline for black women in the second half of ‘96 compared to the first half of ‘96.

The improvements in the AIDS incidence rates overall are probably due to several factors, including improved treatments for opportunistic infections, improved access to treatment, improved antiretroviral therapy, including protease inhibitors, NNRTIs, and improved treatment education. However, the improvements are not equitably shared by all. The NYC, NYS, Federal and other local governments need to address these inequitable patterns with improved outreach for treatment education. Since these populations comprise an increasingly larger percentage of overall AIDS and infection numbers, the improved rates of decline may take a reversal if changes are not implemented.

In their press release of April 23, 1998, the CDC said, "This [AIDS incidence] data will tell us little about where and how many new infections are occurring- information critical for addressing the need for prevention and treatment."

New Infections Data

The CDC reported recent trends regarding new infections in the 25 states that have integrated HIV and AIDS reporting systems. Taking a closer look at the impact of HIV among young people in these states, the majority of newly diagnosed and reported HIV infections were among African Americans and women. Of the 7,200 cases of HIV reported among 13-24 year olds from January 1994 to June 1997, 44% were female, 63% were African American, 5% were Hispanic. At least 26% were heterosexually acquired, 31% comprised men who have sex with men, and 6% comprised injection drug users. The HIV diagnosis in this age group remained relatively stable during the 4-year period, but the groups inflicted with HIV are changing.

The CDC also said, "With treatment advances, the total number of people living with HIV and AIDS is increasing, resulting in an increasing need for treatment and prevention services." Prevention and treatment education services should be targeted towards the groups in "greatest need, with a primary focus on young African Americans and Hispanic men and women at risk through sexual and drug related behaviors."