May 12, 2005
We are now in the third decade of the HIV/AIDS epidemic. HIV has claimed the lives of more than 22 million people worldwide. In our nation alone, more than 500,000 people have died of AIDS. At the same time, countless Americans have been spared from infection through prevention efforts, and the lives of thousands of HIV-infected people have been extended because of advances in treatment.
The HIV/AIDS epidemic has changed significantly over the past two decades. Initially it primarily affected whites, but today the majority of those affected are people of color. Racial and ethnic minorities are now disproportionately at risk for and affected by the HIV/AIDS epidemic. In the United States, there are an estimated 850,000-950,000 people living with HIV. Twenty-five percent or 180,000 to 280,000 people do not know they are infected with HIV. It has been estimated that infections transmitted from this group account for more than half of new HIV infections each year. It is critically important that we get these individuals diagnosed and into medical treatment and HIV prevention services.
I am aware of the media and interest groups reporting increasing rates of HIV among people aged 50 years and older. To address the Committee’s concerns related to such reports, I would like to share with you data on the total number of people living with HIV/AIDS and on rates of newly diagnosed cases of HIV for persons aged 50 plus and for persons younger than age 50. These data have been collected in 32 states with confidential name-based HIV reporting.
The total number of people living with HIV/AIDS is increasing. This is true for both those under 50 and those over 50. For instance, in the 32 states with name-based HIV reporting in 2000, almost 40,000 people who were over 50 were living with HIV/AIDS (see figure 1 in appendix). This number increased to almost 67,000 by 2003. Similarly, the number of people living with HIV/AIDS who are under 50 is also increasing. The most likely explanation for these trends is that with newly available treatments, people who are infected are living longer, healthier lives. We do not believe the increase in people living with HIV or AIDS is caused by an increase in new infections.
Data on newly diagnosed cases are a surrogate for new infections and serve as our best source of data on trends in infection. When you look at the rates of newly diagnosed persons who are under 50 and those who are over 50, you can see the lines are flat (see figure 2 in appendix). Neither line shows a significant change in rates for these age groups. However, the rate of newly diagnosed HIV infection is three to four times higher among those younger than 50 years than among persons aged 50 and older. In 2003, in 32 states with confidential name-based HIV reporting, there were 27,524 HIV/AIDS cases among persons under 50 and 4,308 HIV/AIDS cases among persons 50 years of age and older. Thus, fourteen percent of new HIV/AIDS cases occurred in persons age 50 years and older.
The HIV/AIDS epidemic in our nation affects African Americans and Hispanics disproportionately. This is true for those aged 50 and older as well as for younger persons. When you look at rates of newly diagnosed cases of HIV/AIDS among persons age 50 and older by race, rates are 10 to 15 times higher among African Americans than among whites, and 5 times higher among Hispanics than among whites. The numbers of cases among American Indians, Alaska Natives, and Asian and Pacific Islanders are too small to calculate rates among those groups.
HIV Prevention Programs
Although persons aged 50 and older account for fewer than one-fifth of new HIV diagnoses, HIV transmission remains a concern among this age group. Thus, it is important that they get information and prevention services to help protect them from acquiring and transmitting HIV. Among 141 community-based organizations across the country funded directly by CDC, 112 or nearly 80 percent include this age group as one of their target populations. They provide prevention services to them, such as: targeted outreach, voluntary counseling and testing, partner counseling and referral, and health education and risk reduction.
One of the challenges of prevention among persons 50 and older is the mistaken belief that they are not at risk for HIV or other STDs. Studies have noted that physicians do not always address sexual health with their older patients and that their patients often have only limited knowledge about risk factors for HIV transmission. This lack of awareness on the part of health care providers is a barrier to educating older adults about the risk of HIV. CDC recommends that physicians take a sexual history from their older patients and discuss their risk for HIV and other STDs.
Another important strategy to prevent HIV is to increase the number of people in this country who get tested for HIV. As I stated earlier, one of the reasons this is so important is because research suggests more than half of new infections are transmitted by individuals who do not know they are infected. In addition, when people become aware of their infection, they usually take steps to protect their partners.
CDC strives to increase the number of people getting tested for HIV in medical settings such as publicly funded clinics, clinics run by community-based organizations, private doctor’s offices, or in hospitals. To increase voluntary HIV testing in medical care settings, CDC strongly encourages all health care providers to include HIV testing, when indicated, as part of routine medical care and on the same voluntary basis as other diagnostic and screening tests. In addition, CDC encourages wider availability of testing services outside of medical settings, in community settings such as homeless shelters and mobile testing sites. We believe that widening options for and increasing the availability of testing will help more people learn their HIV status. By increasing the availability of testing in non-traditional venues and encouraging health care providers to offer testing more routinely in medical settings, more people will have the opportunity to get tested, have access to medical care, have access to ongoing prevention services to prevent transmission to partners, and decrease new infections. This is especially true for older adults, as they more frequently must seek medical care for other conditions.
In summary, HIV/AIDS affects Americans from all age groups. All Americans need to know how to avoid infection, and if infected, should be aware of their infection and know how to avoid transmitting the disease to others. CDC and our federal, state, and community partners are working to this end to reduce new infections as much as possible and link those infected into prevention and care services.
Thank you again for this opportunity. I will be pleased to answer any questions.
Last Revised: May 17, 2005