What the New CDC Numbers on HIV/AIDS Really Mean
The federal agency reports that one in 22 African Americans is at risk for HIV/AIDS. But here's what the CDC doesn't say.
Dec. 1 marks the 22nd anniversary of World AIDS Day. This year's theme -- universal access and human rights -- underscores the need for prevention and treatment for all people around the world. Yet in light of recent Centers for Disease Control and Prevention reports, most black Americans are focused on the increasingly frustrating situation here at home. In October the CDC reported that one in 22 (pdf) African Americans is at risk of getting HIV/AIDS. The odds for black women were a little better -- one in 30; for black men they were a little worse -- one in 16.
The statistics are not a surprise. They only confirm the continuation of the epidemic's 15-year proliferation among black men, women and children. The brief phrase -- "one in 22" -- seemed so simple that the Associated Press reported it with little explanation. Like most of the media, it missed what many HIV/AIDS activists and clinicians know: These numbers tell only part of the story of HIV/AIDS and African Americans. And rising above the stigma that is often attached to such global pronouncements of a community's health is a critical part of beating HIV/AIDS.
Getting Real: What's Our Risk?
Delivering a national assessment of HIV/AIDS risk is a complicated business, but the CDC's approach paints a picture so narrow that one can't help thinking of close friends and extended family as people in immediate danger of contracting the virus. And to some degree, that's by design. It is the job of the CDC, as our national disease-surveillance organization, to get our attention. The problem, though, is that statistics like one in 22 can be misleading and counterproductive.
It begins with the way the numbers are collected. "We calculate the lifetime risk of HIV infection, gathering data from 37 states and Puerto Rico [the only states with named HIV/AIDS reporting]," explains Irene Hall, Ph.D., chief of the CDC's HIV Incidence & Case Surveillance Branch in the Division of HIV/AIDS Prevention. Using a combination of mortality statistics and census records, Hall says, the CDC crunches the numbers to arrive at an estimate that supposedly applies to all African-American men and women, regardless of lifestyle, education or income level.
The CDC's own HIV/AIDS surveillance report (pdf) highlights the fact that among African Americans, the risk of getting the virus is "increased by poverty, lack of access to health care and higher rates of incarceration," but the lifetime-risk estimates are not adjusted to reflect the impact of such social conditions.
The problem, explains researcher Robin Stevens, M.P.H., Ph.D., is that "if you don't control for social or economic status, you won't get an accurate assessment of the role race plays in disease statistics."
Nicholas Jewell, Ph.D., a biostatistician and expert in HIV/AIDS at the University of California, Berkeley, says that it's difficult to report these types of statistics, and the way the numbers are reported can be confusing. "A risk of one in 22, for example, is approximately 4.5 percent," he says. "It tells us that 95 percent of African Americans are not at risk for HIV/AIDS in their lifetime," which is a very different message. Similarly, the one-in-30 statistic for black women tells us that 97 percent of black women are not at risk for HIV/AIDS in their lifetime. The number for black men is roughly 94 percent.
Once we look at the numbers this way, we still see a population with a risk that is unacceptably high (55 percent of new cases are diagnosed among blacks), but we are also looking at people who have taken some responsibility for their health and demonstrated partial success in the fight against HIV/AIDS.