CROI: U.S. Lags Behind Europe in AIDS Control

LOS ANGELES, March 2 -- After more than 25 years of battling HIV and AIDS, the U.S. is lagging behind other industrialized nations, according to researchers here.

In 2005 - the latest year for which data are available -- about 17,000 Americans died of outright AIDS, said Harold Jaffe, M.D., of Oxford University in England, at the Conference on Retroviruses and Opportunistic Infections.

The works out to about 58 AIDS deaths per million Americans, reported Dr. Jaffe, who was one of the pioneers of the U.S. public health response to the HIV/AIDS epidemic.

"That rate is twice as high as any country in the European Union and 10 times as high as the United Kingdom," Dr. Jaffe told a packed plenary session.

Since the first AIDS reports in 1981, Dr. Jaffe said, there have been a total of 988,376 AIDS cases and 550,394 deaths in the U.S. and its dependent territories.

From 2001 through 2004, he said, reported AIDS cases were roughly steady at about 40,000 cases reported a year, but the number spiked to 45,669 in 2005.

"Whether the increase is real or some sort of artifact, we don't know," Dr. Jaffe said.

Dr. Jaffe did not propose an explanation for why the U.S. is lagging behind the Europeans, although he chided governments for "wishful thinking" in promoting prevention programs that have not been shown to work.

He noted that President Bush's 2007 budget contains more than million for abstinence-only education programs, even though the research on the effects of such programs is inconclusive at best.

On the other hand, the CDC is spending million for prevention programs this year and does not fund abstinence-only education, said Robert Janssen, M.D., director of HIV/AIDS prevention for the CDC.

Dr. Jansen also said it's not clear why the U.S. is lagging behind Europe in control of AIDS, although "it has been for a long time."

"There are real differences," Dr. Janssen said. "It's not an artifact of surveillance."

It is possible that the U.S. and American epidemics -- although often lumped together in contrast to the developing world -- differ in substantial ways. Europe tends to have HIV and AIDS concentrated in two populations, he said -- homosexual men and recent immigrants from Africa

In contrast, the U.S. has home-grown epidemics among gay men, African-Americans, high-risk heterosexuals and injection drug users. "It's a little like comparing apples to oranges," he said.

Dr. Jaffe said a range of prevention program has been shown to work in the U.S., including screening for blood donors, prevention of mother to child transmission, and consistent condom use.

Despite those successful interventions, he said, "thousands of young Americans are still dying of preventable infections."