Connecticut is using a shrinking pool of federal funding for HIV/AIDS prevention to focus on getting more people into treatment, particularly men whose sexual activity puts them at risk.
New HIV/AIDS cases are falling in Connecticut, especially among injection drug users, but men who have sex with men make up a growing proportion of diagnoses in the state. They are also the largest group affected by HIV nationally.
Getting these men tested and into treatment is key, as medication now drastically reduces the risk of infected people passing on the virus. AIDS workers say that “men who have sex with men’’ includes gay and bisexual men and men who identify themselves as heterosexual, despite having sexual relations with other men.
It’s this group of men that AIDS Project New Haven is particularly trying to reach because they are “more disenfranchised and stigmatized,” and therefore may not be aware of their HIV status and may not be practicing safe sex, explained Executive Director Christopher Cole. The organization is now sending outreach workers to public parks, rest stops and other places where men in the target group meet sexual partners.
The number of HIV/AIDS cases diagnosed in Connecticut has decreased from 851 in 2002 to 407 in 2010, according to the latest figures from the state Department of Public Health (DPH).
About 10,500 people in Connecticut are living with HIV/AIDS and nearly one-half live in Hartford, Bridgeport and New Haven.
Between 2006 and 2010, Hartford had 312 newly diagnosed HIV cases, Bridgeport had 256 and New Haven had 224, according to DPH. The statewide total for the same period was 2,055.
More than 9,000 have died of AIDS in Connecticut since 1981.
In 2010, 36 percent of newly diagnosed cases were men who have sex with men, making that the leading risk factor in the state, and 11 percent were injection drug users. In 2002, injection drug use was the leading risk factor for infection.
Connecticut is seeing a drop in federal HIV prevention funding. Last year the state received $6.1 million in federal funding. This year only $4.7 million was allocated, and state officials say federal funds will continue to decline. Better national data collection revealed that some areas of the country with the highest number of HIV/AIDS cases were underfunded and led to a redistribution of federal resources, according to Christian Andresen, chief of the TB, HIV, STD and Viral Hepatitis Section at DPH.
The national AIDS strategy is emphasizing testing more people and moving them into treatment, said Andresen. An estimated one in five people infected with HIV do not know it. Younger people are especially likely to go undiagnosed.
Among people 13 to 24 with HIV, 60 percent are unaware of their infection, according to a report released this week by the Centers for Disease Control and Prevention. Getting people on medication and reducing their viral loads (the amount of HIV in the blood) can decrease risk of transmission by up to 96 percent, said Andresen.
Connecticut has a large number of “late testers,” according to DPH’s 2010 epidemiological report, which finds that 30 to 40 percent of people already have AIDS when they first test positive for HIV, the virus that causes AIDS. National rates of late testing are similar.
Late testing is evidence that doctors are not following the CDC guidelines on HIV testing, which since 2006 have suggested testing for anyone aged 13 to 64 as part of routine medical care, according to Shawn Lang, director of public policy at the Connecticut AIDS Resource Coalition. “People don’t think they’re at risk,” she said, and so don’t get tested until symptoms occur.”
The state is encouraging routine AIDS testing in local health centers in order to get more people tested and, if needed, in a treatment program. Andresen said that medications work effectively to prevent virus transmission and to reduce the risk of infection after exposure.
While injection drug use transmission is dropping, Andresen said that the state would continue to support some projects that do prevention work with drug users.
Federal funding cannot be used for needle exchange programs; however, such programs in the three cities with the highest AIDS burden –Hartford, Bridgeport and New Haven – receive state money. About $455,000 is spent on the needle exchange program, according to Lang.
Danbury will lose its needle exchange funding next year, but will continue to operate its program, which serves more than 120 people, according to Roberta Stewart, executive director of AIDS Project Greater Danbury.
Stewart realizes that her decreased funding is the result of successful efforts to contain the virus. “I get that intellectually,” she said. But she worries that funding cuts could make it harder to maintain low transmission rates. “It’s much harder for us out there,” she said.
As the emphasis moves from needle to sexual transmission, how best to reach men at risk is “the million dollar question,” said Andresen.
AIDS clinicians and policymakers are meeting in December, said Lang, and will be looking at data in an attempt to understand why prevention has been so much more effective with some groups than others.
Cole said that interviews AIDS Project New Haven did with a small group of men who have sex with men offered some clues. “We learned that stigma was an issue in sharing their HIV status,” he said.
New infections are falling and people live longer thanks to improved medications, but problems persist in some communities. Blacks and Hispanics represent 65 percent of people living with HIV in Connecticut. Nationally, the CDC estimates that women comprise 24 percent of people living with HIV, but in Connecticut that number is 34 percent.
“Not a lot of people are paying attention to AIDS anymore and it’s still a problem,” said Lang. “We’ve got a lot of work to do still.”