Federal health officials and community leaders testified before the House Committee on Oversight and Government Reform on September 16, stating that more needs to be done to confront the domestic HIV/AIDS epidemic.

The hearing—“The Domestic Epidemic Is Worse than We Thought: A Wake-Up Call for HIV Prevention”—was a result of news from the U.S. Centers for Disease Control and Prevention (CDC) that there were 56,300 new HIV infections in the United States in 2006, compared to the less accurate previous estimate of 40,000.

“The message these findings sent is clear,” said Rep. Henry A. Waxman (D–Calif.), the committee chairman. “We’re not doing enough to limit the spread of this deadly disease. What’s more, we’re still seeing severe disparities in HIV’s impact on different populations.”

The disparities he mentions are among men who have sex with men (MSM)—who made up 53 percent of new HIV infections in 2006—and African Americans, who made up 45 percent of new HIV infections in 2006 while only representing 13.4 percent of the country’s population. Waxman believes that barriers to evidence-based HIV prevention—such as the ban on federally funded needle exchange; the focus on abstinence-only programs; and the failure to address societal factors such as poverty, homelessness, racial and gender inequality, homophobia and stigma—are some of the reasons why certain groups are hit the hardest by the virus that causes AIDS. Julie Gerberding, MD, director of the CDC, agrees.

“AIDS is a social disease as much as it is a viral disease, and part of bringing people to accept prevention is to create that expectation in an environment of hope,” Dr. Gerberding said. “Many of the people who are getting this infection now are functioning in a society that offers them very little hope for education, economic or social attainment. If we don’t address the underpinnings of the problem, we’re never going to get where we need to be as a nation.”

Frank Oldham, president and CEO of the National Association of People with AIDS (NAPWA), noted that while the government recognizes numerous awareness days recognized—such as National Black AIDS Awareness Day (February 7) and National Latino AIDS Awareness Day (October 15) —there is none dedicated exclusively to gay men. As a result, NAPWA is launching the first National Gay Men’s HIV/AIDS Awareness Day on September 27.

Oldham said that NAPWA wanted to ensure “that gay men are involved in this epidemic and not complacent about it themselves, and that the rest of society deals with the issues of homophobia and homo-hatred as barriers to HIV prevention and care services for gay men.”

The hearing also highlighted the decrease in the CDC’s budget for HIV prevention by more than 20 percent since 2002. In addition, the current administration requested less than half of what the CDC estimated is necessary for effective HIV prevention. Gerberding told the committee that based on the new data, the CDC would need an additional $877 million in 2009 and an additional $4.8 billion during the next five years.

President George W. Bush this past July signed legislation reauthorizing his President’s Emergency Plan for AIDS Relief (PEPFAR) with a five-year $50 billion budget to fight AIDS abroad. However, Waxman hopes to work with the Appropriations Committee to funnel more funding into domestic HIV prevention programs.

“What’s even more senseless is that by underfunding prevention the nation will incur greater treatment costs down the road,” Waxman said. “It is indisputable that evidence-based HIV prevention saves money in addition to saving lives by avoiding the high cost of medical care and lost productivity, but on this issue the administration apparently prefers to be penny wise then pound foolish.”

Rep. Michael Turner (R–Ohio) stated that while prevention strategies are proved to be effective, they do not work on those who don’t know that they are positive, a group that makes up 25 percent of overall HIV infections. Anthony S. Fauci, MD, director of the National Institute of Allergy and Infectious Diseases (NIAID) within the National Institutes of Health (NIH), gave an example of encountering a 38-year-old patient who presented for the first time with tuberculosis, central nervous system lymphoma and a CD4 count of three.

“That person clearly was infected for many years, [and] has now compromised his own ability to be treated because he’s so advanced. Who knows how many people that person exposed mainly because he did not know he was infected,” said Dr. Fauci, who also shared that the majority of infections are transmitted by individuals who aren’t aware of their positive HIV status.

Gerberding suggested expanding rapid testing, supporting the CDC guidelines to allow routine screening for HIV and finding people early, especially while they are seroconverting because “that is the time they pose the biggest transmission risk.”

“The status quo simply isn’t acceptable,” Waxman said. “We are doing everything we can and should, and I hope this hearing will be the first step in returning the necessary spotlight, resources and political will to HIV prevention efforts in the United States.”