The Centers for Disease Control and Prevention (CDC) released a report last week that stated men who have sex with men (MSM) continue to account for the largest number of HIV diagnoses overall, from 2001 to 2004 in the 33 states that conducted confidential, name-based reporting.

The CDC released this data in their weekly “Morbidity and Mortality Report” on Nov. 18. The report stated the number of HIV diagnoses among MSM remained relatively stable between 2001 and 2003, but increased 8 percent between 2003 and 2004.

Overall, MSM continue to have the highest rate of diagnoses for any risk group, representing 44 percent of all diagnoses during the 2001 to 2004 period. Heterosexuals followed at 34 percent and intravenous drug users were at 17 percent. MSM who are intravenous drug users accounted for another 4 percent.

The report also stated that among males specifically, the majority of diagnoses occurred among MSM, accounting for 61 percent across all racial groups. Conversely, the proportion of diagnoses attributed to heterosexual exposure varied considerably by race, from a low of 6 percent among whites to a high of 26 percent among African-Americans.

CDC epidemiologist Lisa Lee noted this differentiation underscores the need of prevention programs among minority men to address multiple roots of exposure.

“We don’t yet have all the factors driving these trends. Increased diagnoses among MSM could reflect increased HIV incidence, increased testing or some combination of both,” said Ronald Valdiserri, acting director of the CDC’s National Center for HIV, STD and TB Prevention. “I also think it’s important to remember that we are not dealing with a single MSM population. For example, the factors driving risk and diagnosis among white MSM in New York may vary considerably from those driving risk and diagnosis among African-American MSM from North Carolina. What we do know from these and other data is that HIV continues to exact a tremendous toll among all races, especially MSM of color.”

Terry Cunningham, chief of the San Diego County Health and Human Services Agency’s HIV, STD and Hepatitis Branch (formerly the Office of AIDS Coordination), believes MSM continue to dominate diagnoses for a variety of reasons.

“It’s a combination of everything that’s making this jump,” he said. “I think that there’s a significant amount of substance abuse. There’s a significant amount of unsafe sex that’s going on…. That’s the whole gist of it. People are everything from being worn out – from hearing all of the safe-sex messages from the past 23 years – to thinking that there’s a cure. It’s a very complex issue.”

Data collected for the CDC report came from 33 states that have conducted confidential, name-based reporting for at least four years; and for the first time ever, the national total includes data from New York State.

California is one of only 13 states that continue to use a code-based system, while 38 states use HIV name-based reporting systems, according to the CDC.

“To better track the front end of the HIV/AIDS epidemic, the CDC has recommended that all states conduct name-based HIV reporting as an extension of their AIDS surveillance,” Valdiserri said. “Over time, an increasing number of states have implemented HIV [name-based] reporting, thus improving our ability to track new HIV diagnoses.”

The CDC has been in conversations with each of the 13 states that do not report HIV by name, emphasizing the procedures and the approach to transition from a code-based system to a name-based system.

Cunningham believes name-based reporting in California makes sense.

“It’s going to be beneficial for us in funding, because the CDC has mandated that it has to be HIV names reporting by 2007. I think that we see a different epidemic in California than has been seen on the East Coast,” he said. “We will get a better picture from the HIV names reporting, but it still will be a couple years before we really get that picture. It would be guess work to try and figure out what’s going on now.”

Not everyone agrees with heading in the name-based direction, however.

West Hollywood Mayor John Duran has publicly voiced his opposition to name-based HIV reporting. “As a person living with HIV, I believe the reporting of names to governmental agencies will deter those who do not know their HIV status and who are willing to get tested,” said Duran in an e-mail message posted to a San Diego GLBT newsgroup.

Duran referenced the current system California uses, saying, “Today the County Health Department utilizes a unique identifier system to count HIV cases. They argue the system has problems and that it is imperative to have names. I say to the county: Fix the system.”

The San Francisco AIDS Foundation also opposes name-based reporting and argues California should focus on insisting the CDC accept the data and work with the state to design a code-based system that is acceptable to the federal government.

Cunningham noted the HIV rate per 100,000 people in San Diego County declined in 2000, but that there was a significant increase in 2003 and the rate remained the same in 2004.

According to Cunningham and San Diego County data, the HIV rate has increased in the county, from 1.3 cases per 100,000 in 2000 to 2.3 in 2003-04.

“Those numbers really give a false sense of security,” Cunningham said. “That’s only with the statistics that we collect. There’s a lot of private providers [that] do testing.” Cunningham said the county of San Diego only does about 25 percent of the testing that goes on in San Diego County, so their documented HIV rate may not be an accurate representation.

Other data in the CDC report indicated that the overall diagnoses in the 33 states from 2001 to 2004 decreased slightly from 41,207 to 38,685. The rate per 100,000 was 22.8 in 2000 compared to 20.7 in 2004.

Racial disparities are still severe in terms of the diagnoses rate. The CDC report stated that although the rate of HIV diagnoses among African-Americans declined by 5 percent per year, from 88.7 per 100,000 in 2001 to 76.3 in 2004, the ratio of African-Americans remained 8.4 times higher in 2004 than the rate among whites, whose rate was documented at 9.0 per 100,000.