As discussed in part A and part B, the 30% by age 30 projection for 1995-2005 appears to have been tragically prescient.
But what of the coming decades?
CDC Revises and Updates.
In 2006 TheBody.com published an article: "HIV/AIDS and Young Men Who Have Sex With Men".
In 2006, an estimated 56,300 people in the United States became infected with HIV. Of these, 34% -- or approximately 19,000 -- were adolescents or young adults aged 13-29 years.[See table]
Of all age groups of MSM, HIV/AIDS cases increased most among YMSM aged 13-24.[See Graph]
The article cited multiple studies and reports from the CDC.
In one recent study, 77% of young, urban MSM aged 15-29 who tested HIV-positive as part of the study mistakenly believed they were not infected. The percentage was even higher for young black HIV-infected MSM, 90% of whom did not know their infection status. People who don't know they are infected might be less likely to take measures to keep from spreading the virus to others.
[...]
[Y]ounger MSM, who did not witness the toll of AIDS in the early years of the epidemic, might view HIV infection as less dangerous and more treatable, leading them to become complacent about risks.
According to its new detailed analysis of national data, the CDC reported that 53% (28,720) of all new HIV infections were among gay and bisexual men and of those about 38% (10,850) were under the age of 30. Note: that's new infections in 2008 alone.
Each year's number of infected people adds to the next because the survival rate has now vastly improved. The count of those living with HIV/AIDS has been going up by about 30,000 per year. Add to the count of infections those infected who have died in the epidemic.
As a larger share of the subpopulation of homosexually-active men becomes infected, the share of uninfected men shrinks. There may come a point where the rate of increase will slow due to reaching a near-saturation level.
Professor Stall, CROI, and refined CDC evidence.
Credible Sources?
In 2008, AIDSmap reported on the Conference on Retroviruses and Opportunistic Infections (CROI).
The annual Conference on Retroviruses and Opportunistic Infections (CROI) began in 1994 as a small meeting of scientists studying HIV and clinicians treating people with HIV. It is now one of the most important annual HIV gatherings and provides a forum for basic scientists, clinical investigators, and global health researchers to present, discuss, and critique their investigations into the epidemiology and biology of human retroviruses and the diseases they produce.AIDSmap is operated by the worldwide non-profit organization, NAM (National AIDS Manual) whose mission is,
"to support the fight agaist AIDS with independent, accurate, accessible and comprehensive information. We aim to create and disseminate information resources rooted in the experience of those most affected, enabling individuals and communities to take action and control in responding to HIV and AIDS."
AIDSmaps has many funders including UNAIDS and the World Health Organization.
US Centers for Disease Control.
The AIDSmap article cited the the CDC's major statistical report on the epidemic:
Centers for Disease Control and Prevention. Trends in HIV/AIDS diagnoses among men who have sex with men - 33 states, 2001-2006. MMWR 57: 681-686, 2008.
Longtime HIV/AIDS researcher, Ron Stall, presented a major paper at the 2008 the Conference on Retroviruses and Opportunistic Infections in which he made a projection based on updated data from the CDC:
Ron Stall of the University of Pittsburgh [...] said that his systematic review of incidence studies concluded that incidence in community samples of American gay men was around 2.4% a year. Moreover, Stall went on to demonstrate the long term implications of such an incidence rate.
Taking this figure as a starting point, Stall ran a mathematic model to see how this incidence in a group of 18 year-olds would translate into HIV prevalence as the group got older. The key assumptions of the model were that each year 2.4% of the group acquired HIV, and that mortality rates were the same as for equivalent age groups in the general population. By age 20, around 5% of the group would be HIV-positive; by age 25, around 15% would have HIV; by age 30, around 25% would be living with HIV, and when they were 40, 41% of the group would be HIV-positive.
POZ reported on Stall's research and interviewed him:
Stall’s conclusion that HIV prevention wasn’t working well for gay and bisexual men was based on his careful scrutiny of all the available data he could find on HIV incidence, which estimates how many new infections occur each year. He and his colleagues found that by the most conservative estimate, 2.39 percent of gay and bisexual men in the U.S. were becoming infected annually between 1995 and 2005. Stall then calculated what would happen to a group of men who were 20 years old in 1995 and had a 2.39 percent HIV incidence rate. He found that by 2005, when the men had turned 30, nearly a quarter of them were likely to be infected with HIV, and that by 2015, when the men would turn 40, over 40 percent would be HIV positive.
POZ is
"the nation’s leading publication and website about HIV/AIDS. Offering unparalleled editorial excellence, POZ and poz.com are identified by our readers as their most trusted sources of information about the disease. [...] More than 150,000 copies of POZ are distributed at thousands of doctors’ offices and AIDS service organizations nationwide. The magazine is also distributed at the world’s most important and well-attended conferences focusing on HIV/AIDS prevention, treatment and community issues."
Credible Researcher?
Ron Stall, PhD, MPH, has been a CDC researcher at the Division of HIV/AIDS Prevention; he is currently Professor and Chair of the Department of Behavioral and Community Health Sciences at the Graduate School of Public Health, University of Pittsburgh; more recently he has served as a member of the external peer review panel for the CDC.
He explains his work on HIV/AIDS reasearch:
The primary focus of my research has been in HIV prevention and behavioral epidemiology, both in the United States and abroad. I also have conducted numerous research projects in the areas of substance abuse epidemiology, smoking, aging, mental health, and housing as health care. Although a great deal of my research has been conducted among gay men, I also have worked with other populations at high risk of HIV infection and expect to expand on this work.
TheBody.com
TheBody.com is the largest source of HIV and AIDS information on the internet. It covers "HIV prevention, HIV testing, HIV symptoms, HIV/AIDS treatment and HIV/AIDS-related health issues, as well as first-person stories from HIV-positive people."
Here is a transcript from a 2008 press conference that Professor Stall held at one of the most important HIV-related medical conferences of that year [MP3 file available]. He estimated that by age 35 more than 30% of men who have sex with men (MSM) will have been infected with HIV:
Our review, using very stringent review criteria, identified 20 different studies from 1995 to 2005, the protease era in Western Europe, North America and Australia, that yielded, in turn, 65 annualized incidence rates across this period.Also see: Paper presented at the American Association of Physicians for Human Rights, AIDS Prevention Summit, 15-17 July. Dallas, Texas. Paul, J., R Stall.
[T]here were no increases or decreases in incidence rates among MSM in the industrialized countries from 1995 to 2000. Rates are not going up or down. The weighted mean incidence rate across all these countries is 2.5% per year.
Turning to the United States model: We looked at just the estimates for the United States. In community-based samples, which were the lowest rate of HIV incidence, compared to HIV alternative test sites or STD [sexually transmitted disease] samples, we calculated a mean incidence rate of about 2.4% per year.
[We] wanted to find out: What does 2.4% mean? What does 2.4%, in particular, mean over long periods of time? So we did a thought experiment, using a closed cohort of young gay men at the age of 18, none of whom were infected at 18, but calculated an incidence rate of infection of 2.4% per year as these men moved from age 20 to age 40. The model that we constructed yielded an estimate that at about age 25, about 15% of the men would be HIV positive; by age 35, about a third; and by age 40, about 41%.
The reason that we used the age of 40 as our cut-point is that AIDS was discovered a quarter of a century ago. These men would have had to have been, by definition, younger than 15 years of age. In addition, because we know that HIV incidence rates were stable from 1995 to the present, the vast majority of their sexual lives would have been in the context of this background incidence rate of about 2.4 or 2.5%.
We were kind of horrified that our model yielded prevalence estimates that high. And accordingly, we went back and looked at the largest samples published by the CDC [U.S. Centers for Disease Control and Prevention] of prevalence rates among men in the United States. The CDC just published, in 2005, a very large study of HIV prevalence rates, by age, in five American cities. What we find is that the model actually fits exactly what's going on in terms of HIV prevalence among gay men, at least in America's largest urban centers. This model that we are extrapolating based on the incidence rates, which culminates in an HIV prevalence rate of 40% at age 40, is not a prediction of something that may happen one day. We are describing epidemiological phenomena that are occurring all around us, and will continue to occur among young American men, if we do not find ways to lower HIV incidence rates further.
Stall has worked as a leading CDC researcher and is recognized as an expert in behavioral epidemiology and the HIV/AIDS epidemic. He has recently estimated that about a third of MSM will be HIV-infected by age 35 and about 40% by age 40.
Conclusion.
Several well-respected sources, each considered highly credible by pro-gay groups and by the CDC and other prominent HIV/AIDS researchers, have been reporting for more than fifteen years now that the risk of HIV-infection is very high for homosexually-active men in the USA.
As suggested by CDC evidence and as estimated by credible HIV/AIDS researchers:
"30% of all 20-year-old homosexually-active men will be HIV positive or dead of AIDS by the time they are 30."
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