The Centers for Disease Control and Prevention says it doesn't have the money to do widespread testing following the discovery of an increase in HIV infections among male black college students in North Carolina.
"I'm mortified more isn't being done," said Dr. Peter Leone, HIV medical director at the North Carolina Department of Health and Human Services. "It suggests apathy at the federal level."
In the first documented outbreak of HIV on U.S. college campuses, North Carolina researchers were shocked to find that students represented more than 1 in 5 of the state's new HIV infections among 18- to 30-year-olds. College students were 3.5 times more likely than non-students to become infected.
"Twenty years into the... HIV epidemic and we're seeing a re-emergence of HIV in a young male population — that's disturbing," Leone said. "It's our best and brightest who are getting infected — it will be felt for the next five, 10, 15 years."
The increase was first noticed in late 2002, and officials now believe it began in mid-2001 and is still continuing. They worry that unwitting infected students will spread the virus across the country when they return to their hometowns during class breaks or after graduation.
The North Carolina researchers found 84 newly infected male college students over the past three years, 73 of them black. The cases were linked to 37 North Carolina colleges. Up to a dozen cases related to the outbreak also were found in schools in Georgia, Florida, South Carolina, Virginia, West Virginia and the District of Columbia.
While those numbers are small, they are worrisome because they are higher than expected. Health officials fear there could be many more undetected cases.
Despite the alarm, the government has done little to curb the outbreak, Leone said. No additional federal funding has been provided to health agencies in the South, he added.
"There's no way we've diagnosed all the infections," Leone said. "We have every reason to believe there's continuing ongoing transmission."
CDC officials say they are doing the best they can. They are providing technical assistance, planning more HIV surveys in North Carolina, and designing an intervention program for young black men who have sex with other men, said Lisa Fitzpatrick with the CDC.
"The overall problem is that CDC funding has been cut," Fitzpatrick said. "We need money from Washington to trickle down to us so we can help North Carolina."
The agency is urging other states, especially in the South, to check for similar college outbreaks, Fitzpatrick said. However, North Carolina discovered its cases through a new way of testing for HIV that other states are not using yet.
North Carolina officials pooled blood samples of people who tested negative in conventional HIV tests. Then they used a different test that can detect the virus itself, rather than relying on the conventional test that checks for antibodies which show up in the blood later.
While all but two of the men infected in the outbreak had sex at least once with another man, they typically did not consider themselves to be gay or bisexual, according to North Carolina's research.
That finding worries health officials who fear their prevention messages — mainly tailored to strictly gay or straight men — might not be getting through to those who do not identify themselves as homosexuals, even though they have casual sex with men. Leone said most of the people infected didn't think they were at risk.
"We've been somewhat remiss in focusing on people's sexual identity," Fitzpatrick said. "It doesn't matter what their sexual identity is, we need to focus on their behaviors."
Those infected also frequently traveled outside the state, used the Internet to meet partners and were 34 times more likely than non-college men to have sex with other college students.
"Because of the way we pigeonhole people in this society, we don't think of college students as being at risk for HIV," Fitzpatrick said. "Our prevention efforts have not focused heavily on college campuses ... they are actually an important place to implement prevention activities."
By Daniel Yee