Steve Quayle News Alerts

By David Brown
Washington Post Staff Writer
February 11, 2004; Page A02

SAN FRANCISCO -- A new strategy of AIDS testing allowed public health officials in North Carolina to identify a mini-epidemic last year among black college students and to deliver prevention messages while the outbreak was still growing.

The investigation uncovered an invisible network of sexual liaisons involving 61 male students at 21 colleges who became infected with the human immunodeficiency virus (HIV) within the past four years. Nearly all were infected through homosexual activity.

No place, person or mode of contact appears to be driving the outbreak, the researchers said. It may be that HIV was introduced by chance into the small, closed population of gay black North Carolina college students, from where it then spread widely and rapidly.

The outbreak was described in detail yesterday at the 11th Conference on Retroviruses and Opportunistic Infections, the annual midwinter AIDS meeting held in the United States. The investigation sheds light on the growing epidemic in young, gay black men and shows how, with effort, it can be tracked and addressed in real time.

"We believe that this may not be unique to college students or to North Carolina, but speaks more to transmission of HIV among young black men in the southeastern U.S.," said Lisa Hightow, an infectious-diseases physician at the University of North Carolina at Chapel Hill.

The investigation began in late 2002 when a new surveillance program run by the state health department identified two men attending different colleges in the same city who had just become infected. Health officials knew the infections were recent because both men had the virus in their blood but no antibodies -- a condition that lasts for only about two weeks after infection.

"When we saw that, we knew that something was going on," Hightow said.

North Carolina health officials routinely interview everyone newly diagnosed with HIV infection. These men -- the names of their colleges and city of residence were not disclosed -- were interviewed and asked to provide the names of the sexual partners they had had during the previous year.

Following the chain of transmission led to 69 linked cases of HIV infection, 61 involving college students and 8 involving men outside college. The interviews revealed that the "network" was not something the infected people consciously belonged to or joined intentionally, but was a population of shared race, age, interests and geography in which the members found most of their sex partners.

"I don't think anything different was going on from what had been going on for years," said Peter Leone, the physician in charge of HIV prevention at the state health department. He said that if 10 percent of the 33,000 black male college students in North Carolina are gay or bisexual, then the pool of most likely and available partners would be about 3,300 people.

Once HIV is introduced into such a group, he said, "it doesn't take long to come into contact with someone who is infected."

The outbreak became "amplified" not only because the pool of partners was small, but also because many people had sex soon after they became infected -- a time when the amount of virus in their bloodstream is often 10 times higher than it would be years later. The higher a person's "viral load," the more likely it is for that person to pass on the virus.

The investigators believe the cases represent an outbreak with a distinct beginning and not simply a steady state of HIV transmission. That is because they found the number of new HIV infections in college men has risen rapidly in just a few years. In 2000, there were six; in 2001, 19; in 2002, 29; and in 2003, 30.

Of that total of 84 new infections, 73 were in blacks and 11 in whites. (Not all became infected through the web of transmission that was the "network.") About 60 percent of them reported having sex with men only; one third with both men and women; and 4 percent with women only. They attended 33 colleges in North Carolina, two in South Carolina, one in Georgia and one in Florida.

The outbreak was identified in time for the authorities to ask North Carolina's colleges to include safer-sex messages in orientation sessions this past fall, Hightow said. Stories about the outbreak appeared in campus newspapers, and many college health offices offered free HIV testing.

"We can't say that it's over yet," Hightow said of the outbreak.

The testing that uncovered the cases is one done by the state health department, which processes 120,000 blood samples a year. Samples that test negative for antibodies to HIV are pooled in batches, and the batches are then tested for HIV genetic material with the highly sensitive polymerase chain reaction (PCR) method.

If a pool turns up positive, technicians can test the individual samples. This eventually leads to the single sample that contains HIV but not antibodies -- and, therefore, represents a brand-new infection. Doing this extra step adds about $2 to the cost of a standard HIV test, which is about $3.50, Leone said.

http://www.washingtonpost.com/wp-dyn/articles/A30684-2004Feb10.html