HIV outbreak hits college campuses

A report presented by North Carolina health workers at the annual Conference on Retrovirus and Opportunistic Infections last week identified the first outbreak of HIV among college students since the virus was initially detected in 1981.

According to the report, the number of new cases of HIV among male college students has jumped from six in 2000 to 30 in 2003, totaling 84 in four years. This contrasts sharply with a survey in the 1990s, which found low rates of HIV infection across college campuses.

While the incidence of HIV among other demographic groups in North Carolina has remained stagnant, there has been a significant spike in the number of HIV cases among college students, said University of North Carolina at Chapel Hill Infectious Disease Fellow Dr. Lisa Hightow, who was involved in the study.

"We decided to call this an outbreak because we saw such a dramatic increase in the number of HIV cases among college students," Hightow said. "Plus, the fact that we found many cases of acute or recent infection means there is a concern that the infection is spreading."

An initial study, limited to the Triangle, began when Hightow and her colleagues identified an increase in area college students contracting HIV. The results of that study, in which 25 male college students with HIV were detected, led Hightow to suspect that the statewide rising incidence of HIV was much more extensive than in the Triangle.

In the ensuing statewide study, an overwhelming majority of the men identified as HIV positive in the larger study said they were either gay or bisexual, with 58 percent having had sex only with men in the year preceding their diagnosis and 33 percent having had sex with both men and women. Four percent of the men said they only had sex with women during the same time frame and there was no information for the other five percent. Just as in the smaller Triangle study, the statewide study found that 88 percent of the students infected with HIV were black males.

Hightow said she was not surprised that most of the students infected with HIV were black, but more concerned that there are college students at risk for HIV who are not being targeted for testing.

"We know that in the South, blacks are being disproportionately affected by HIV, so it wasn't very surprising that these cases are in young, black men," Hightow said. "Although it wasn't surprising, it still is alarming. We are worried that we're missing a huge portion of the student population in our prevention efforts, because we know that all students are not going to get tested."

Hightow added that they will not be releasing the names of the college campuses, at which the incidence of HIV has been accelerating, because she is afraid "it may add a stigma to those colleges." She said it is important to emphasize that this is not a school-specific situation, but something that affects colleges across North Carolina.

Although there has been a rise in the number of HIV cases since 2000, the study does not point toward any reason for the increase.

"If we knew that, we'd be in a lot better shape," Hightow said. "We don't know why we're seeing this and we don't know what's changed."

Hanson also noted that Duke is similarly in the dark about the reasons why an outbreak of HIV among college students is occurring.

"We, ourselves, are quite interested and curious as to what is happening," Hanson said. "We are waiting for continued information [and] have not formed any ideas of our own as to why this has been happening."

Hightow said her best guess is that HIV must have somehow gotten introduced into a closed pool of college student partners. "When HIV gets introduced to a group, it can spread easily," she said. "You know, college students tend to sleep with other college students; blacks tend to sleep with blacks; and whites with whites."

Further compounding the situation is college student health services' inability to completely determine to what extent the outbreak of HIV is affecting their student populations. Dr. Patricia Geiger, director of Appalachian State University Health Services, said she suspects that there are students who have contracted HIV at Appalachian, but since state health department testing is confidential, students do not need to notify student health.

"We haven't actually seen an increase in the number at our health services, but that doesn't mean that they're not there," Geiger said. "Even though we can't tell you how many people have HIV, we can tell you that we have many people at risk. That's true at any school."

Geiger said she believes one of the major factors for why this outbreak is occurring is complacency about sexual protection among college students.

"A lot of people have gotten complacent about HIV and are now putting themselves at risk--and the numbers show that this is what's happening," she said. "People used to be afraid of it more than they are now. They don't even realize it's a problem. It's never gone away. It just left the front pages. I know it's there."

Duke Student Health Director Dr. Bill Christmas also pointed to complacency among college students as being troubling. Citing Rodriguez, he noted that "students are now beginning to use testing as a way of prevention rather than safer sex practices." Since having learned about the rise in HIV cases, Hanson said Student Health has been trying to raise awareness of the testing options available.

At Student Health, there are two HIV testing options. There is a traditional, confidential test, where students take a blood test and the sample is sent to the Duke Hospital laboratory to be analyzed. For those students who do not want the test on their medical record, there is the super-confidential Orasure, which tests cheek fluid in the mouth for HIV. Both of these tests are covered by the student health fee.