Tuesday, November 21, 2017
Health

Criticized for HIV spike, Florida takes hundreds of cases off the books

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State lawmakers blasted the state surgeon general in January for cutting staff and spending at a time when new HIV cases were spiking in Florida.

A month later, the Florida Department of Health quietly revised its figures.

The department's division of disease control lowered the number of new HIV cases logged in 2014 from 6,147 to 4,613 — erasing one in four new infections from the rolls that year, state records show.

The previous tally from 2014 represented a significant uptick as diagnoses nationwide were declining. It was enough to make Florida the national leader in new HIV cases, an embarrassing distinction for the state, Gov. Rick Scott and the health department, and more importantly, a serious public health concern.

The revised figures still represented an increase in new infections through 2014, but a small one. They put Florida behind published counts for California and Texas.

Mara Gambineri, a health department spokeswoman, said the changes had nothing to do with the controversy. Instead, she said, they were routine adjustments intended to remove cases that had been included more than once.

"Maybe they spelled their name differently … or were previously diagnosed in another state," Gambineri said.

But experts say an adjustment that large raises questions, even accounting for duplicate cases.

"There shouldn't be that many differences," said Jen Kates, who oversees the Global Health & HIV Policy Program at the nonprofit Kaiser Family Foundation.

The state tweaks the number of new HIV diagnoses regularly, and doesn't consider the data final until the July after they are reported. But the most recent revision was the largest of any dating back to 2009, according to a Tampa Bay Times analysis of available reports.

The changes weren't limited to the new cases from 2014. State health officials revised the counts dating back to 2005, reducing the overall number of cases diagnosed over the past decade by more than 7,300. No previous adjustment between one year's report and the next removed more than 1,400 cases, the Times analysis found.

The figures now show a slight decline in new cases from 2011, when Scott took office, to 2014. The previous report showed the number of new infections rising.

Scott's office declined to comment on the revisions. Spokesman John Tupps said the governor is "proud that Florida is investing record amounts of funding for HIV/AIDS prevention."

Experts say the process of tallying diagnoses can be tricky. Adjustments are almost always necessary, said Mary Ann Chiasson, a public health professor at Columbia University who helped oversee HIV/AIDS surveillance in New York City from 1986 to 1999. But they tend to be small, she said.

Accuracy matters. The figures help public health experts determine how effectively they are fighting the epidemic, and how much funding state, counties and cities should receive.

The Centers for Disease Control and Prevention, which uses the data collected by each state to compile national statistics, declined to comment on the adjustments in Florida.

Gambineri said her department found more duplicates than usual this year because of changes in how data was collected across the country. In addition, she noted that earlier this year Florida made a change to the way it reports new HIV cases. Instead of counting cases by the year they were reported, the state now tallies cases by the year they were diagnosed, she said.

She also said the number of new diagnoses for 2014 may have been artificially inflated because residents of other states come to Florida for HIV testing.

"We have more than 1,500 public sites where people can get tested," she said, adding that non-residents who test positive in Florida should be counted in the state where they live.

She declined to provide the Times with a breakdown on how cases had been either reclassified or removed from the most recent data set.

The reduction surprised some service providers.

"On the ground, it doesn't really feel like a slow-down," said Audrey Gardner, the medical case management program director for the Northeast Florida AIDS Network.

Sylvia Hubbard, who runs a Tallahassee-based nonprofit called Minority Alliance Advocating Community Awareness and Action, or MAACA, said she had seen a sharp increase in new HIV diagnoses.

The controversy over Florida's climbing HIV diagnoses had been building for several months. It boiled over in January, when several members of the Florida Senate highlighted the original 2014 figure in relation to state Surgeon General John Armstrong's confirmation. It became one of the key reasons the Senate declined to keep the Scott appointee in the job in March.

"It was a huge concern," said state Sen. Oscar Braynon, a Miami Gardens Democrat who opposed Armstrong's confirmation. "The number (of new HIV cases) was going through the roof and the health department was making (personnel) cuts."

The state published its new set of numbers for 2014 in late February, before Armstrong lost his job. It also issued "provisional" figures for 2015 that show the number of cases continuing to rise.

Asked why the health department didn't use the revised 2014 numbers to defend Armstrong, Gambineri said her office had tried to get the word out by distributing a new HIV/AIDS fact sheet and submitting editorials to newspapers across Florida. A sample editorial she provided to the Times, however, did not mention the revised numbers.

Braynon said he believes the health department was "trying look better after they were shamed about these numbers."

"We've seen this before," Braynon said. "They are conveniently using statistics to make a political point."

Times news researcher Caryn Baird contributed to this report. Researcher Carolyn Edds contributed data analysis. Contact Kathleen McGrory at [email protected] or (727) 893-8330. Follow @kmcgrory.

   
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