By Rebecca Bowers

EXECUTIVE SUMMARY

The goal of a new national plan is to end the HIV epidemic in the United States. The plan entails four main strategies: diagnosing HIV as early as possible after infection, treating HIV rapidly and effectively to achieve sustained viral suppression, protecting people at risk for HIV using prevention approaches such as pre-exposure prophylaxis, and responding quickly to growing HIV clusters to stop new infections.

  • Although the number of HIV infections in the United States has dropped by more than two-thirds since the height of the AIDS epidemic in the mid-1980s, new research from the Centers for Disease Control and Prevention indicates that the estimated number of new infections has leveled off.

A national plan is aimed at ending the HIV epidemic in the United States. The plan entails four main strategies: diagnosing HIV as early as possible after infection, treating HIV rapidly and effectively to achieve sustained viral suppression, protecting people at risk for HIV using prevention approaches such as pre-exposure prophylaxis, and responding quickly to growing HIV clusters to stop new infections.

“After a decades-long struggle, the path to eliminate America’s HIV epidemic is clear,” says Eugene McCray, MD, director of the Centers for Disease Control and Prevention (CDC) Division of HIV/AIDS Prevention. “Expanding efforts across the country will close gaps, overcome threats, and turn around troublesome trends.”

Although the number of HIV infections in the United States has dropped by more than two-thirds since the height of the AIDS epidemic in the mid-1980s, new CDC research indicates that the estimated number of new infections has leveled off.1

For the report, researchers examined trends from 2010 to 2016. The report indicates that after five years of substantial decreases, the number of HIV infections began to level off in 2013 at a rate of approximately 39,000 infections per year.

Differences Among Groups

Data from the report indicate that although the number of infections remained stable among gay and bisexual men, trends varied by race/ethnicity and age. Such trends are important in addressing the epidemic, since gay and bisexual men account for about 70% of new infections.

The number of infections remained stable among black gay and bisexual men, yet it rose 30% among Latino gay and bisexual men. Infections among white gay and bisexual men decreased 16%, the data indicate.

By race/ethnicity and age, infections fell more than 30% among black gay and bisexual males 13 to 24 years of age, yet they remained stable among Latino gay and bisexual males in the same age group. The data suggest that infection rates rose about 65% among both black and Latino gay and bisexual males 25 to 34 years of age.

Among heterosexual populations, infections fell about 17% among both men and women combined. The number of infections for injection drug users decreased about 30%, but has stabilized in more recent years.1

Time to Use Proven Techniques

Why has the decline in the number of HIV infections plateaued? The CDC estimates that effective prevention and treatment measures for HIV are not adequately reaching those who could benefit most from them. Those who live in rural areas and in the South are among those disproportionately affected.

Research indicates that intensified local HIV prevention efforts have proven effective already. Decreases in infections have occurred in urban areas, such as New York and Washington, DC, that have committed to ending new infections. From 2010 to 2016, infection rates dropped about 23% in New York and about 40% in Washington, DC.1

The new national program is designed to increase the use of proven strategies quickly in the 48 counties that have the highest HIV burden, as well as in Washington, DC; San Juan, Puerto Rico; and seven states with a disproportionate rural HIV burden. The program’s goal is to reduce new HIV infections by 90% over a 10-year period.

The CDC plans to work with other national agencies, local and state governments, communities, and people with HIV to expand new prevention and treatment efforts in the targeted areas. It will establish HIV elimination teams in areas with a high burden of HIV infections, with experts in epidemiology, healthcare systems, and disease investigation who will work together with local stakeholders.

The CDC also will work with national, state, and local health agencies to increase the capacity to diagnose all HIV infections in the high-burden areas. By using new systems, the effort will help make HIV testing routine in clinical settings and more accessible in non-clinical settings. Support will be given to enact quick HIV treatment and develop systems for helping people with HIV stay in care.

“We have an historic opportunity to improve the precision of prevention,” notes Jonathan Mermin, MD, MPH, director of the CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention. “This infusion of resources will finally relegate America’s HIV epidemic to the pages of history.”

The CDC recommends at least annual testing for people at high risk for HIV, which includes men who have sex with men and injection drug users. It is estimated that in 2015, about 15% of persons in the United States living with HIV were unaware of their infection. However, this same population accounted for about 40% of annual HIV transmissions.2,3

REFERENCES

  1. Centers for Disease Control and Prevention. Estimated HIV incidence and prevalence in the United States, 2010-2016. HIV Surveillance Supplemental Report 2019;24:1-89.
  2. Gopalappa C, Farnham PG, Chen YH, Sansom SL. Progression and transmission of HIV/AIDS (PATH 2.0). Med Decis Making 2017;37:224-233.
  3. Centers for Disease Control and Prevention. Estimated HIV incidence and prevalence in the United States, 2010-2015. HIV Surveillance Supplemental Report 2018;23(No. 1). Available at: https://bit.ly/2GUIGaI. Accessed March 21, 2019.