EXECUTIVE SUMMARY
New estimates from the CDC indicate the number of new HIV infections in the United States fell 18% between 2008 and 2014.
- Men who have sex with men were the only ones who did not demonstrate an overall decline in annual HIV infections in the same period. Statistics indicate annual HIV infections dropped in such groups as injection drug users and heterosexuals.
- The CDC is working with national, state, and local partners to see that HIV testing is simple, available, and routine; that those living with HIV get care and treatment, starting the day of diagnosis; and that those not infected with HIV have access to prevention tools, such as comprehensive syringe services and pre-exposure prophylaxis.
Just-released estimates from the CDC indicate the number of new HIV infections in the United States fell 18% between 2008 and 2014.1 However, men who have sex with men (MSM) were the only group that did not experience an overall decline in annual HIV infections in the same period.
Other declines were noted in the new CDC analysis. Statistics indicate annual HIV infections dropped:
- more than half (56%) among injection drug users (from 3,900 to 1,700);
- more than one-third (36%) among heterosexuals (from 13,400 to 8,600);
- almost one-fifth (18%) among young gay and bisexual males ages 13 to 24 (from 9,400 to 7,700), with a similar drop among white gay and bisexual males (from 9,000 to 7,400).
The statistics also show substantial drops in some states and Washington, DC. Rates dropped by 10% each year in Washington, DC, over the six-year period, followed by Maryland (8%), Pennsylvania (7%), Georgia (6%), New York and North Carolina (both 5%), Illinois (4%), and Texas (2%).2
The new national high-impact approach to HIV prevention is working, said Jonathan Mermin, MD, director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, in a statement accompanying the data presentation.
“These data reflect the success of collective prevention and treatment efforts at national, state, and local levels,” Mermin noted. “We must ensure the interventions that work reach those who need them most.”
Reach Those Most at Risk
Why were gay and bisexual men the only group to not experience an overall decline in annual HIV infections? The new analysis indicates that reduced infections among whites and the youngest gay and bisexual men were offset by increases in other groups. Encouraging news came in the form of stable annual infections among gay and bisexual men overall (about 26,000 per year) and black gay and bisexual men (about 10,000 infections per year).
However, a 35% jump was noted among gay and bisexual males ages 25-34 (from 7,200 to 9,700), as well as a 20% spike among Latino gay and bisexual males (from 6,100 to 7,300).
Data also suggest regional disparities in southern states, home to more than one-third of the U.S. population but representing 50% of estimated infections in 2014.
Progress remains uneven across communities and populations, said Eugene McCray, MD, director of CDC’s Division of HIV/AIDS Prevention.
“High-impact prevention strategies must continue to be developed and implemented at the state and local levels to accelerate progress,” McCray said in the statement accompanying the data presentation. “That means more testing to diagnose infections, increasing the proportion of people with HIV who are taking HIV treatment effectively, and maximizing the impact of all available prevention tools.”
At the national conference, CDC scientists presented a detailed breakdown of the data for gay, bisexual, and other men who have sex with men. Although MSM constitute about 2% of the U.S. population, they accounted for two-thirds of people diagnosed with HIV in 2015. The researchers used data from the National HIV Surveillance System on HIV diagnoses among MSM and the first CD4 test result after diagnosis to estimate HIV incidence, prevalence, and percentage of undiagnosed infection by racial/ethnic and age groups for 2008-2014 using a method based on a CD4 depletion model. Counts of CD4 cells can be used to determine states of HIV infection. As HIV stays in the body longer, CD4 cell counts decrease.3
Get HIP to Reduce Rates
The national prevention agency is implementing its High-Impact Prevention (HIP) approach to make further strides in reducing rates. The program involves delivering scientifically proven, cost-effective, and scalable interventions, with special emphasis for the most heavily affected populations and geographic areas. (Contraceptive Technology Update reported on the program; see the March 2016 STI Quarterly article, “Snapshot from National HIV Prevention Conference: Strides have been made, yet hurdles remain,” available at: http://bit.ly/2mchI2w.)
The CDC is working with national, state, and local partners to see that HIV testing is simple, available, and routine; that those living with HIV get care and treatment starting the day of diagnosis; and that those not infected with HIV have access to prevention information and tools, such as comprehensive syringe services programs and pre-exposure prophylaxis (PrEP).
Information presented at the same conference by The Rollins School of Public Health at Emory University and the CDC indicates that for gay and bisexual men, for HIV prevention, PrEP along with testing for and treatment of sexually transmitted infections (STI), can reduce not only HIV, but also some STIs, even in the presence of some reductions in condom usage.2 The model suggests that more than 40% of chlamydia infections and 42% of gonorrhea infections would be prevented over the next decade if 40% of PrEP-eligible gay and bisexual men took PrEP medication and were tested twice a year for STIs. The data indicate that this would occur even with a 40% reduction in condom use while on PrEP.2
REFERENCES
- Centers for Disease Control and Prevention. New HIV infections drop 18 percent in six years. Available at: http://bit.ly/2o8r94f. Accessed March 23, 2017.
- Johnson AS, Song R, Hall I. State-level estimates of HIV incidence, prevalence, and undiagnosed infections. Presented at the 2017 Conference on Retroviruses and Opportunistic Infections. Seattle; February 2017.
- Singh S, Song R, Johnson AS, et al. HIV incidence, prevalence, and undiagnosed infections in men who have sex with men. Presented at the 2017 Conference on Retroviruses and Opportunistic Infections. Seattle; February 2017.
Still, much work remains as agencies push for wider access to key resources.
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