CDC’s 2020 HIV Surveillance Report Shows COVID Disruptions

On May 24, 2020, the Centers for Disease Control and Prevention (CDC) published a new HIV surveillance report: Diagnoses of HIV Infection in the United States and Dependent Areas, 2020 and a new HIV supplemental surveillance report: Monitoring Selected National HIV Prevention and Care Objectives by Using HIV Surveillance Data, United States and 6 Dependent Areas, 2020. CDC will also publish an AtlasPlus update that will include data from these reports.

The COVID-19 pandemic in the United States led to disruptions in HIV testing services and access to clinical services throughout 2020. This disruption resulted in a steep, single-year decline in HIV diagnoses that is mostly attributed to declines in testing caused by less frequent visits to health centers, reduced outreach services, and shifting of public health staff to COVID-19 response activities. Given these disruptions, data for 2020 should be interpreted with caution. For these reasons, although data are presented for HIV diagnoses, trends that include 2020 are not discussed in the commentary sections of the new reports. COVID-19 disruptions in HIV testing and care during 2020 have also made estimation of incidence, prevalence, and knowledge of status unreliable. Therefore, the HIV surveillance supplemental report Estimated HIV Incidence and Prevalence in the U.S., which provides data on estimated incidence, prevalence, and knowledge of status in the U.S., was not published this year.

The overall number of HIV diagnoses in the United States in 2020 (30,403) was 17% lower than in 2019. Disruptions in clinical care services, patient hesitancy in accessing clinical services, shortages in HIV testing reagents and materials, shifting of partner services staff to COVID-19 activities, and disruptions in services provided by community-based organizations in 2020 likely led to underdiagnosis of HIV in the U.S. Although state and local health departments quickly developed and implemented innovative strategies for HIV-related testing and care services, such as self-testing and telehealth, during the first year of the COVID-19 pandemic, these strategies did not make up for declines in laboratory-based HIV testing. In addition, telehealth visits might not have included orders for laboratory testing due to social distancing recommendations, or patients may have been reluctant to access testing during this time. Underreporting of laboratory test results to state and local HIV surveillance programs was not a major contributor to declines in diagnoses, as all jurisdictions reported entry and reported to CDC all laboratory results received.

Since the COVID-19 pandemic is still ongoing, more time and data are needed to accurately assess COVID-19’s impact on HIV in the United States. Assessments of trends in HIV diagnoses that include the year 2020 are discouraged.

During 2020, HIV diagnosis percentages and rates were highest among gay, bisexual, and other men who have sex with men; persons aged 25–34 years; Black/African American persons; and persons residing in the South. Nearly half (47%) of diagnoses among persons who inject drugs were among White persons and occurred in the South (44%). From the perspective of racial and ethnic disparities, both absolute and relative disparities in HIV diagnoses were largest between Black/African American and White persons aged 13–24 years.

In 46 U.S. jurisdictions with complete reporting of laboratory results, approximately 82% of people with HIV diagnosed during 2020 were linked to care within one month of diagnosis, and among all persons with diagnosed HIV in the areas, 65% had viral suppression. Data on PrEP coverage show that in 2020, 300,606 or 25% of people eligible for PrEP were prescribed it. Black/African American persons and males who inject drugs had the lowest percentages (largest absolute disparity) and were furthest from the Ending the HIV Epidemic in the U.S. Initiative (EHE) target goals (95%) in linkage to care (Black/African American persons: 80%; males who inject drugs: 78%) and viral suppression (Black/African American persons: 60%; males who inject drugs: 52%). Black/African American persons also were furthest from the EHE target goal (50%) for PrEP coverage (9%).

As we continue to navigate the COVID-19 pandemic, it is critical that we continue our work to expand and improve HIV prevention, care, and treatment for groups who could most benefit, including persons residing in the South; transgender persons; Black/African American women; and gay, bisexual, and other men who have sex with men. We should continue our work to improve access to prevention services for persons who inject drugs, a population for whom progress continues to be threatened by the nation’s opioid and stimulant epidemics. Through the EHE initiative, CDC is working with partners to accelerate progress by delivering innovative key prevention strategies to populations disproportionately affected by HIV. These innovative, community-driven solutions are at the heart of EHE—and show what could be possible with expanded investment, collaboration, and locally tailored strategies. CDC is concerned about the drop in HIV testing and slowing uptake of PrEP in 2020; getting back on track will require scale-up of all EHE strategies. Without a substantial increase in resources to intensify these efforts, we will fall far short of reaching our goals. Ensuring that health equity is centered in all the work we do, and having adequate resources to expand innovative, status-neutral approaches that optimize health and close gaps in HIV prevention, care, and treatment, will position us for future success as we move through the changing COVID-19 pandemic landscape together.

We are grateful for the continued support for HIV prevention in the United States.