Decline signals HIV prevention and treatment efforts in the U.S. are paying off, but not all communities are seeing the same progress.
The number of annual HIV infections in the United States fell 18 percent between 2008 and 2014 — from an estimated 45,700 to 37,600 — according to new estimates from the Centers for Disease Control and Prevention (CDC) presented today at the Conference on Retroviruses and Opportunistic Infections (CROI) in Seattle. Progress, however, was not the same among all populations or areas of the country.
“The nation’s new high-impact approach to HIV prevention is working. We have the tools, and we are using them to bring us closer to a future free of HIV,” said Jonathan Mermin, M.D., director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. “These data reflect the success of collective prevention and treatment efforts at national, state and local levels. We must ensure the interventions that work reach those who need them most.”
The most recent analysis of the number of new HIV infections estimated to occur each year in the U.S. provides a sign of progress in HIV prevention. In addition to the national decline, a new CDC analysis also examined trends by transmission route from 2008 to 2014 and found annual HIV infections dropped:
- 56 percent among people who inject drugs (from 3,900 to 1,700);
- 36 percent among heterosexuals (from 13,400 to 8,600);
- 18 percent among young gay and bisexual males ages 13 to 24 (from 9,400 to 7,700);
- 18 percent among white gay and bisexual males (from 9,000 to 7,400);
- And substantially in some states and Washington, D.C. — Washington, D.C. (dropping 10 percent each year over the six-year period); Maryland (down about 8 percent annually); Pennsylvania (down about 7 percent annually); Georgia (down about 6 percent annually); New York and North Carolina (both down about 5 percent annually); Illinois (down about 4 percent annually); and Texas (down about 2 percent annually).
Furthermore, CDC researchers did not find any increases in annual HIV infections in the 35 states and Washington, D.C., where annual HIV infections could be estimated — they decreased or remained stable in all of those areas.
CDC researchers believe the declines in annual HIV infections are due, in large part, to efforts to increase the number of people living with HIV who know their HIV status and are virally suppressed — meaning their HIV infection is under control through effective treatment. This is a top public health priority. Studies have shown that, in addition to improving the health of people living with HIV, early treatment with antiretroviral medications dramatically reduces a person’s risk of transmitting the virus to others.
Increases in the use of pre-exposure prophylaxis, or PrEP, may also have played a role in preventing new infections in recent years. CDC issued interim clinical guidelines in 2012 for PrEP, a pill that people who do not have HIV can take daily to reduce their risk of infection from sex by more than 90 percent. The FDA approved PrEP for HIV prevention in 2012.
“Maximizing the power of these new prevention tools in conjunction with testing and education efforts, offers the hope of ending the HIV epidemic in this nation,” said Eugene McCray, M.D., director of CDC’s Division of HIV/AIDS Prevention. “Science has shown us the power of HIV treatment medicines in benefitting people with and without HIV.”
Progress must accelerate for people at greatest risk
Gay and bisexual men were the only group that did not experience an overall decline in annual HIV infections from 2008 to 2014. This is because reduced infections among whites and the youngest gay and bisexual men were offset by increases in other groups. Annual infections remained stable at about 26,000 per year among gay and bisexual men overall and about 10,000 infections per year among black gay and bisexual men — a hopeful sign after more than a decade of increases in these populations. However, concerning trends emerged among gay and bisexual males of certain ages and ethnicities, with annual infections increasing:
- 35 percent among 25- to 34-year-old gay and bisexual males (from 7,200 to 9,700);
- 20 percent among Latino gay and bisexual males (from 6,100 to 7,300);
These data also show regional disparities in southern states, which are home to 37 percent of the U.S. population but accounted for 50 percent of estimated infections in 2014. Future analyses will examine racial and ethnic disparities of annual HIV infections.
“Unfortunately, progress remains uneven across communities and populations,” said Dr. McCray. “High-impact prevention strategies must continue to be developed and implemented at the state and local levels to accelerate progress. 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.”
While HIV infections fell from 2008 to 2014 among people who inject drugs, this progress may be threatened by the nation’s opioid epidemic.
“The opioid epidemic in our country is jeopardizing the dramatic progress we’ve made in reducing HIV among people who inject drugs,” said Dr. Mermin. “We need to expand the reach of comprehensive syringe services programs, which reduce the risk of HIV infection without increasing drug use, and can link people to vital services to help them stop using drugs.”
CDC focuses on high-impact, cost-effective solutions
CDC is working to accelerate prevention progress by implementing its High-Impact Prevention (HIP) approach. HIP involves delivering scientifically proven, cost-effective, and scalable interventions, with particular attention to the most heavily affected populations and geographic areas.
As part of HIP, CDC is taking action with national, state and local partners to help ensure:
- HIV testing is simple, available and routine;
- People living with HIV get care and treatment, starting the day they are diagnosed;
- And that people who are not infected with HIV have prevention information and tools, such as comprehensive syringe services programs and PrEP, as indicated.
The bulk of CDC’s HIV prevention funding is provided to state and local health departments who tailor their programming to address the most urgent local needs.