Recently we took a close look at the improvement that has been made in the overall percentage of people diagnosed with HIV who have achieved viral suppression in the United States. The most recent data for 2014 showed that 57.9% of all people diagnosed with HIV are virally suppressed and have exceeded the 2014 National HIV/AIDS Strategy (NHAS) target of 54.5%. This overall result hides the fact that some populations are at risk of being left behind. In this blog we’ll examine the NHAS indicators that are used to monitor progress on viral suppression in two groups of concern: youth diagnosed with HIV and people diagnosed with HIV who inject drugs.

Why Focus on Viral Suppression?

Studies have shown that achieving and maintaining a very low level of HIV in the blood (viral suppression) or an even lower level that is undetectable with standard tests (undetectable viral load) improves the health of those living with HIV and prevents sexual transmission of HIV. Modeling of various prevention strategies has shown that increasing viral suppression among people living with HIV may be the single most effective strategy for preventing new infections and ending the epidemic in the United States.

Given the strength of this growing body of evidence, it is important that we work even harder toward achieving universal viral suppression. The NHAS recognizes the importance of viral suppression and makes it one of the four key pillars of the nation’s response to HIV. In addition to increasing viral suppression among all people diagnosed with HIV, the NHAS focuses on improving viral suppression among 3 key populations that have been disproportionately affected by HIV and have had lower viral suppression rates in the past. These key populations are youth, people who inject drugs, and transgender women. Improving viral suppression in these groups is important for the health of these individuals since it protects the immune system and slows progression of the disease and also important for preventing the further spread of HIV to others.

The NHAS indicators use the standard definition of viral suppression that is used in CDC’s HIV surveillance. It is defined as having a viral load result of <200 copies/mL at the most recent viral load test among people who have been diagnosed with HIV. CDC monitors viral suppression using laboratory data from jurisdictions that report all values of CD4 and viral load tests. In 2014, there were 38 jurisdictions with complete laboratory reporting, representing 72% of all people 13 years old and older living with diagnosed HIV in the United States. The number of jurisdictions reporting these data is expected to increase in the coming years, providing an even better representation of the nation as a whole.

Youth and People Who Inject Drugs

The NHAS has set the target for increasing viral suppression rates among all people living with HIV to at least 80% by 2020. The most recent data from CDC show that viral suppression overall has continued to improve: In 2014, 57.9% of people living with diagnosed HIV in the U.S. were virally suppressed, an increase over 54.7% in the prior year. The data also show improvement in viral suppression among youth and people who inject drugs, but disparities remain when compared to the national average. The data show that:

• 48.1% of youth diagnosed with HIV were virally suppressed in 2014. This exceeded our 2014 target of 43.2% for viral suppression among youth (ages 13-24) living with diagnosed HIV infection. Even though the result exceeded that target, it was well below the national average of 57.9%.
• About half (50.3%) of people diagnosed with HIV who inject drugs were virally suppressed in 2014. This exceeded the 2014 target of 49.7% for this group. Even though the result (50.3%) exceeded the target, it was well below the national average of 57.9%.

We must ensure that all people living with HIV are able to achieve viral suppression to improve their health and prevent the transmission of HIV to others. These indicators show us that we must do more to increase viral suppression among people living with HIV who are ages 13-24 and people who inject drugs. We must improve the efficiency, effectiveness, and impact of HIV care and treatment to better serve youth and people who inject drugs so that no group and no one is left behind. We need to better understand the circumstances of and issues faced by these groups with regard to access to HIV care, retention in care, and medication adherence in care. But it is not enough merely to understand these issues. We must ensure that the delivery of healthcare and supportive services are responsive to these issues and are able to better serve the needs of these groups. We stand at a moment where a huge battle can be won in the fight against HIV and we must make sure everyone has the resources needed to make this happen.

In the next post in our continuing NHAS Indicators series, we will look at the viral suppression data among transgender women who are receiving medical care.