Ending the HIV Epidemic Data Shows Hits, and Misses

By: Ranier Simons, ADAP Blog Guest Contributor

Numbers may be boring, but when it comes to matters of life and death, numbers are essential, and quality data is indispensable. The Centers for Disease Control and Prevention (CDC) last week released its most recent HIV Incidence and Prevalence report.[1,2] The report is based on data from 2018-2022, with the data gathering completed in December 2023. The U.S. is not currently on track to reach Ending the HIV Epidemic (EHE) 2025 and 2030 prevention goals.[3] While progress is being made, there remains much work that needs to be done.

Photo Source: HIV.gov

Overall, estimated new HIV infection rates declined 12% in 2022 in comparison to 2018 among people 13 years of age or older.[2] The overall rate of decline encompasses higher levels of decline of specific groups. Bear in mind that the 12% decrease is attributed to a decline among men. No statistically significant change was observed among females. It is important to note the data is based on the sex assigned at birth (SAAS).[2] Although there was an overall decrease in the rate of new HIV infections, it is important to note that in 2022, 81% of all new infections were among males.[2]

A notable decrease, giving optimism for future trends occurred among young people. The largest reduction in HIV infections in 2022 compared to 2028 was among men ages 13-24, at 30%. The decrease was predominately among gay and bisexual men. The CDC suggests the data shows efforts to reach that demographic are working regarding testing, treatment, and PrEP uptake.

Concerning race and ethnicity, the new report indicated an 18% decrease in the HIV infection rate among people identifying as Black/African American.[2] In 2022, 37% of all new infections were among Black/African American persons, and the highest rate of infection was observed among the same group. The 18% decrease is undoubtedly a positive progression. However, people identifying as Black/African American are only 12% of the general population. Thus, the high infection rate informs the existence of factors causing disparities that need to be examined and corrected. The highest rates of new infection in 2022 in the US (per 100,000 people) were Black/African Americans at 34.1, those identifying as multiracial at 21.6, and Hispanic/Latino persons at 20.7.[2]

Photo Source: CDC

Regionally, data indicates a welcome improved trend in the South. Even though 49% of new infections in 2022 were in the South, the region experienced a 16% decrease in new infection rate.[2] Regional rates were 14.5 South, 11.0 West, 8.9 Northeast, and 7.4 Midwest.[2] The South historically has a heavy burden of HIV in comparison to the rest of the country. Much of that has been driven by socioeconomic factors. The region has the highest poverty rate and lowest household median income.[2,5] The South is also characterized as having the highest knowledge gap of HIV status in the US. In 2022, the report indicates that 14 out of 100 people 13 years of age and older in the South were unaware of their HIV status.[2] Lack of knowledge of status could mean untimely receipt of medical care and treatment.

The category of transmission was another positive area showing a decrease. There was a 10% decrease in new infections attributed to male-to-male sexual contact (MMSC) and a 27% decrease when grouping together MMSC and injection drug use (IDU).[2] There were no changes detected regarding heterosexual contact and IDU, nor infections among females. In 2022, 67% of all new HIV infections were a result of MMSC. Among male new infections, 83% were attributed to MMSC. Thus, the 10% decrease is a step in the new direction.

These trends are just a few of the positive highlights revealed in the latest CDC HIV surveillance report. While positive, statistics show that the US is not on track with EHE goals and lags improvements made in other developed countries. Hopefully, this new data will continue to drive optimism as well as drive continued scientific, financial, legislative, and social bolstering of the multifaceted fight to eradicate HIV.

[1] CDC. (2024, May 21). Estimated HIV Incidence and Prevalence. Retrieved from https://www.cdc.gov/hiv-data/nhss/estimated-hiv-incidence-and-prevalence.html?CDC_AAref_Val=https://www.cdc.gov/hiv/library/reports/hiv-surveillance/vol-28-no-3/index.html

[2] CDC. (2024, May 21). HIV Surveillance Supplemental Report: Estimated HIV Incidence and Prevalence in the United States, 2018–2022. Retrieved from https://stacks.cdc.gov/view/cdc/156513.

[3] CDC. (2024, March 30). Ending the HIV Epidemic in the US Goals. Retrieved from  https://www.cdc.gov/ehe/php/about/goals.html

[4] Carson-Holt, E. (2024, May 2024). HIV transmissions down by 12%. One age group in particular is bringing those numbers down. Retrieved from https://www.lgbtqnation.com/2024/05/hiv-transmissions-down-by-12-this-age-group-in-particular-is-bringing-those-numbers-down/

[5] AIDSVU. (2024). Deeper Look: HIV in the South. Retrieved from https://aidsvu.org/resources/deeper-look-south/#:~:text=The%20heavy%20burden%20of%20HIV,factors%20like%20poverty%20and%20unemployment.

Disclaimer: Guest blogs do not necessarily reflect the views of the ADAP Advocacy Association, but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about public health-related issues and updates.  

Increased HIV Infection Numbers Spark Concern

By: Ranier Simons, ADAP Blog Guest Contributor

One of the most influential and basic tenets in the fight against HIV/AIDS is prevention. Testing is an integral tool for prevention. It is imperative to identify people living with HIV who are unaware of their status, which is globally estimated to be around six million people.[1] Testing stops individual disease progression by getting people into treatment and curbs the spread of HIV by informing individuals of their status in hopes of influencing behavior modification regardless of status. With the exception of the Washington, D.C. area, whereby decreased testing was actually associated with increased HIV diagnoses,[2] testing was adversely affected by the COVID-19 pandemic. National data shows that in healthcare and non-healthcare settings, there was a 43% and 50% drop in the number of the Centers for Disease Control & Prevention (CDC)-funded HIV tests administered.[3] 

Photo Source: aidsmap

According to the city’s Annual HIV, Hepatitis, Sexually Transmitted Infections (STIs), and Tuberculosis (T.B.) Surveillance Report released on February 7, 2023, there were 230 new HIV diagnoses in 2021, up from 219 in 2019.[2] About 1.8 percent of D.C. residents, 11,904, are living with HIV. The current new diagnosis numbers are much lower than the peak of 1,374 new cases in 2007, yet the upward trend is concerning.[2] The COVID-19 pandemic resulted in the closing of many healthcare facilities and changes in the capacity of remaining centers to deliver care. As a result, people did not seek out their regular preventive health visits and lost access to places that previously provided convenient testing. Kaiser Family Foundation reports that D.C. has the most HIV cases per capita and nearly three times the national rate compared to U.S. states.[2] This historical trend marks D.C. as one of the places the CDC watches closely. Thus, observing the increasing trend could shed light on trends that may be reported nationally as time goes on.

Washington, D.C. officials aim to reduce new infections to 130 per year by 2030, with a plan to have 95% of all people aware of their status, with 95% of diagnosed people on treatment, with 95% of those reaching undetectable viral suppression status.[2] HIV disproportionately affects Black residents, who comprise about 44 percent of the population of D.C. but almost 75 percent of HIV cases.[2] In response to this data, public health officials are looking into ways to reduce the stigma associated with prevention, testing, and treatment. Additionally, efforts to reduce socioeconomic barriers to HIV prevention are being explored.

Having stable housing is one crucial factor that contributes to improved health prevention. Stable housing enables people to have a home base to maintain their lives. Having a consistent place to stay makes it easier to maintain regular habits of antiretroviral treatment or PrEP. Stable housing also increases a sense of safety and community, giving people a support network. To examine the result of stable housing on the unhoused, in 2022, D.C. started a pilot program. The federally funded program paid for housing for one year for seven at-risk residents requiring them to set aside 30 percent of their income, undergo employment training, stay on PrEP, and participate in intensive case management.[2] The goal is to have all seven at a point where they can live independently. All seven have stayed in the apartment building and have maintained their PreP treatment.

Photo Source: aidsmap

To further reduce barriers to testing caused by the pandemic, D.C. started a free at-home HIV and STD testing program in June 2020. D.C. residents can request an at-home testing kit, mail it in and see their results on a secure online portal. This is in addition to free walk-in testing available at any Labcorp patient service center, even if someone does not have insurance or their insurance does not cover lab testing.[4]

As people slowly begin to resume pre-pandemic levels of preventative care behaviors, medical professionals are predicting continued increases in HIV infection numbers. It is imperative that all jurisdictions nationally examine their populations with the same rigor as D.C. has done to curb increasing rates of HIV infection. D.C. is just a microcosm of the nation at large.

[1] Ong, J. J., Coulthard, K., Quinn, C., Tang, M. J., Huynh, T., Jamil, M. S., Baggaley, R., & Johnson, C. (2021). Risk-Based Screening Tools to Optimise HIV Testing Services: A Systematic Review. Current HIV/AIDS Reports, 19(2), 154-165. https://doi.org/10.1007/s11904-022-00601-5

[2] Portnoy, J. (2023, February 7). HIV diagnoses up slightly in D.C. after testing dipped during pandemic. Retrieved from https://www.washingtonpost.com/dc-md-va/2023/02/07/hiv-dc-pandemic-testing-disparities/

[3] CDC. (2022) HIV Testing Dropped Sharply Among Key Groups During First Year of COVID-19 Pandemic. Retrieved from https://www.cdc.gov/media/releases/2022/p0623-HIV-testing.html

[4] D.C. Health. (2022). Get Checked DC. Retrieved from https://www.getcheckeddc.org/

Disclaimer: Guest blogs do not necessarily reflect the views of the ADAP Advocacy Association, but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about public health-related issues and updates.