Perspective

CDC says HIV prevention progress in US has stalled

Photo of Robert Redfield
Robert R. Redfield

The number of new HIV infections in the United States has stalled in recent years, according to a CDC report outlining trends from 2010 to 2016, ending a dramatic decline in new infections.

The number of new infections began stabilizing in 2013 at about 39,000 per year following 5 years of significant declines, according to the report, which was published weeks after President Trump asked in his State of the Union address for bipartisan support for a plan to end the HIV epidemic in the U.S. by 2030. The goal is to reduce new HIV infections by 90% in the next 10 years.

Key strategies of the plan are diagnosing HIV early, treating HIV quickly to achieve viral suppression, protecting those at risk for HIV using pre-exposure prophylaxis and other preventive measures, and responding to HIV clusters quickly to prevent new infections. The plan is designed to help the counties and cities with the highest rates of HIV burden, the CDC noted.

“Now is the time for our nation to take bold action. We strongly support President Trump’s plan to end the HIV epidemic in America,” CDC Director Robert R. Redfield, MD, said in a news release. “We must move beyond the status quo to end the HIV epidemic in America.”

The CDC report showed differing rates of infection among subgroups, with declines noted in some populations and increases in others.

From 2010 to 2016, the CDC found that although annual infections remained stable in black men who have sex with men (MSM), they increased 30% among Latino MSM and 16% in white MSM. Heterosexual men and women experienced a 17% decrease in infections, and individuals who inject drugs saw a 30% decrease, although the decline has stabilized in recent years, the CDC noted.

The CDC said it estimates the decline in infections stabilized because those who would benefit most from preventive treatments do not have access to them, including those living in rural communities and in the South and disproportionately affected populations such as African Americans and Latinos. – by Erin Michael

References:

CDC. Estimated HIV incidence and prevalence in the United States, 2010-2016. https://www.cdc.gov/hiv/pdf/library/slidesets/cdc-hiv-incidence-prevalence-2010-2016.pdf. Accessed February 28, 2019.

CDC. CDC data confirm: Progress in HIV prevention has stalled. https://www.cdc.gov/media/releases/2019/0227-hiv-prevention-stalled.html. Accessed February 28, 2019.

Disclosure: Redfield is the head of the CDC.

Photo of Robert Redfield
Robert R. Redfield

The number of new HIV infections in the United States has stalled in recent years, according to a CDC report outlining trends from 2010 to 2016, ending a dramatic decline in new infections.

The number of new infections began stabilizing in 2013 at about 39,000 per year following 5 years of significant declines, according to the report, which was published weeks after President Trump asked in his State of the Union address for bipartisan support for a plan to end the HIV epidemic in the U.S. by 2030. The goal is to reduce new HIV infections by 90% in the next 10 years.

Key strategies of the plan are diagnosing HIV early, treating HIV quickly to achieve viral suppression, protecting those at risk for HIV using pre-exposure prophylaxis and other preventive measures, and responding to HIV clusters quickly to prevent new infections. The plan is designed to help the counties and cities with the highest rates of HIV burden, the CDC noted.

“Now is the time for our nation to take bold action. We strongly support President Trump’s plan to end the HIV epidemic in America,” CDC Director Robert R. Redfield, MD, said in a news release. “We must move beyond the status quo to end the HIV epidemic in America.”

The CDC report showed differing rates of infection among subgroups, with declines noted in some populations and increases in others.

From 2010 to 2016, the CDC found that although annual infections remained stable in black men who have sex with men (MSM), they increased 30% among Latino MSM and 16% in white MSM. Heterosexual men and women experienced a 17% decrease in infections, and individuals who inject drugs saw a 30% decrease, although the decline has stabilized in recent years, the CDC noted.

The CDC said it estimates the decline in infections stabilized because those who would benefit most from preventive treatments do not have access to them, including those living in rural communities and in the South and disproportionately affected populations such as African Americans and Latinos. – by Erin Michael

References:

CDC. Estimated HIV incidence and prevalence in the United States, 2010-2016. https://www.cdc.gov/hiv/pdf/library/slidesets/cdc-hiv-incidence-prevalence-2010-2016.pdf. Accessed February 28, 2019.

CDC. CDC data confirm: Progress in HIV prevention has stalled. https://www.cdc.gov/media/releases/2019/0227-hiv-prevention-stalled.html. Accessed February 28, 2019.

Disclosure: Redfield is the head of the CDC.

    Perspective
    Carlos del Rio

    Carlos del Rio

    The fact that, since 2013, we have not seen a decrease [in new HIV infections] is very concerning because in 2012, we had the approval of pre-exposure prophylaxis (PrEP), so the lack of decrease in new infections could be a result of the poor role out of PrEP. We are also not doing a good job keeping people engaged in care and, as a result, in the number of people virally suppressed. The percent of people living with HIV who are virally suppressed has not changed that much; it is still around 40%, and obviously what we are seeing is ongoing HIV transmission, and when you have ongoing HIV transmission, new infections do not go down. It simply shows that what is being done is not having an effect anymore, and this obviously relates to the current initiative that the president announced in the State of the Union address. You have to realize that to get a 75% reduction in new infections in 5 years and a 90% reduction in 10 years, you are talking about having to do way more than what we are currently doing. It is not just doing more of what we are currently doing; it is really doing something much more impactful.

    We must implement PrEP, which has been grossly underused. Where it is mostly used is among men who are white, whereas the epidemic primarily affects blacks and Hispanics. We really need to scale up and make PrEP available to black men and to women. PrEP scale-up and, really, PrEP implementation and availability are huge steps. The second big step we must take is to find people who are infected, either who do not know they are infected or, more importantly, who know they are infected but have fallen out of care. We have to get them back into care. The math we have done here in Georgia suggests there are about 8,000 people out of care, and quite frankly, if you were to tell me today we are going to get all those 8,000 people into care, I would not know where to put them because the care sites are already saturated. We need to maintain perspective that there is a need to increase our capacity to care for people who have HIV and that a clinical care setting is grossly inadequate. The final issue is that we cannot forget social determinants of health. This epidemic is occurring among people who are poor; it primary impacts people who live in unstable housing, who have food insecurity, who lack education and jobs. If we do not address those issues, we are not addressing the root of the problem, and therefore, we will continue seeing an epidemic in the U.S.

    Although the data reflect the status of HIV across the nation, I think we need to be careful and realize that HIV in the U.S. is not one epidemic but multiple micro-epidemics. The epidemic in Atlanta is very different from the epidemic in San Francisco or the epidemic in Seattle. Therefore, what worked in Seattle may not work in Atlanta. Local epidemics need local responses.

    • Carlos del Rio, MD, FIDSA
    • Past chair, HIV Medicine Association
      Professor of medicine and chair, department of global health
      Emory University Rollins School of Public Health

    Disclosures: Del Rio reports no relevant financial disclosures.