Strategies For Prevention And Action
The CDC has implemented the National HIV/AIDS strategy through 2020 that utilizes data since 2010. The strategic goals are to: 1) Reduce new infections, 2) Increase access to care and improve health outcomes for people living with HIV, 3) Reduce HIV-related health disparities and health inequities, and 4) achieve a more coordinated national response to the HIV epidemic . Through that plan, 216 million dollars have been awarded to 90 community-based organizations nationwide to deliver effective HIV prevention to create strategies for those at greatest risk, including African-Americans and other people of color .
A strategy that has built off the efforts of the CDCâs National HIV/AIDS strategy is the United Nationâs program HIV/AIDS established in 2013, 90â90-90. The goal is that by 2020, 90% of people who are HIV Infected will be diagnosed, 90% of people who are diagnosed will be on antiretroviral treatment, and 90% of those who receive antiretroviral treatment will be virally suppressed . This a global initiative that also funds the United States among other territories strongly affected by HIV/AIDS. Ambitious ground roots methods such as this will be vital to attacking this epidemic head on.
How Does Hiv Affect Different Groups Of People
There are different ways to answer this question.
If we look at HIV diagnoses by race and ethnicity, we see that African Americans are most affected by HIV. In 2015, African Americans made up only 13%* of the US population but had 45% of all new HIV diagnoses. Additionally, Hispanic/Latinos** are also strongly affected. They made up 18% of the US population but had 24% of all new HIV diagnoses.
If we look at HIV diagnoses by how people got the virus , we see that gay and bisexual men are most at risk. In 2015, gay and bisexual men accounted for 67% of all new HIV diagnoses. In the same year, individuals infected through heterosexual sex made up 24% of all new HIV diagnoses.
Combining those two views allows us to see the most affected populations, by race and by risk factor.
New HIV Diagnoses in the United States for the Most-Affected Subpopulations, 2015
Subpopulations representing 2% or less of HIV diagnoses are not reflected in this chart.MSM = men who have sex with men
There are also variations by age. Young peopleaged 13-24 are especially affected by HIV. In 2015, they comprised 16% of the US population but accounted for 22% of all new HIV diagnoses. All young people are not equally at risk, however. Young gay and bisexual men accounted for 84% of all new HIV diagnoses in people aged 13-24 in 2015, and young, African American gay and bisexual men are even more severely affected.
CDCs fact sheets explain the impact of HIV on various populations in the United States.
Newsmaternal Health Statistics Staggering For Black Women
As in many communities of color, discrimination and stigma are significant factors that deter women and girls from knowing they should get tested, seeking more information on prevention and treatment options, and disclosing their status.
Compared with their white counterparts, black women and men experience longer delays in diagnosis and are less likely to be virally suppressed, the report cited.
Angarone notes that lack of access to care and under-education coupled with stigma make for a perfect storm of health disparity.
Advances are being made, but it seems like the African American community is missing out on some of those advances, Angarone told NBC News.
Often theres a stigma associated with HIV that can lead to a delay in seeking treatment. HIV may be kept secret or some may not disclose their status because of fear of how they would be viewed in the community. During visits with providers are African American women being told about HIV testing or Prep? Are AA women even aware that you can be tested for HIV even without being sick?
According to the Black Womens Health Imperative, every 35 minutes a woman tests positive for HIV in the U.S. Of the total estimated number of women living with HIV at the end of 2013, 61 percent were African American, and only 30 percent of them were virally suppressed.
People With Diagnosed Hiv In 44 States And The District Of Columbia 2019*
* The 44 states are AL, AK, AZ, AR, CA, CO, CT, DE, FL, GA, HI, IL, IN, IA, LA, ME, MD, MA, MI, MN, MS, MO, MT,NE, NV, NH, NM, NY, NC, ND, OH, OK, OR, RI, SC, SD, TN, TX, UT, VA, WA, WV, WI, and WY. Had 2 viral load or CD4 tests at least 3 months apart in a year. Based on most recent viral load test.
Impact On Communities Of Color
- Racial and ethnic minorities have been disproportionately affected by HIV/AIDS since the beginning of the epidemic, and represent the majority of new HIV diagnoses, people living with HIV disease, and deaths among people with HIV.37,38
- Black and Latino people account for a disproportionate share of new HIV diagnoses, relative to their size in the U.S. population .39,40 Black people also account for more people living with HIV than any other racial group â an estimated 479,300 of the 1.2 million people living with HIV in the U.S. are black.41
- Black people also have the highest rate of new HIV diagnoses, followed by Latino people â in 2019, the rate of new HIV diagnoses per 100,000 for Black people was about 8 times that of white people Latino people had a rate 4 times that of white people.42
- Black people accounted for close to half of deaths among people with an HIV diagnosis in 2019.43,44
- Survival after an AIDS diagnosis is lower for Black people than for most other racial/ethnic groups, and Black people have had the highest age-adjusted death rate due to HIV disease throughout most of the epidemic.45 HIV ranks higher as a cause of death for Black and Latino people, compared with White people.46 Further, HIV was the 6th leading cause of death for Black people ages 25-34 in 2019.47
You May Like: Is Undetectable Hiv Contagious
Preventing Hiv Transmission From Pregnant Women To Children
The Joint United Nations Program on HIV/AIDS reported that the following sixteen African nations in 2012 “ensure that more than three-quarters of pregnant women living with HIV receive antiretroviral medicine to prevent transmission to their child”: Botswana, Gabon, Gambia, Ghana, Mauritius, Mozambique, Namibia, Rwanda, São Tomé and Principe, Seychelles, Sierra Leone, South Africa, Eswatini, Tanzania, Zambia and Zimbabwe.
Impact Across The Country
- Although HIV has been reported in all 50 states, the District of Columbia, and U.S. dependencies, the impact of the epidemic is not uniformly distributed.
- Ten states accounted for about two-thirds of HIV diagnoses among adults and adolescents in 2019 .31 Regionally, the South accounted for more than half of HIV diagnoses in 2019.32
- Rates of HIV diagnoses per 100,000 provide a different measure of the epidemicâs impact, since they reflect the concentration of diagnoses after accounting for differences in population size across states. The District of Columbia has the highest rate in the nation, compared to states, nearly 3 times the national rate and Georgia was the state with highest rate , twice that of the national rate.33,34 Nine of the top 10 states by rate are in the South.35
- New HIV diagnoses are concentrated primarily in large U.S. metropolitan areas , with Miami, Orlando, and Atlanta topping the list of the areas most heavily burdened.36
|Table 1: Top Ten States/Areas by Number and Rate of New HIV Diagnoses , 2019|
|CDC. HIV Surveillance Report, Diagnoses of HIV Infection in the United States and Dependent Areas, 2019 vol. 32. May 2021.|
You May Like: Can You Get Hiv From Dried Blood
The Differential Hiv Experience Of African
While African-Americans make up 12 percent of the U.S. population, they accounted for 46 percent of new HIV infections in 2010, substantially higher than the rate for Whites or Hispanics. The majority of these were men however, African-American women also have a high rate of HIV diagnosis nearly 20 times that of White women . More disheartening is that 1 in 16 African-American men and 1 in 32 African-American women will eventually be diagnosed with HIV.
The causes of this HIV health disparity are complex. HIV infection prevalence is higher and more broadly represented in the African- American community compared to the White population thus African-Americans are at increased risk of infection simply by choosing intimate partners within their own ethnic communities.24 Additionally, African-American communities experience high rates of other sexually transmitted infections, and some of these infections can significantly increase the risk of contracting HIV. African-Americans also tend to be diagnosed at later stages in the disease and therefore begin therapy later, increasing the length of time of their infectivity. Once engaged in HAART, African-Americans are more likely to discontinue therapy prematurely,25 risking resurgence of HIV infectivity and further health complications.
- Text Description: Diagnosis of HIV Infection Among Adults and Adolescents, by Transmission Category Graph
Male-to-male sexual contact: 61%
Antiretroviral Treatment Availability In The Usa
In December 2014, the USA released guidelines recognising the benefits of early treatment for someone living with HIV, as well as the benefits treatment can have on preventing HIV being transmitted to others.101
Despite this, for every 100 people living with HIV in the USA in 2015, only 63 initiated care treatment, 49 were retained in care, and 51 achieved viral suppression.102
More people in HIV care are accessing antiretroviral treatment , increasing from 89% in 2009 to 94% in 2013. However treatment outcomes vary across different ethnic groups. Fewer African American/black people than Hispanics and white people are on ART and fewer have a suppressed viral load. African American/black people are also less likely to have sustained viral suppression over time and to experience longer periods with viral loads at a level that increases their risk of transmitting HIV.103104
Adolescents and young people also struggle to access effective treatment, with worse outcomes than all other age groups at every stage of the HIV treatment cascade. More than a quarter of adolescents and young adults who test positive for HIV are not receiving care services within a month of diagnosis. Around a quarter of adolescents and young adults who access treatment do not stay on it. Only half of all adolescents and young adults who test positive for HIV achieve viral suppression, while one in three adolescents and young adults who achieve viral suppression do not sustain it.105
Also Check: How Long Can Hiv Go Undetected
Hiv Care & Viral Suppression
92% of people newly diagnosed with HIV in 2019 entered care within one month of their diagnosis .
Between January and June 2020, 77% of persons diagnosed were virally suppressed within six months .
Among all people living with HIV in San Francisco, 67% have their virus under control in 2020. . People who are virally suppressed have better health outcomes and do not transmit HIV to other people.
The proportions of persons with HIV who received care and were virally suppressed in 2019 were higher in San Francisco than in California and the U.S. .
Black/African Americans had a lower proportion of linkage to care and viral suppression. Trans women, persons aged 30-39 years, MSM-PWID, and persons experiencing homelessness at diagnosis had a lower proportion of viral suppression. .
Among persons diagnosed with AIDS in the years 2012-2019, survival probability at 36 months was lower among Black/African Americans and Whites compared to Latinx and Asians/ Pacific Islanders. .
Key Points: Hiv Incidence
HIV incidence declined 8% from 2015 to 2019. In 2019, the estimated number of HIV infections in the U.S. was 34,800 and the rate was 12.6 .
, the annual number of HIV infections in 2019, compared with 2015, decreased among persons aged 1324 and persons aged 45-54, but remained stable among all other age groups. In 2019, the rate was highest for persons aged 25-34 , followed by the rate for persons aged 35-44 .
, the annual number of HIV infections in 2019, compared with 2015, decreased among persons of multiple races, but remained stable for persons of all other races/ethnicities. In 2019, the highest rate was for Blacks/African American persons , followed by Hispanic/Latino persons and persons of multiple races .
, the annual number of new HIV infections in 2019, as compared to 2015, decreased among males, but remained stable among females. In 2019, the rate for males was 5 times the rate for females .
, the annual number of HIV infections in 2019, compared with 2015, decreased among males with transmission attributed to male-to-male sexual contact, but remained stable among all other transmission categories. In 2019, the largest percentages of HIV infections were attributed to male-to-male sexual contact
For more details on recent HIV incidence statistics, see Estimated HIV Incidence and Prevalence in the United States, 2015-2019.
You May Like: Can You Get Hiv From Dried Blood
Appendix 1 Additional Detail Related To Canada’s Modelling Method
Reference: Yan, Ping Zhang, Fan and Wand, Handan . Using HIV Diagnostic Data to Estimate HIV Incidence: Method and Simulation. Statistical Communications in Infectious Diseases: Vol. 3: Iss. 1, Article 6.
The statistical modelling method that was used to estimate the number of new HIV infections in Canada is based on a back-calculation method that combines HIV and AIDS diagnostic data with data on the proportions of recent infections among newly diagnosed individuals . The model estimates the time trend in the number of past HIV infections, up until the present time since surveillance data can only record the date of diagnosis and not the date of infection . From this trend in past HIV infections, the model then projects forward to calculate the expected number of HIV diagnoses . The back-calculation method used for incidence estimation in Canada is similar to methods used in the European Union, the USA, and Australia.
Hiv Testing And Counselling In The Usa
It is estimated that 40% of new HIV infections in the country are transmitted by people who are living with undiagnosed HIV, making increasing access to testing and counselling a fundamental priority for HIV prevention.57
In 2015, the US government expanded Medicare coverage to include annual HIV testing for everyone aged 15 to 65-years-old, regardless of their risk, as well as pregnant women and people outside of this age range who are at increased risk. This means that people with health insurance both public and private have good access to testing, often at no cost. For those without insurance or those wishing not to use their insurance, HIV testing can often be obtained at little or no cost.58
In July 2012, the first HIV home-testing kit was approved for use in the USA. Between then and 2017, approximately 1.1 million home-testing kits were sold in the country, primarily through private purchase, online and at pharmacies.59
HIV testing is also available in non-clinical or community-based settings. These services typically provide same-day rapid HIV testing and some offer HIV prevention services. Nonclinical testers may also offer outreach and mobile testing to reach people who are particularly marginalised. Settings include churches, bathhouses, parks, shelters, syringe services programmes, health-related shops and peoples homes.60
HIV related stigma, socially conservative communities, and low HIV risk perception all serve as barriers to testing.64
Read Also: Hiv 1 2 Antibodies
How Hiv Impacts Lgbtq+ People
While HIV affects Americans from all walks of life, the epidemic continues to disproportionately impact certain members of the LGBTQ+ community.
HIV continues to be a major public health crisis both in the United States and around the world. While major scientific advances have made it easier than ever to prevent and treat HIV, there remains no vaccine or cure, and tens of thousands of people continue to contract HIV every year. Insufficient funding for public health programs, ideological opposition to common sense prevention policies, and societal barriers like stigma and discrimination, have made it especially difficult for us to turn the tide against the epidemic. Together, HRC and the HRC Foundation are committed to working with our friends, partners, members, and supporters to end the dual epidemics of HIV and HIV-related stigma.
HIV disproportionately impacts segments of the LGBTQ community.
Transgender people have also been hit especially hard by the epidemic despite comprising a similarly small percentage of the U.S. population. While better data is needed to understand the full impact of HIV on the transgender community, one international analysis found that transgender women in certain communities have 49 times the odds of living with HIV than the general population. Although HIV prevalence among transgender men is relatively low according to the CDC, some data suggest transgender men may still yet be at elevated risk for HIV acquisition.
Hiv And Sex Education
The status of sexual health education varies substantially throughout the USA and is insufficient in many areas. In most states, fewer than half of high schools teach all 16 topics CDC recommends for effective sex education. Many also argue that sex education is not starting early enough.71
The percentage of schools in which students are required to receive instruction on HIV prevention is decreasing, from 64% in 2000 to 41% in 2014.72
Conservative support for abstinence-only sex education has also been a major barrier to progress, and has been shown to be associated with increased HIV rates among adolescents.73
President Obama eliminated three-quarters of the budget for abstinence-only sex education in 2009, which had previously received the majority of funding.7475 However, funding for abstinence-only sex education began to rise again in the following years and stood at US $85 million in 2016.76
In February 2018, this was renewed for two more years at US $75 million annually under the new name of sexual risk avoidance education.77 As of 2019, 37 states require that information on abstinence be provided, 27 of which require for abstinence to be emphasised, with the 10 remaining states requiring that abstinence is covered. In contrast, only 12 states require discussion of sexual orientation. Of these, nine states require that discussion be inclusive.78
Recommended Reading: Can Hiv Lay Dormant