Why America’s Approach to HIV Prevention Has Stalled

In the midst of news surrounding the Trump administration’s plan to eradicate HIV/AIDS in the United States by 2030, the Centers for Disease Control and Prevention (CDC) announcedthat the annual decline in new HIV transmission rates has leveled off.

What does this mean for plans to combat the HIV/AIDS epidemic?

Experts say that the spotlight directed by the government coupled with gains made in prevention resources over the past decade signify a clear path forward to progress.

That being said, they stress significantly more needs to be done to make an HIV/AIDS-free future anything close to being a reality. Essentially, the current approach hasn’t worked.

“Right now, we have the tools to end the epidemic,” Dr. Ronald G. Collman, director of the Penn Center for AIDS Research in Philadelphia, Pennsylvania, told Healthline. “But we have to keep addressing how people have access to prevention and care, and the structures in our healthcare systems and communities both facilitate and make it difficult for people to get care, treatment and prevention — that is really how we need to focus our efforts.”

However, he added that it’s “important that we still continue to develop new strategies and continue on that quest for a cure.”

HIV: Behind the numbers

At the end of February, the CDC revealed that, based on the most recent data from 2010 to 2016, the number of reported new HIV cases leveled off in 2013 following what was seen as five years of significant drops in new diagnoses.

The number now stands at 39,000 new transmissions each year.

Beyond that total number, the CDC zeroed in further, showing that year-to-year HIV numbers declined in some populations, but in other communities more vulnerable to HIV transmission, the numbers increased.

In keeping with previous statistics, new cases were highest in men who have sex with men (MSM), accounting for 70 percent of new transmissions nationwide.

During that six-year period from 2010 to 2016, new cases decreased 16 percent among white MSM overall, remained stable among black MSM overall, but increased by 30 percent in Latino MSM overall.

Zooming in further, HIV transmissions decreased more than 30 percent in black MSM between 13 and 24 years old, stayed stable in Latino MSM of the same age, but increased a whopping 65 percent in black and Latino MSM ages 25 to 34.

Outside of the LGBTQ community, the numbers were down 17 percent in heterosexual men and women in total. This includes a 15 percent decrease in heterosexual African-American women.

New transmissions in people who inject drugs decreased by 30 percent.

The new release doesn’t specifically touch on transgender people, but past statistics from the CDC show that from 2009 to 2014, 2,351 transgender people were reported to be diagnosed with HIV in the United States.

Collman said that while some numbers like the drop in new cases among men who have sex with men are encouraging, the infection rates among Latinos and African-Americans show that increasingly more work needs to be done.

“When you start to look at race and age, even more stark disparities start to emerge,” he added. “I think as we look at the entire picture of the number of diagnoses in the United States, we have to maintain our focus on subgroups that are most impacted. As we make potential gains in one area, we have to ensure no one is left behind.”

Collman stressed that when discussing HIV, it is crucial not to frame it as some “generalized broad epidemic” without taking into account the role that the healthcare access, socioeconomic realities, and racial disparities that are part of affected communities play in shaping these statistics.

“More than half of infections are occurring in the southeastern part of the United States — this epidemic is not geographically uniform. Secondly, is that very large proportion of those affected populations are in the African-American community, particularly in young men who have sex with men,” Collman said.

He explained the need to target these populations by focusing on the large proportion of transmissions that occur from people who are newly diagnosed.

“Nationally, about 80 percent of infected people do not know they are infected, and much lower percentage receives a diagnosis. Viral loads are much higher during that acute infection phase — during the chronic infection phase. What that means is that we have to really identify people rapidly,” he said.

Collman asserted that if the medical community is going to “control this epidemic” it isn’t just about giving people therapies, it’s about giving them those therapies “fast and get them on treatment right away” before the virus may be transmitted to others.