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NHPC 2015: New HIV Cases Decline, but Population and Geographic Disparities Persist


HIV diagnoses have declined by nearly 20% overall during the past decade, but progress has been uneven across demographic groups, according to new Centers for Disease Control and Prevention(CDC) data reported at the 2015 National HIV Prevention Conference taking place this week in Atlanta. One encouraging finding was a leveling off of newly diagnosed infections among black gay and bisexual men in recent years, following a steady rise. The CDC also reported disappointing new data on geographical disparities, showing that death rates among people with HIV are 3 times higher in southern states.

"It is the best of times and the worst of times [in HIV], with some success and some major disparities," said Jonathan Mermin, director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, who opened the conference on Sunday and gave a Monday plenary address on the CDC's high-impact HIV prevention initiative, which aims to focus resources on the most effective interventions and the most heavily affected groups.

"All interventions are not effective, and all effective interventions are not equal," Mermin added. "Limited resources demand choices. Targeted PrEP [pre-exposure prophylaxis] and syringe distribution are cost-effective and cost-saving...The biggest impact will come from getting [people living with HIV] diagnosed and into care."

Diagnosis Trends by Demographic Group

The CDC released data at the conference from a national analysis of trends in HIV diagnoses over 2 time periods -- 2005-2014 and 2010-2014 -- to provide both a decade-long perspective and a look at more recent changes.

Findings showed that annual HIV diagnoses in the U.S. fell by 19% overall between 2005 and 2014 (from 48,795 to 39,718 per year), which the agency attributed to "dramatic and continuing declines over the decade among several populations including heterosexuals, people who inject drugs, and African Americans."

Newly diagnosed infections fell by 35% among heterosexuals, by 40% among all women (from 12,499 to 7,533), by 42% among black women, and by 63% among injection drug usersbetween 2005 and 2014. During the more recent period, black women saw the steepest drop, of 25%.

The same level of success was not uniformly seen among men who have sex with men -- a group that accounts for nearly two-thirds of all new HIV diagnoses in the U.S. Overall, new diagnoses among gay and bisexual men rose by 6% over the decade (from 25,155 to 26,612), before stabilizing in recent years at a less than 1% increase. This rise among gay men combined with a decline among heterosexual men led to a modest 11% decrease for all men (from 36,296 to 32,185).

However, for gay men trends differed substantially according to race/ethnicity. White gay and bisexual men saw an 18% decline in newly detected infections over the decade (from 9,966 to 8,207) -- similar to that of the population as whole. In contrast, new diagnoses among black and Latino gay and bi men rose by 22% (from 8,235 to 10,080) and by 24% (from 5,492 to 6,829), respectively.

But there has been an encouraging leveling off in new diagnoses among black men during the last 5 years, with a less than 1% increase. Looking specifically at young black gay and bi men age 13-24, this group experienced a steep 87% increase in newly diagnosed infections over the entire decade (from 2,094 to 3,923), but a 2% decline between 2010 and 2014. Unfortunately, the same trend was not apparent for young Latino men, who saw diagnoses rise by 16% in recent years.

HIV testing remained stable or increased during the study period, according to the CDC, indicating that the decreases or stabilizations cannot be attributed to fewer people being tested.

"Although we are encouraged by the recent slowing of the epidemic among black gay and bisexual men -- especially young men -- they continue to face a disproportionately high HIV burden and we must address it," Mermin stated in a CDC press release. "There is hope that the National HIV/AIDS Strategy and other efforts are beginning to pay off, but we can't rest until we see equal gains for all races and risk groups."

"[This data] tells us that our prevention strategies are working, but progress is uneven across populations," said Eugene McCray, director of CDC's Division of HIV/AIDS Prevention, who presented the data at a plenary address on Sunday. "We urgently need to accelerate access to testing, treatment, and new biomedical prevention strategies so that everyone can protect themselves and their partners."

McCray suggested that it is unlikely that the declines and stabilizations are due to any specific single intervention -- such as pre-exposure prophylaxis or PrEP, which is only now coming into widespread use -- but is more likely attributable to a combination of prevention efforts including getting more people living with HIV into care and on treatment, which both improves their own health and reduces transmission to others.

Geographical Disparities

McCray also presented new data on differences across states in death rates among people living with HIV and in the number of people who know their HIV status.

Data from 2012 show that the national mortality rate among people with HIV was 19.2 deaths per 1000 people. But this varied by state, from a low of 7.9 deaths per 1000 in Vermont to a high of 30.8 per 1000 in Louisiana. Of the 10 states that failed to meet the national goal for reducing HIV deaths, 7 were in the southeast.

Looking at rates of HIV diagnosis, 87% of people in the U.S. knew their HIV status in 2012, but again there was a wide range, from a low of 77% in Louisiana to a high of 93% in New York State and Hawaii. Just 5 states reached the national goal of 90% (Colorado, Connecticut, and Delaware, Hawaii, and New York), and again the worst performing states were in the south.

"It is unacceptable that people with HIV living in many southern states are more likely to die than those living in other parts of the country," Mermin said in another CDC press release. "Some states are making great strides toward getting people with HIV diagnosed and into care, but every state must do this if we are to reach our national goals for prevention and care."

"We need to ensure everyone living with HIV has access to high quality health care no matter where they live," McCray stressed.



CDC. HIV Diagnoses Decline Almost 20 Percent, But Progress is Uneven. Press release. December 6, 2015.

CDC. Southern States Trail Rest of Nation in HIV Treatment, Testing. Press release. December 6, 2015.

CDC. Trends in U.S. HIV Diagnoses, 2005-2014. CDC Fact Sheet. December 6, 2015.