HIV rates are decreasing in the US. But progress is not equal

Q:Health officials at the US Centers for Disease Control and Prevention (CDC) report encouraging news about HIV. Between 2017 and 2019, the estimated number of new infections in the US decreased by 12%, from 36,500 to 32,100. The decline appears to be largely due to fewer cases among young gay and bisexual men.

New HIV infections have declined annually since 2016, thanks to greater access to testing and treatment, as well as more education and the use of pre-exposure prophylaxis (PrEP), which can protect sexually active people at higher risk. infected. Among young gay and bisexual men in the United States, 56% were aware of their HIV status in 2019, compared to 42% in 2017. And PrEP prescriptions among sexually active 16- to 24-year-olds, the age most at risk for new infections. — increased from 8% in 2017 to 20% in 2021.

“Improved access to testing, treatment, and PrEP is driving progress for young people,” said Dr. Jonathan Mermin, director of the CDC’s National Center for HIV, Viral Hepatitis, and STDs. [sexually transmitted diseases] and TB [tuberculosis] Prevention, during the briefing. “When evidence-based interventions are implemented, we see results.”

During the briefing, Mermin pointed to specific changes contributing to the decline in cases, including a collaboration between the CDC and Emory University to make HIV self-test kits more accessible. The program hopes to distribute 200,000 tests this year and reach 1 million in five years, and it is already on track to surpass those goals.

read more: How COVID-19 disrupted the fight against HIV

However, positive trends are still not evenly distributed among different racial and ethnic groups. Persistent disparities continue to challenge the CDC’s goal of reducing new HIV infections by 90% by 2030. More young gay and bisexual men who are white are accessing treatment and prevention options like PrEP than their Hispanic and black counterparts. In this group, 45% of white men who test positive are receiving PrEP or HIV treatment, compared with 27% of black men and 36% of Hispanic men. Disparities are particularly stark when it comes to access to PrEP specifically. Overall, 30% of the nearly 1.2 million Americans at highest risk of HIV infection and eligible were taking PrEP, but only 11% were black and 21% were Hispanic. while 78% were white.

The discrepancy also extends to other treatments. The latest data shows that while 66% of people living with HIV were controlling their infection with antiretroviral drugs in 2021, compared to 63% in 2017, only 62% of blacks and 64% of Hispanics had their viral levels under control. hold at an unknown level compared to 72% of Whites;

“Deeply entrenched social determinants of health continue to affect HIV treatment and prevention outcomes,” said Dr. Robin Neblett Fanfair, acting director of CDC’s Division of HIV Prevention. “Racism, systemic inequities, social marginalization, and long-term barriers to care are key drivers of HIV’s disproportionate impact on certain communities, including gay and bisexual men and especially Black women.”

Neblet Fanfair said the agency is targeting community-based campaigns for populations and areas of the country with the lowest PrEP uptake, including among black and Hispanic gay and bisexual men in the South. These campaigns educate people about PrEP by partnering with local health care providers and clinics that treat sexually transmitted infections. CDC also plans to allocate more funding to patient hotlines and other services to help communities expand access to HIV prevention and treatment.

While the Affordable Care Act mandated that insurers fully cover PrEP, with no co-pays for those who need it, a recent Texas judge’s ruling puts that coverage in jeopardy by striking down the mandate and ruling that employers don’t have to provide coverage for PrEP. for The Biden administration has appealed the decision, but if the appeal is unsuccessful, it could deepen the rift over who can get the drug and who can’t.

“While we are on the right track, progress is not happening fast enough or fairly among all people or in all areas of the country,” Mermin said. And as encouraging as the decline in infections is, the rate of improvement falls short of the CDC’s ambitious goal. “We know the way, but does our nation have the will?”

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