The U.S. HIV diagnosis rate dropped by 19 percent during the past decade, although such encouraging news is tempered by the uneven progress seen among different risk groups. The Centers for Disease Control and Prevention (CDC) conducted an analysis of HIV diagnoses (as opposed to estimated transmissions of the virus) among various populations between 2005 and 2014 as well as from 2010 to 2014. Findings were presented at the 2015 National HIV Prevention Conference in Atlanta.
Since 2005, HIV diagnoses have declined among heterosexuals, injection drug users and African Americans, in particular among black women. Success has been uneven among men who have sex with men (MSM). Among MSM as a whole, HIV rates have risen during the past decade, specifically among blacks and Latinos; whites’ rates have dropped. Young MSM of all races saw steep increases. There are encouraging signs, however, that the rates for MSM as a whole, including young MSM, have recently begun to level off.
Annual HIV diagnoses are not necessarily a close indicator of how many new transmissions occur each year. If HIV testing rates rise, this may give the impression that there have been more recent transmissions than is actually the case. People with HIV may have been living for the virus for many years before they get tested, so a positive test does not always indicate a recent transmission. Still, because HIV testing rates have remained stable or increased among the various groups considered in the CDC analysis, the health agency believes its diagnosis data does reflect an overall drop in new infections. Also, because testing rates among Latino MSM have remained stable, the CDC believes that a recent increase in HIV diagnoses among that group points to an actual upswing in recent infections.
"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,” Jonathan Mermin, MD, director of the CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, said in a press release. “Much more must be done to reduce new infections and to reverse the increases among Latino men.”
About 40,000 Americans are diagnosed with HIV annually.
HIV diagnoses among women dropped 40 percent between 2005 and 2014, from 12,499 to 7,533. African-American women saw a 42 percent decline in the HIV diagnosis rate during that time; during the 2005 to 2014 period, they experienced a 25 drop in diagnoses. About six in 10 new diagnoses among women currently occur in African-American women.
The 10-year diagnosis rate decline for men was more measured at 11 percent, dropping from 36,296 to 32,185, on account of the stubborn rate among MSM.
Two-thirds of HIV diagnoses in 2014 were among MSM. From 2005 to 2014, the diagnosis rate increased about 6 percent among all MSM, from 25,155 to 26,612. The trends were mixed based on race. The diagnosis rate increased 24 percent among Latino MSM, from 5,492 to 6,829, and 22 percent among black MSM, from 8,235 to 10,080, while dropping 18 percent among white MSM, from 9,966 to 8,207. MSM 13 to 24 years old saw the steepest increases: The diagnosis rate increased 87 percent among both black and Latino young MSM, from 2,094 to 3,923 and from 866 to 1,617, respectively, and rose 56 percent among young white MSM, from 756 to 1,179.
Looking just at the diagnosis rates between 2010 and 2014, the CDC found more encouraging signs of a leveling off among MSM. Diagnoses increased less than 1 percent among the group as a whole, from 26,386 to 26,612, and there was a comparably small rate of increase among black MSM, from 10,013 to 10,080. However, diagnoses increased 13 percent among Latino MSM, from 6,060 to 6,829. Diagnoses have also recently stabilized among white and black 13-to-24-year-old MSM, with a 2 percent decline among young black MSM, from 3,882 to 3,923, and a less than 1 percent decline among young white MSM, from 1,186 to 1,179. Diagnoses are still rising among young Latino MSM, though the rate of change during the 2010 to 2014 period was slower than during the previous part of the past decade. Latino MSM’s diagnosis rate saw a 16 percent increase between 2010 and 2014, from 1,383 to 1,617.
When asked about possible explanations for the apparent recent progress in the HIV epidemic among MSM, specifically if the advent of Truvada (tenofovir/emtricitabine) as pre-exposure prophylaxis (PrEP) may have played a significant role, Eugene McCray, MD, director of the Division of HIV/AIDS Prevention at CDC, said, “It is less likely that the leveling off is a direct result of any single intervention, and far more likely to be the result of a combination of prevention efforts.” He then added, "We must continue risk reduction education, increasing the number of people who know their HIV status, encourage consistent and correct condom use--for those who can consistently use them, increase awareness of PrEP, and continue to ensure that those living with HIV have access to quality care that protects their health and helps prevent transmission to their partners.”
PrEP was approved in the United States in July 2012, but use was scant for the first year. After a flood of media attention about the HIV prevention method during late 2013, HIV-negative Americans began taking Truvada in increasing numbers. According to a rough estimate, about 22,000 people were using PrEP at the beginning of 2015, most of them MSM.
African Americans, representing 13 percent of the U.S. population, comprised 44 percent of HIV diagnoses in 2014. And while Latinos make up 17 percent of the population, 23 percent of new diagnoses occurred among that group.
To read the CDC press release on the report, click here.
To read a CDC fact sheet on 2010 to 2014 diagnosis trends, click here.