New CDC Data Highlight Progress and Challenges in Ending the HIV Epidemic

On May 21, 2024, the Centers for Disease Control and Prevention (CDC) published 3 new HIV surveillance reports to “assist HIV prevention partners in focusing prevention efforts, allocating resources, monitoring trends, and determining gaps and successes in HIV prevention,” according to a letter from the directors. 

The latest HIV incidence estimates show a 12% decrease in new infections compared to 2018, with a 30% decrease among young people aged 13-24 years. Increases in prevention efforts like preexposure prophylaxis and viral suppression are likely contributing to this decline. Geographically, there was a 16% decrease in new HIV infections in the South in 2022 compared to 2018. In ending the HIV epidemic jurisdictions, HIV incidence decreased by 21% among persons aged 13 years and older in 2022 compared to the 2017 baseline year, with no increases seen for any populations.

Despite progress in HIV prevention, ongoing social and economic factors continue to lead to health disparities, especially among Black and Hispanic/Latino individuals. In 2022, nearly half of new HIV infections among women were in Black women, while male-to-male sexual contact accounted for two-thirds of new infections. The number of new HIV infections decreased among Black and White men, but remained stable among Hispanic/Latino men, making up a significant portion of new infections among gay, bisexual, and other men who have sex with men.

At the end of 2022, an estimated 1.2 million people in the United States were living with diagnosed and undiagnosed HIV. Awareness of HIV status increased slightly from 86% to 87% in 2022, with improvements seen among various demographic groups but a decrease among those aged 35-44 years. More young individuals, Asian, Black, Hispanic/Latino, and males with infections attributed to MMSC were aware of their HIV status in 2022 compared to 2018.

The directors noted that the CDC Monitoring Report excluded PrEP coverage data due to a formula error affecting race/ethnicity data. The CDC has paused PrEP coverage reporting for a year to address the error, update estimates, and determine the best presentation method. This update is expected to provide more precise and comprehensive information about PrEP coverage in the United States. Though disparities in coverage trends are not expected to change significantly, some disparities may shift due to the formula error.

In 2022, 82% of individuals diagnosed with HIV were linked to care within one month, with Asian persons having the highest percentage (88%) and Black persons, American Indian/Alaska Native persons, Native Hawaiian/other Pacific Islander persons, and women having the lowest percentages. Among those diagnosed with HIV and still alive in 2022, 65% were virally suppressed, with Black persons and women having the lowest percentages. 

Despite progress in reducing perinatally acquired HIV, the rate among Black persons in 2022 was 5 times the overall rate. To achieve national HIV goals, efforts must address social inequalities and other barriers to care that fuel health disparities.

In 2022, there were 38,043 HIV diagnoses in the US and 6 territories and freely associated states, with over half occurring in the South. The number of HIV diagnoses among gay, bisexual, and other MSM remained stable compared to 2018, with White persons making up almost half of all HIV diagnoses attributed to injection drug use. Increases in HIV diagnoses were seen among certain groups, such as transgender women, Hispanic/Latino gay, bisexual, and other MSM, and Hispanic/Latino persons overall, while decreases were noted among persons aged 13-24 years and Black women.

“Overall, data from these reports demonstrate that expanding the reach of HIV testing, PrEP, and treatment have been effective–but our reach must extend even further, and progress must be faster, to achieve our national goal of ending new HIV infections in the United States,” said the directors. “This requires sharpening our collective focus on efforts that address inequities and their drivers, including racism and other social and structural determinants of health, and ensuring that whole person approaches to HIV prevention, care, and treatment are brought to scale and equitably reach all people who need them to stay healthy.” 

Reference 
Fanfair R, Mermin J. CDC publishes new HIV surveillance reports. CDC. May 21, 2024. Accessed May 23, 2024. https://www.cdc.gov/nchhstp/director-letters/cdc-publishes-new-hiv-surveillance-reports.html