The number of new HIV infections and the transmission rate in the United States dropped by 11 and 17 percent, respectively, between 2010 and 2015, but fell short of the goals put forth by President Obama's U.S. National HIV/AIDS Strategy (NHAS), researchers from the Perelman School of Medicine at the University of Pennsylvania and Johns Hopkins Bloomberg School of Public Health reported this week in the journal AIDS and Behavior.
In 2010, the NHAS set key targets for the reduction of HIV incidence (25 percent) and the transmission rate (30 percent) by 2015, in response to the stubbornly persistent infection rate of approximately 50,000 per year. The effort aimed to spur a more coordinated national response and set ambitious targets not only to reduce new HIV infections, but also provide better access and care to persons living with HIV, and reduce HIV-related health disparities.
"Even though we missed the goals by a sizable margin, it's promising to see that we made important progress in reducing rates of HIV infection and transmission," said Robert Bonacci, MPH, a fourth year medical student at the Perelman School of Medicine, and lead author. "Scaling up HIV treatment and care alone was not enough. We need a simultaneous expansion of diagnostic and prevention services, paired with an intensified focus on communities disproportionately affected by HIV, particularly gay men, young people, transgender people, African American and Hispanic communities, and those who live in the southern U.S., to sufficiently impact the HIV epidemic."
The researchers utilized U.S. Center for Disease Control and Prevention (CDC) data on HIV prevalence and mortality for 2007 to 2012, and their own previously published incidence estimates for 2008 to 2012, along with mathematical modeling to evaluate whether the original NHAS incidence and transmission rate goals were achieved. Changes seen from 2010 through 2012 were extrapolated for the time period between 2013 through 2015.
From 2010 to 2015, the number of new infections decreased from 37,366 to 33,218, an 11.1 percent reduction, while the rate of transmissions decreased from 3.16 to 2.61, a 17.3 percent reduction, the researchers reported. Over the same period, estimated all-cause mortality decreased from 17,866 to 16,085, while HIV prevalence increased from 1,181,300 to 1,270,755 persons living with HIV.
In the years since the NHAS launched, funding levels for HIV programs in the U.S. have remained relatively flat, with the exception of an expansion of HIV treatment funding.
Connecting patients to care and keeping them on treatment continues to be a challenge. Putting patients on antiretroviral therapy (ART) can reduce HIV transmission by up to 96 percent. Yet, despite this breakthrough, only 37 percent of people living with HIV have been prescribed ART. Even worse, only 30 percent have achieved viral suppression, reports the CDC.
Perhaps most challenging is that disparities persist at each stage of the HIV care continuum. For certain populations, namely gay men, young people, transgender people, the African American and Hispanic communities, and those who live in the southern U.S., the gains of the last five years have not been distributed equally across all communities. For gay and other men who have sex with men, the epidemic may even be worsening.
In July 2015, the NHAS was updated by the White House Office of National AIDS Policy, extending the updated strategy through 2020. It charts a course for collective action across the government and all sectors of society to get close to the strategy's vision, according to AIDS.gov.
"After the release of the first National HIV/AIDS strategy, researchers cautioned that failure to expand diagnostic, prevention and care services to necessary levels would result in underachievement on the NHAS goals for 2015. Our analysis suggests that is just what happened," said David Holtgrave, PhD, chair of the department of Health, Behavior and Society at the Bloomberg School, and the study's senior author. "HIV prevention efforts must be reinvigorated in the NHAS's second era."
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