HIV infections are declining, however most at-risk persons are not on PrEP

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New HIV infections in the US have declined slightly over a four-year period, but the country is far from meeting its goal of ending the epidemic, according to the latest data released on Tuesday by the Centers for Disease Control and Prevention were published.

According to the CDC report, the overwhelming majority of people who are at high risk from the virus do not receive essential medicines to prevent infection because of wide racial disparities in access to treatment.

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According to the report, infections fell by 12% from 36,500 in 2017 to about 32,100 in 2021. According to the data, the decline was due to a 34% drop in new HIV infections among 13-24 year olds.

The US has set a national goal of ending the HIV epidemic by reducing new infections by 90% by 2030.

But the country is not on track to meet that goal if progress continues at the current pace, said Dr. Jonathan Mermin, director of the CDC’s National Center for HIV and STD Prevention, in a phone call with reporters on Tuesday.

Gay and bisexual men and black and Hispanic communities are at higher risk of infection because of racism, economic inequality, social marginalization and residential segregation, said Dr. Robyn Neblett Fanfair, a senior officer of the CDC’s HIV prevention efforts.

About two-thirds of new HIV infections reported in 2021 were among gay and bisexual men, with members of black and Hispanic communities accounting for the vast majority of new cases in this group. According to the data, about 40% of new infections in the gay community were black men and 35% were Hispanic men.

In heterosexual women, black women accounted for 60% of new infections. In heterosexual men, about 61% of new infections affected black men, according to the CDC. About 60% of injecting drug users diagnosed with HIV in 2021 were white.

More than half of the new infections, 52%, were reported in the south.

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Big difference in treatment

According to the CDC report, only 30% of the 1.2 million people at highest risk of HIV in 2021 were taking medication to prevent infection, called pre-exposure prophylaxis. However, this proportion of people taking PrEP has increased significantly, from 13% of the at-risk population in 2017.

U.S. health officials aim to increase the number of people taking PrEP to at least 50% of the at-risk population by 2025, but to meet that goal there are strong racial disparities in treatment that need to be addressed.

Only 11% of Blacks and 21% of Hispanics at risk of HIV infection received PrEP in 2021. In contrast, 78% of at-risk whites took medication to prevent infection in the same year.

The CDC is launching a campaign in the South focused on black and Hispanic gay and bisexual men to close the PrEP coverage gap, Neblett told Fanfair.

Access to PrEP is being jeopardized by a recent ruling by a federal judge in the US North District of Texas that overturned Obamacare’s requirement that most private insurance plans cover the drugs. A federal appeals court has temporarily put that decision on hold and temporarily resumed coverage of those services.

Mermin declined to comment directly on the case but said he is concerned about any situation that makes it harder for people to seek HIV prevention services.

President Joe Biden has asked Congress to allocate $850 million to support efforts to end the US HIV epidemic, a 48% increase from 2023 levels. Biden’s request includes $237 million for a national PrEP program.

According to the CDC, preventing HIV infection is made even more difficult by the fact that about one in eight people who are infected with the virus do not know they are infected.

By 2025, health authorities are aiming for 95% of people diagnosed with HIV to have had their viral load reduced to undetectable levels with effective treatment. According to the CDC, people who have been diagnosed with HIV and whose virus is suppressed can lead healthy lives and do not transmit the virus to their sexual partners.

Overall, 66% of people diagnosed with HIV in 2021 had suppressed the virus through treatment, but racial disparities remain.

While 72% of whites diagnosed with HIV were virally suppressed, 62% of blacks and 64% of Hispanics diagnosed with HIV were virally suppressed.

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