Dear Colleague: May 23, 2023

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Dear Colleagues: Information from CDC's Division of HIV/AIDS Prevention

May 23, 2023

Dear Colleague:

Today, the Centers for Disease Control and Prevention (CDC) published three new HIV surveillance reports:

CDC also published an AtlasPlus update that includes data from these reports. These data can assist HIV prevention partners in focusing prevention efforts, allocating resources, monitoring trends, and determining gaps and successes in HIV prevention.

Estimated HIV Incidence and Prevalence: Key Findings
Overall, the new HIV incidence estimates show signs of hope. Specifically, the estimated number of HIV infections in 2021 (32,100) fell 12% compared with 2017, driven by a considerable decrease (34%) among gay, bisexual, and other men who have sex with men ages 13‒24 years. Data from the other reports suggest that increased reach of HIV testing, pre-exposure prophylaxis (PrEP), and treatment among this group contributed to the decline. There were no increases in HIV incidence for any populations in 2021 compared with 2017. HIV estimates for 2020 and 2021 should be interpreted with caution due to adjustments made to the CD4-based depletion model to account for the impact of COVID-19 on HIV testing and diagnosis in the United States.

Although progress is being made in HIV prevention, many people still lack the prevention and care they need to stay healthy. In 2021, infections attributed to male-to-male sexual contact (MMSC) accounted for 66% of new infections. By age, 39% of new infections were among persons aged 25‒34 years, and infections among Black women accounted for 52% of all new infections among women. It is estimated that 1.2 million persons in the United States were living with diagnosed and undiagnosed HIV at the end of 2021. More people with HIV were aware of their status in 2021 than in 2017, with an uptick from 86% to 87%. Knowledge of status increased among persons aged 13‒24 years, Asian persons, Black/African American persons, Hispanic/Latino persons, persons in the South, and among persons with infections attributed to MMSC. HIV prevention efforts must go further and progress must be faster for gains in reaching populations equitably and for national goals to be reached.

Monitoring Report: Key Findings
In 48 U.S. jurisdictions with complete reporting of laboratory results, approximately 82% of people with HIV diagnosed during 2021 were linked to care within one month of diagnosis. No demographic group or group by transmission category met the 95% EHE target for linkage to care within one month. Asian persons had the highest rate of linkage to care within one month, and Native Hawaiian/other Pacific Islander (NHPI) persons (80%), Black/African American persons (80%), women who inject drugs (77%), and men who inject drugs (74%) had the lowest rates. The portion of people with diagnosed HIV who were virally suppressed due to effective treatment was slightly higher in 2021 than in 2017, up from 63% to 66%; however, data are not directly comparable due to reporting differences. The lowest percentages of viral suppression were among men who inject drugs (53%), Black/African American persons (62%), persons aged 25‒34 years (64%), persons aged 35‒44 years (64%), and women (64%).

Among key HIV prevention indicators, the greatest improvement was in the number of people taking PrEP to prevent HIV. Data on PrEP coverage show that, in 2021, 30% of the 1.2 million persons eligible for PrEP were prescribed it compared to 13% in 2017. PrEP coverage was lowest among Black/African persons (11%), women (12%), and persons aged 16‒24 years (20%).

The U.S. made remarkable strides in eliminating perinatally acquired HIV between 2010 and 2019. In 2021, the downward trend continued with 0.6 cases of perinatally acquired HIV per 100,000 live births, down from the 2010 rate of 1.9 cases per 100,000 live births. Still, the rate among Black/African American persons (3.1) was 5.2 times the overall annual rate in 2021.

HIV Diagnoses: Key Findings
In 2021, in the United States, the percentage of HIV diagnoses was highest among gay, bisexual, and other men who have sex with men (67%), and HIV diagnosis rates were highest among Black/African American persons (34.8), persons aged 25‒34 years (28.8), and people in the South (14.7). White persons accounted for almost half of all HIV diagnoses attributed to injection drug use. Notably, HIV diagnoses increased by 25% among transgender women, decreased 17% among persons aged 13‒24 years, and decreased 10% among Black/African American persons. Over half (52%) of all HIV diagnoses in the United States occurred in the South.

In general, data suggest that progress in reaching our HIV prevention goals continued during the COVID-19 pandemic. However, an estimated 13% of people with HIV do not know their status, and we must continue our work to expand and improve HIV prevention, care, and treatment for groups who could most benefit, including persons residing in the South; transgender persons; Black/African American women; and gay, bisexual, and other men who have sex with men. Our ability to make further progress in stopping HIV transmission hinges on acknowledging and addressing disparities and their drivers, including racism and other social and structural determinants of health.

Overall declines in HIV incidence and increases in diagnosis and entry into care suggest that the expanded reach of HIV testing, PrEP, and treatment efforts have been effective. We have the tools to end the HIV epidemic in the U.S., but our nation will not succeed until they are brought to full scale and equitably reach the people who need them to stay healthy. To achieve our national goal of ending HIV in the United States, we must increase investments in proven HIV prevention programs, expand HIV self-testing, grow and diversify the sites providing HIV services, and center equity in every aspect of our work.

Thank you for your continued support for HIV prevention in the United States.

Sincerely,

/Robyn Fanfair/

Robyn Neblett Fanfair, MD, MPH
Captain, USPHS
Acting Division Director
Division of HIV Prevention
National Center for HIV, Viral Hepatitis, STD, and TB Prevention
Centers for Disease Control and Prevention
www.cdc.gov/hiv

/Jonathan Mermin/

Jonathan H. Mermin, MD, MPH
Rear Admiral and Assistant Surgeon General, USPHS
Director
National Center for HIV, Viral Hepatitis, STD, and TB Prevention
Centers for Disease Control and Prevention
Stay connected: @DrMerminCDC & Connections

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