HIV Strategy and Planning

HIV Prevention in the United States

High-Impact Prevention: Saving Lives and Money

In the United States today, nearly 1.2 million people are estimated to be living with HIV, about 50,000 Americans become newly infected each year ¹, and one in five people with HIV is unaware of their infection.

While current prevention efforts have helped to keep the number of new infections stable in recent years, continued growth in the population living with HIV will ultimately lead to more new infections if prevention, care, and treatment efforts are not intensified. To reduce new HIV infections, CDC is investing in proven interventions that will have the greatest possible impact on reducing the spread of HIV in the United States.

This line graph illustrates two HIV statistics from 1981-2009. The first line shows the number of Americans living with HIV, which has increased from less than 200,000 in 1981 to nearly 1.2 million in 2009. The second line shows new HIV infections in the United States, estimated using an incidence surveillance methodology from 2006 to 2009 and back-calculation for earlier years. New HIV infections peaked in 1984 and 1985 approximately 130,000 and are now roughly stable at approximately 50,000.

Populations Most Affected

According to CDC's latest estimates, in 2009, 77 percent of new HIV infections were in men, and from 2006–2009, young men who have sex with men (MSM) were the only risk group in which new HIV infections are increasing. The rate of new HIV diagnoses among MSM in 2009 was at least 44 times that of other men and 40 times that of women. African Americans and Latinos face a disproportionate burden of HIV with the rate of new HIV infections for African Americans eight times and Latinos three times that of white Americans. Racial and ethnic disparities are even more severe among women. Rates of new HIV infections in 2009 were 15 times higher among African American women and four and a half times higher among Hispanic/Latina women than white women. Also, injection drug use remains a risk factor for HIV infection, responsible for 9 percent of new HIV infections in 2009. HIV is also associated with demographic and socioeconomic factors such as income, education, employment, geographic region, and population density.¹

HIV in America: A Winnable Battle

Estimated Return on U.S. Investment in HIV Prevention, 1991–2006

More than 350,000 infections averted²
More than $125 billion in direct medical costs saved³

HIV is a winnable battle. Preventing HIV is a top public health priority with evidence-based, cost-effective solutions that can have a substantial impact on the nation's health. The National HIV/AIDS Strategy released in July 2010 has called for reducing new HIV infections by 25 percent over five years.
The United States has made tremendous progress against HIV/AIDS, preventing hundreds of thousands of new infections and helping people live longer, healthier, more productive lives with effective treatments.²
Although new infections are stable and people with HIV are living longer, greater effort is needed — the growing population of people living with HIV will lead to increases in new HIV infections if current prevention efforts are not intensified. Too many people do not know their HIV status and not enough people are receiving proper prevention, treatment, and care services.

HIV Prevention Saves Lives and Money

HIV prevention saves lives — Major HIV prevention successes include:
- Reducing annual HIV infections from an estimated high of about 130,000 in 1985 to about 50,000 today¹
- Reducing mother-to-child HIV infections from 1,000–2,000 per year in the early 1990s to less than 200 today
- Reducing new infections among injection drug users by 80 percent since the late 1980s
- Increasing the proportion of people who know they have HIV from 75 percent in 2003 to 80 percent in 2008
HIV prevention saves money by averting the high healthcare costs of infection — an estimated $360,000 per lifetime for each person living with HIV. It is estimated that a total of more than $125 billion in direct medical costs has been saved from 1991–2006.³

CDC's Approach: High-Impact Prevention

It is critical to ensure that every HIV prevention dollar is used effectively. That's why CDC devotes its HIV resources to High-Impact Prevention: combinations of scientifically proven, cost-effective, and scalable interventions targeted to the right populations in the right geographic areas.
CDC's High-Impact Prevention approach supports the National HIV/AIDS Strategy, which calls on the nation to intensify HIV prevention efforts in the hardest-hit geographic areas and populations, using the interventions that will have the greatest impact.
As the nation's lead HIV prevention agency, CDC works with other federal agencies, state and local health departments, national organizations, community-based organizations, and the private sector to reduce the spread of HIV in the United States.
We have more proven prevention tools than ever to help stop the spread of HIV. Proven tools include HIV testing and linkage to care; access to condoms and sterile syringes; risk reduction programs for HIV-positive and -negative individuals; antiretroviral therapy for infected individuals to reduce the risk of transmission; and screening and treatment for other sexually transmitted infections.

This line graph includes 3 lines depicting the estimated number of Americans living with over the next ten years. One line depicts the number if HIV incidence remains stable; the second line shows that a 25% reduction in incidence in 10 years would prevent 62,000 infections and save $23 billion in health care costs; the third line shows that a 25% reduction in incidence in 5 years would prevent 109,000 infections and save $42 billion in health care costs.

High-Impact Prevention: Key Components

Use cost-effective interventions
Focus on activities that can be brought to full-scale in the targeted population
Apply the right combination of interventions for the targeted population
Prioritize programs that will have the maximum impact on reducing new HIV infections

Examples of CDC Initiatives to Support High-Impact Prevention
Expanded Testing Initiative $111 million total from FY 2007 – FY 2010 Targeted funding for HIV testing in communities at risk; 2.8 million persons tested for HIV; more than 18,000 persons newly diagnosed; $1.2 billion in direct medical costs averted	Enhanced Comprehensive HIV Prevention Planning $34.8 million anticipated total from FY 2010 – FY 2012 Innovative demonstration projects implementing combination prevention in cities with the highest AIDS burden	Health Department Funding $359 million annually from FY 2012 – FY 2016 (assumes level funding) A new approach to health department funding that better matches prevention dollars to the HIV burden in every jurisdiction, focusing on high-impact interventions

References

¹ Prejean J, Song R, Hernandez A, Ziebell R, Green T, et al. Estimated HIV Incidence in the United States, 2006-2009. PLoS ONE 2011; 6: e17502.2

² Holtgrave DR. Written testimony for the U.S. House of Representatives Committee on Oversight and Government Reform, September 16, 2008.

³ Farnham PG, Holtgrave DR, Sansom SL, Hall HI. Medical Costs Averted by HIV Prevention Efforts in the United States, 1991–2006. JAIDS 2010; 54: 565-67.