Dear Colleague: May 27, 2021

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

May 27, 2021

Dear Colleague,

Today, the Centers for Disease Control and Prevention (CDC) published three new reports using HIV surveillance data: Estimated HIV Incidence and Prevalence in the United States, 2015–2019 pdf icon[PDF – 3 MB]; Monitoring Selected National HIV Prevention and Care Objectives by Using HIV Surveillance Data—United States and 6 Dependent Areas, 2019; and Diagnoses of HIV Infection in the United States and Dependent Areas, 2019. To improve data interpretation and utility, these reports all feature data from the same timeframe: 2015-2019. HIV prevention partners can use these reports to monitor trends, determine successes, identify gaps in HIV prevention, and help direct prevention efforts and resource allocation.

HIV Incidence and Prevalence Report: Key Findings*
CDC estimates of annual HIV infections in the United States show hopeful signs of progress in recent years. CDC estimates show new HIV infections declined 8% from 2015 to 2019, after a period of general stability. Overall, estimated annual infections fell from 37,800 in 2015 to 34,800 in 2019; much of this progress is likely due to larger declines in recent years among young men who have sex with men (MSM). From 2015 to 2019, the number of HIV infections among MSM decreased 9% overall and infections among young MSM aged 13-24 years declined 33% overall, with declines in young MSM of all races, although young Black/African American and Hispanic/Latino MSM continue to be severely and disproportionately affected. In terms of overall race/ethnicity, while HIV infections were somewhat lower in 2019 among African American, Hispanic/Latino, and white persons than in 2015, none of these declines were statistically significant—but, together, they contributed to an overall national-level decline. The South also continues to be disproportionately affected, accounting for more than half of new HIV infections in 2019. The number of HIV infections in 2019, compared with 2015, remained stable among persons who inject drugs (PWID), due likely in part to the ongoing opioid crisis. Finally, the estimated percentage of diagnosed infections among persons living with HIV at year-end 2019, compared with 2015, increased 2%. At year-end 2019, an estimated 1.2 million persons aged 13 years and older were living with HIV infection, including about 13% of persons whose infection had not been diagnosed.

Monitoring Report: Key Findings**
Data suggest the progress seen in recent years is likely linked to increased uptake of key prevention and treatment strategies in recent years, such as pre-exposure prophylaxis (PrEP) and ongoing treatment and care, which are necessary to maintain viral suppression. These trends are encouraging although substantial gaps remain. Data on PrEP coverage published today show that in 2019, nearly 285,000 or 23% of people eligible for PrEP were prescribed it. This level of PrEP coverage represents substantial progress. CDC previously reported that in 2015, roughly 3% of persons eligible for PrEP were prescribed it. In addition, in 2019, 66% of people with diagnosed HIV were virally suppressed (in 45 U.S. jurisdictions)—in 2015, only 60% were virally suppressed (in 38 U.S. jurisdictions). New CDC data also show that in 2019, 81% of people with diagnosed HIV were rapidly linked to care within one month of diagnosis (in 45 U.S. jurisdictions). This is important because it can shorten the time to viral suppression, which helps people stay healthy and virtually eliminates the chance of onward transmission. In 2015, only 75% of people with diagnosed HIV were rapidly linked to care (in 38 U.S. jurisdictions). These data are encouraging. However, the nation will need to achieve 50% PrEP coverage and 95% rapid linkage to care and viral suppression to reach the goals outlined in the Ending the HIV Epidemic in the U.S. (EHE) initiative.

Addressing continued disparities will also be crucial, as data show that HIV prevention and treatment services are still not reaching the groups who could benefit most. Black/African American persons continue to face rates of infection that are more than 8 times as high as white persons, and Hispanic/Latino persons face rates almost 4 times as high, in large part because these populations experience the greatest barriers to accessing prevention and care services. For example, in 2019, only 8% of Black/African American and 14% of Hispanic/Latino persons who were eligible for PrEP were prescribed it, compared to 63% of white persons. Additionally, in 2019, just 61% of Black/African American and 65% of Hispanic/Latino persons with diagnosed HIV were virally suppressed, compared to 71% of white persons.

HIV Surveillance Report—Diagnoses: Key Findings***
In 2019, 36,801 persons received a diagnosis of HIV infection; from 2015-2019, HIV diagnoses decreased by 9% in the United States and 6 dependent areas. Specifically, the number of HIV diagnoses decreased among males and females; Black/African American, white, and Asian persons; multiracial persons; persons aged 13-24 years, 35-44 years, and 45-54 years; heterosexuals; and among MSM overall. HIV diagnoses increased among transgender males and females, white transgender persons, and transgender persons aged 25-34 years and 35-44 years. HIV diagnoses also increased among American Indian/Alaska Native persons; MSM aged 30-34 years, 55-59 years, and 60-64 years; and PWID overall, with notable increases occurring among white PWID, likely due to concentrated HIV outbreaks among this group associated with the opioid crisis. Diagnoses remained stable among persons aged 25-35 years; persons aged 55 years and over; Hispanic/Latino persons; Native Hawaiian/other Pacific Island persons; and among MSM who inject drugs.

Overall, these reports suggest improvements in linkage to care, viral suppression, and increased PrEP use are likely contributing to recent progress. However, the reports also signal an urgent need to expand and improve HIV prevention, care, and treatment for groups who could most benefit. Intensified efforts are particularly needed in the South and among disproportionately affected populations like transgender persons, Black/African American and Hispanic/Latino MSM, and gay and bisexual men, overall. We must also work to improve access to prevention services for people who inject drugs, a population for whom progress continues to be threatened by the nation’s opioid epidemic. Through the EHE initiative, CDC is working with partners to accelerate progress by delivering key prevention strategies in innovative ways to populations hardest hit by HIV—for example, by expanding the use of telemedicine and HIV self-test kits. Ensuring that health equity is centered in all the work we do and expanding innovative approaches that optimize health and close gaps in HIV prevention, care, and treatment will position us for future success in the post-pandemic landscape.

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

Sincerely,

/Demetre Daskalakis/

Demetre Daskalakis, MD, MPH
Director
Division of HIV/AIDS Prevention
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
Centers for Disease Control and Prevention
www.cdc.gov/hiv

*Due to reporting delays, estimates for 2019 are likely the most unstable and should be interpreted with caution.

**Please use caution when interpreting PrEP data. Different data sources were used in the numerator and denominator to calculate PrEP coverage. Please also note that it is difficult to assess progress in PrEP, linkage to care, and viral suppression from year-to-year due to differences between years in the number of jurisdictions with complete data reporting.

***The increase in diagnoses among transgender persons overall is partly attributed to the increase among white transgender persons. Although the population size is small, diagnoses among white transgender persons increased 123% (from 43 in 2015 to 96 in 2019).