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HIV

HIV

Goal

Prevent human immunodeficiency virus (HIV) infection and related illness and death.

Overview

HIV infections in the United States continue to be a major public health crisis. An estimated 1.2 million Americans are living with HIV, and 1 out of 8 people with HIV do not know they have it.1 Although recent data show that annual HIV infections declined 18% in the U.S. from 2008 to 2014, HIV continues to spread.2

In 2010, the White House released a National HIV/AIDS Strategy. The National HIV/AIDS Strategy was updated to 2020 (NHAS 2020) in July 2015. The strategy includes 3 primary goals:

  1. Reducing new HIV infections
  2. Increasing access to care and improving health outcomes for people living with HIV
  3. Reducing HIV-related disparities and health inequities

Why Is HIV Important?

HIV is a preventable disease. Effective HIV prevention interventions have been proven to reduce HIV transmission. People who get tested for HIV and learn that they are infected can make significant behavior changes to improve their health and reduce the risk of transmitting HIV to their sex or drug-using partners. Recent scientific advances have demonstrated that early initiation of antiretroviral therapy (ART) not only preserves the health of people living with HIV but also reduces their risk of transmitting HIV to others by 93%.3

It is estimated that 91% of new HIV infections in the U.S. are transmitted from people not diangosed or diagnosed but not in care.4

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Understanding HIV

In this era of increasingly effective treatments for HIV, people with HIV are living longer, healthier, and more productive lives. Deaths from HIV infection have greatly declined in the United States since the 1990s. As the number of people living with HIV grows, it will be more important than ever to increase national HIV prevention and health care programs.

There are gender, race, and ethnicity disparities in new HIV diagnoses.5

 In 2015:

  • 81% of annual HIV diagnoses occurred in men.
  • More than half occurred in gay and bisexual men, regardless of race or ethnicity.
  • 45% of annual HIV diagnoses occurred in African Americans, 27% in whites, and 24% in Hispanics/Latinos.

Improving access to quality health care for populations disproportionately affected by HIV, such as people of color and gay and bisexual men, is a fundamental public health strategy for HIV prevention. People getting care for HIV can receive:

  • Antiretroviral therapy
  • Screening and treatment for other diseases (such as sexually transmitted infections)
  • HIV prevention interventions
  • Mental health services
  • Other health services

Emerging Issues in HIV

As the number of people living with HIV increases and more people become aware of their HIV status, prevention strategies that are targeted specifically toward HIV-infected people are becoming more important. Prevention work with people living with HIV focuses on:

  • Linking to and staying in HIV medical care, starting treatment, and getting virally suppressed
  • Increasing the availability of ongoing HIV prevention interventions
  • Providing prevention services for their partners

It is also important to foster wider availability of comprehensive services for people living with HIV and their partners through partnerships among health departments, community-based organizations, and health care and social service providers.

Public perception in the United States about the seriousness of HIV has declined in recent years. There is evidence that risky behaviors may be increasing among uninfected people, especially gay and bisexual men. Pre-exposure prophylaxis (also known as PrEP) is a way to prevent becoming infected with HIV by taking a pill. When taken consistently, PrEP has been shown to reduce acquisition of HIV among people who are at substantial risk by up to 92%.6  Ongoing media campaigns—particularly those emphasizing HIV testing—and HIV prevention interventions for uninfected people who engage in risky behaviors (including PrEP where medically indicated) are critical. Efforts to diagnose people infected with HIV, get them virally suppressed, and provide prevention and support services are also vital.

References

1Centers for Disease Control and Prevention. HIV in the United States: At A Glance. Available from: https://www.cdc.gov/hiv/statistics/overview/ataglance.html

2Centers for Disease Control and Prevention. CDC Fact Sheet HIV Incidence: Estimated Annual Infections in the U.S., 2008-2014, Overall and by Transmission Route. February 2017. Available from: https://www.cdc.gov/nchhstp/newsroom/docs/factsheets/hiv-incidence-fact-sheet_508.pdf

3Cohen M, Chen Y, McCauley M, et al. Antiretroviral Therapy for the prevention of HIV-1 Transmission. NEJM. 2016;375(9):830–9. 

4Skarbinski J, Rosenberg E, Paz-Bailey G, et al. Human Immunodeficiency Virus Transmission at Each Step of the Care Continuum in the United States. JAMA Intern Med. 2015 Apr;175(4):588–96.

5Centers for Disease Control and Prevention. HIV Surveillance Report, 2015; vol. 27. http://www.cdc.gov/hiv/library/reports/hiv-surveillance.html. Published November 2016. Accessed 04/07/2017.

6U.S. Public Health Service. Pre-exposure prophylaxis for the prevention of HIV infection in the United States – 2014: A clinical practice guideline [Internet]. Atlanta (GA): Centers for Disease Control and Prevention; 2014. Available from: http://www.cdc.gov/hiv/pdf/guidelines/PrEPguidelines2014.pdf

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