As the Trump administration's goal to end the HIV epidemic in the United States by 2030 rolls out, a new report reveals that a decline in HIV infections has plateaued. Between 2010 and 2013, HIV incidence in the United States significantly decreased, but between 2013 and 2016, incidence remained steady -- with about 38,700 new infections nationwide in 2016, according to the report released by the US Centers for Disease Control and Prevention on Wednesday.
The report comes as new efforts are underway to eliminate HIV transmissions nationwide. In President Donald Trump's State of the Union address this month, he announced an initiative aimed at reducing new HIV infections in the United States by 75% in the next five years and by 90% in the next 10 years. HIV, or human immunodeficiency virus, can lead to acquired immunodeficiency syndrome or AIDS if left untreated.
"In recent years, we have made remarkable progress in the fight against HIV and AIDS. Scientific breakthroughs have brought a once-distant dream within reach," Trump said in the address. "My budget will ask Democrats and Republicans to make the needed commitment to eliminate the HIV epidemic in the United States within 10 years. Together, we will defeat AIDS in America."
The latest trends in America's HIV epidemic
The new CDC report includes data from the 50 states and the District of Columbia between 2010 and 2016, the year with the most recently available data.
The data suggests that the annual number of HIV infections in 2016, compared with 2010, was higher among adults age 25 to 34 but decreased among people 13 to 24 and those 45 to 54. The annual number of infections in 2016, compared with 2010, was stable among adults 35 to 44 and 55 or older, according to the report. The data also suggests that the annual number of HIV infections in 2016 decreased from 2010 among women but remained stable among men. In 2016, the rate of HIV infection for men was 4.7 times the rate for women, according to the report.
In 2016, the highest percentages of HIV infections -- 68.2% overall -- were attributed to male-to-male sexual contact, the report said. Between 2010 and 2016, among men who have sex with men, HIV infections decreased in white men, remained stable among black men, and increased in Latino men, according to the report. Regionally, the annual number of HIV infections in 2016 dropped from 2010 levels in the Northeast but remained stable in the Midwest, South and West. In 2016, rates of HIV infection were 19.3 per 100,000 people in the South; 12.8 per 100,000 in the Northeast; 12.8 per 100,000 in the West; and 8.2 per 100,00 in the Midwest, according to the report. Overall in 2016, an estimated 1,140,400 people age 13 and older were living with HIV infection in the United States, including 162,500, or 14.2%, whose infection had not been diagnosed, according to the report.
What's needed to end the epidemic
"The new data confirms that progress in reducing HIV infections in the United States has stalled," said Heather Bradley, an assistant professor of epidemiology and biostatistics at Georgia State University's School of Public Health, who was not involved in the report but who has conducted research on HIV surveillance.
To reduce infections, more people living with HIV need to be diagnosed, and those diagnosed need to be in care and treated with viral suppression medications, according to a paper published last week in the journal AIDS and Behavior.
The paper involved using CDC data from 2010 to 2015 to project trends in the HIV epidemic that could occur between 2019 and 2030 under three scenarios: No changes happen; or 95% of those targets for diagnosis, care and viral suppression are met by 2025; or 95% of those targets are met by 2030.
"What we found is that, if we could achieve those targets by 2025 -- so that's just six years from now -- plus avert an additional 20% of infections by targeted interventions for people at risk for HIV -- for example, increasing pre-exposure prophylaxis coverage -- we may be able to achieve up to a 67% decrease in new HIV infections in the next 10 years," said Bradley, who was first author of that paper.
Although that could be achieved, she added that it would require a lot of government resources.
"The administration's goal for 2030 is a 90% reduction in incidence; our paper suggests, at most, a 67% reduction can be achieved with currently available HIV prevention tools scaled up to levels never before seen in the US HIV epidemic," Bradley said.
"We are greatly in need of a national strategy with achievable goals for reducing new infections, but a strategy doesn't work without substantial resources and political commitment behind it," she said. "To achieve meaningful reductions in HIV diagnoses, we've got to see an injection of resources that are commensurate with the goals we have."
Trump's plan to end America's HIV epidemic will fund programs in geographic hot spots of HIV infections, data to identify and track the spread of HIV, and the creation of local efforts in targeted areas to expand HIV prevention and treatment. However, the exact costs of the program have not been confirmed.
"Now is the time for our Nation to take bold action," CDC Director Dr. Robert Redfield said in a statement Wednesday. "We strongly support President Trump's plan to end the HIV epidemic in America," he said. "We must move beyond the status quo to end the HIV epidemic in America."
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