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Tremendous Progress Made in HIV, but Serious Disparities Remain

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Douglas M. Brooks, MSW

Summary: Data released at this year’s CROI meeting demonstrates need for continued focus and action.

This week, I’m in Boston for the annual Conference on Retroviruses and Opportunistic Infections (CROI). It’s one of the premier scientific meetings where we hear the latest research in HIV prevention and treatment. Last year, for example, researchers presented undeniable evidence that pre-exposure prophylaxis (PrEP) is effective in preventing HIV infection in real-world settings. These findings were a game changer and led to our decision to cite PrEP as one of the four pillars of the National HIV/AIDS Strategy: Updated to 2020 [PDF 2,230 KB]. Just yesterday, researchers highlighted data on the use of a vaginal ring containing PrEP medication, noting that it shows promise for overcoming difficulties with adherence to PrEP.

Today at CROI, our colleagues from the Centers for Disease Control and Prevention (CDC) released new data on viral suppression and new estimates for lifetime risk of HIV diagnosis. The data on viral suppression illustrate solid progress we’ve made over the past years, noting that from 2009 to 2013, the proportion of people receiving HIV care who were virally suppressed increased from 72% to 80%.

For the first time, estimates of lifetime risk of HIV diagnosis were shown by state and risk group. There is some good news and some bad news. The good news is that the analysis found that lifetime risk of HIV diagnosis in the U.S. is now 1 in 99, an improvement from a previous analysis that reported overall risk at 1 in 78.

But, the analysis also underscores the well-known disparities that persist in HIV diagnoses. Without appropriate prevention and intervention efforts, if current HIV diagnosis rates continue, about 1 in 2 Black men who have sex with men (MSM) and 1 in 4 Latino MSM will be diagnosed with HIV during their lifetime.

We do not take these estimates lightly. And the Administration has already taken steps in our HIV prevention and treatment strategies to prioritize Black and Latino MSM. For example, in the last few years, we have:

  • Focused our dollars and efforts on the people, places and practices where the greatest burden exists. For example, starting in 2012, CDC shifted health department prevention funding according to the geographic and demographic characteristics of the epidemic.
  • Focused on PrEP, investing millions to expand access to this powerful HIV prevention tool, and continued to support testing programs, including those focused on young MSM. In fact, CDC devotes more HIV prevention resources to MSM, especially MSM of color, than to any other risk group.
  • Focused on getting people the treatment they need to stay healthy and maximize the benefits of treatment as prevention by eliminating the Ryan White HIV/AIDS Program AIDS Drug Assistance Program waiting lists and continuing to invest in the Ryan White HIV/AIDS Program, administered by the Health Resources and Services Administration. About 45% of the half million clients served by the Ryan White Program are MSM.
  • Implemented the Affordable Care Act, allowing thousands more Americans living with HIV or at high risk for HIV to enroll in quality, affordable coverage.
  • Released our nation’s updated Strategy and its accompanying Federal Action Plan [PDF 773 KB] as a guidepost for the country to become a place where new infections are rare and when they do occur, high quality care is available to everyone. We, the Federal government, have committed to taking nearly 100 distinct steps during 2016 to move toward that point, and many of those actions focus on the populations that face the highest burden of HIV.

The estimates released today are indeed concerning. Our mandate to engage, educate, and care for (and keep in care!) the people most at risk, including Black Americans, Latino Americans, and people living in southern states, is even more pronounced today. HIV does not have to be a death sentence anymore, and we have the tools to stop this epidemic in its tracks and to turn the tide of these recent projections.

President Obama has said that ending the scourge of this disease is within our grasp. It absolutely is. To do so, we must focus on the right people, the right places and the right practices [PDF 604 KB]. It will take all of us utilizing the tools we have in the most effective way possible. We need to redouble our efforts and keep a laser focus, especially on those experiencing disparities. But, improving statistics like those released today transcends race, location, and sector. While scientific progress gives us tremendous new tools each year, our collective work [PDF 617 KB] to bring them to the people who need them continues. And it will take each of us—each state, each community and each neighborhood—to get there.