HIV progress lags for gay, bisexual minorities, Southern states

Issue: January 2016

ATLANTA — New cases of HIV infection in the United States dropped 19% from 2005 to 2014 due to continuing declines among several populations, according to data presented at the CDC’s National HIV Prevention Conference. However, the data suggested that gay and bisexual minorities and people residing in the South are disproportionately affected by HIV.

According to the CDC, 1.2 million people in the U.S. have HIV, and 40,000 new infections are diagnosed each year.

HIV trends vary by race, ethnicity

While new infections in white gay and bisexual men decreased by 18%, diagnoses among Hispanic gay and bisexual men steadily increased up to 24% even though HIV testing remained stable in recent years (2010-2014). In addition, new diagnoses increased by 22% in black gay and bisexual men before leveling off in 2010. Further increases were observed in younger black gay and bisexual men aged 13 to 24 years, with an 87% increase between 2005 and 2014. The trend, however, showed a 2% decline since 2010, according to the data.

Jonathan Mermin

“Although we are encouraged by the recent slowing of the epidemic among black gay and bisexual men — especially young men — they continue to face a disproportionately high HIV burden and we must address it,” Jonathan Mermin, MD, director of the CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, said in a press release. “Much more must be done to reduce new infections and to reverse the increases among Latino men. There is hope that the National HIV/AIDS Strategy and other efforts are beginning to pay off, but we can’t rest until we see equal gains for all races and risk groups.”

The overall trend of HIV diagnoses in gay and bisexual men increased nearly 6% from 2005 to 2014. Meanwhile, declining trends were observed in heterosexuals (35% decrease) and injection drug users (63% decrease). The steepest decline was among black women who showed a 42% decrease between 2005 and 2014 with continuing declines in more recent years (25% between 2010 and 2014). Despite this trend, black women continue to be disproportionately affected by HIV and accounted for 60% of diagnoses among women in 2014, according to a press release.

Additional data presented by Eugene McCray, MD, director of the CDC’s Division of HIV/AIDS Prevention, showed rates of HIV testing were stable or increased in populations with reduced HIV diagnoses.

“The recent 5-year trends coincide with the launch of the first National HIV/AIDS Strategy and — now that the investment in high-impact prevention approaches has increased — offer promise for further progress,” McCray said in the release. “We have the tools to stop HIV right now. We urgently need to accelerate access to testing, treatment, and new biomedical prevention strategies so that everyone can protect themselves and their partners.”

Gaps in treatment, testing in South

Findings from a 2012 state-by–state analysis also presented during the plenary speech indicated that HIV-related deaths were three time greater in some Southern states compared with other parts of the country.

Eugene McCray

The national death rate was 19.2 deaths per 1,000 people with HIV and ranged from 7.9 deaths per 1,000 people in Vermont to 30.8 deaths per 1,000 people in Louisiana. Of the 10 states that did not meet the national goal of reducing death rates among patients with HIV to 21.7 per 1,000 people by this year, seven were located in the South.

“It is unacceptable that people with HIV living in many Southern states are more likely to die than those living in other parts of the country,” Mermin said in the release. “Some states are making great strides toward getting people with HIV diagnosed and into care, but every state must do this if we are to reach our national goals for prevention and care.”

People from Southern states also were less likely to know their HIV status. Seventy-seven percent of people in Louisiana were aware of their HIV status vs. 93% of people in New York and Hawaii, according to the data. Overall, 87% of Americans knew their status in 2012.

Along with Hawaii and New York, data indicated that Colorado, Connecticut, and Delaware reached the national goal to increase awareness of HIV status in 90% of people living with HIV. Most (70%) of the lowest percentages were in Southern states, which suggests people in the South were less likely to receive medical care and protect their partners against infection.

McCray said the CDC is responding to this situation by expanding HIV testing in the South, improving access to care and increasing awareness of prevention tools such as condoms, pre-exposure prophylaxis and interventions aimed to reduce risky behavior.