HIV infections in U.S. decline, but fall short of goal

arrow of pills points downward

Annual HIV infections in the United States decreased an estimated 11 percent from 2010 to 2015 and the virus transmission rate fell an estimated 17 percent in the same time frame.

Despite the progress, the decline is still short of goals outlined in the comprehensive National HIV/AIDS Strategy announced by the Obama administration in 2010.

That first NHAS called for a 25 percent reduction by 2015 in HIV incidence, the number of new infections in a year and a 30 percent reduction in the rate of transmission, the average annual number of disease transmissions per 100 people living with HIV.

For a new study in the journal AIDS and Behavior, scientists used mathematical modeling to provide the first estimates of the nation’s progress toward the 2015 targets.

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“The good news is that we appear to have made important strides in the prevention of HIV and the reduction of HIV transmission rates in the United States,” says senior author David Holtgrave, chair of health, behavior and society at Johns Hopkins University Bloomberg School of Public Health. “Unfortunately, these key gains only got us roughly halfway to the 2015 goal line.”

While it is understandable that federal and local resources are limited, there must be more effort to allocate them strategically, with an intensified focus on reaching communities disproportionately affected by HIV, particularly gay men, young people, transgender people, African Americans, Hispanics, and those who live in southern states, Holtgrave says.

“After the release of the first National HIV/AIDS strategy, researchers cautioned that failure to expand diagnostic, prevention and care services to necessary levels would result in underachievement on the NHAS goals for 2015. Our analysis suggests that is just what happened.”

Epidemic may be worsening for some

To evaluate whether the United States achieved the NHAS goals, researchers used mathematical models to estimate HIV incidence and rate of transmission for 2015. Those estimates were used to calculate the net percent change from 2010 to 2015.

Their calculations were based on surveillance data published by the Centers for Disease Control and Prevention on HIV prevalence and mortality for 2007 to 2012, as well as the researchers’ own previously published estimates of HIV incidence for 2008 to 2012. Changes from 2010 through 2012 were extrapolated through 2015.

The results show that in 2015 there were about 33,218 new HIV infections in the United States, down from an estimated 37,366 in 2010—a reduction of 11.1 percent. The HIV transmission rate was estimated at 2.61 in 2015, a reduction of 17.3 percent from the 2010 rate of 3.16.

“Our models indicate that the country’s incremental progress in reducing new HIV infections was not enough to achieve the NHAS targets for 2015,” says study leader Robert Bonacci, a medical student at the Perelman School of Medicine at the University of Pennsylvania.

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“Going forward, as we implement the recently released updated NHAS for 2020, we must take a critical look at the past five years and apply the lessons learned to maximize the impact on our communities most affected by HIV.”

Access to medicine

Advances in antiretroviral therapy have made HIV a manageable chronic condition rather than a fatal disease. In the United States, the average life expectancy for people living with HIV is increasing toward that of the general population.

Yet certain populations—particularly gay men, young people, transgender people, black and Hispanic Americans, and those who live in southern states—continue to be disproportionately affected, and gains have not been spread evenly across all communities. For some, especially gay and other men who have sex with men, the epidemic may be worsening. Additionally, of the 1.2 million people living with HIV in the United States, many lack access to the lifesaving drugs that reduce HIV transmission by lowering the level of virus in the blood.

The Center of Excellence for Diversity in Health Education and Research at the University of Pennsylvania funded the study.

Source: Johns Hopkins University

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