As the Trump administration rolls out its plans to stanch the HIV epidemic in the United States, a federal report released Wednesday shows that the gradual declines in HIV infections witnessed in recent years have stalled.
The number of new HIV infections has held steady at about 39,000 cases each year since 2013, according to the report from the Centers for Disease Control and Prevention, which focused on infections from 2010 to 2016. Before 2013, officials had seen drops in annual case numbers for roughly half a decade.
The new report is consistent with data previously shared by federal health officials, but it comes as the administration embarks on its plan to end the country’s HIV epidemic within a decade. President Trump unveiled that effort earlier this month during the State of the Union.
“Together, we will defeat AIDS in America — and beyond,” Trump said.
The plan specifically aims to cut new HIV infections by 75 percent within five years and by at least 90 percent within a decade. Top federal health officials — including CDC Director Robert Redfield and Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases — have outlined steps that include diagnosing people with the virus as early as possible, starting treatment early to suppress the virus, and protecting people from infections.
Although public health researchers and advocates have been largely welcoming of the initiative, some have said that the administration has an uneven track record on HIV policy. Trump, for example, went a year after firing his HIV/AIDS advisory panel before new members were sworn in, and the administration has also turned back health protections for LGBT Americans.
Men who have sex with men account for about 70 percent of new HIV infections, the new CDC report said. Among men who have sex with men, infections fell 16 percent from 2010 to 2016 for whites, stayed flat for blacks, and increased 30 percent for Latinos.
Other groups facing elevated risks of HIV infection include transgender people and people who inject drugs.
The report also found:
- Rates of HIV infections dropped from 2010 to 2016 for blacks, whites, and people of multiple races, but stayed flat for Asians and Latinos. But overall, blacks had the highest infection rate — 49.6 per 100,000 people — which was almost double the rate for the demographic group at second-highest risk, people of multiple races, which had a rate of 26.9 per 100,000 people.
- In 2016, the rate of infections for men was 23.9 per 100,000 people, but just 5.1 per 100,000 women.
- The Northeast saw a decline in infections from 2010 to 2016, but the Midwest, South, and West all had similar infection rates over the time period.
The CDC estimates that of the roughly 1.1 million people living with HIV in the United States, 15 percent do not know they have the virus. That is why diagnosis and early treatments are key parts of the administration’s new plan: If people know they have the virus, they can start antiretroviral therapies. And if the drugs reduce a person’s viral levels to an undetectable point, that person seems to be unable to spread the virus to another person.
Another element of the new effort focuses on expanding the number of people on pre-exposure prophylaxis, or PrEP — a drug that people who are at higher risk of being exposed to HIV can take to dramatically reduce their chances of contracting the virus. But the CDC has said only about one-fifth of the 1.1 million people who should be taking PrEP do so, in part because of cost and insurance issues and in part because doctors do not always offer it.
The national progress in HIV reduction over the years obscures regional disparities, the persistence of which help explain why the declines have stalled. Cities like San Francisco and New York have aggressively implemented plans similar to the new federal initiative, but such efforts might run into more obstacles in places like the rural South, where stigma and access to care are larger issues.
The federal plan takes geography into account. It is targeting its initial efforts at 48 counties, Washington, D.C., and San Juan, Puerto Rico — places where more than 50 percent of new HIV infections are acquired. The initiative is also focused on seven states with HIV challenges in rural areas: Arkansas, Kentucky, Oklahoma, Missouri, Mississippi, Alabama, and South Carolina.