U.S. HIV Rates Are Dropping. But the Progress Is Not Equal

Health officials from the U.S. Centers for Disease Control and Prevention (CDC) are reporting encouraging news about HIV. From 2017 to 2019, the estimated number of new infections in the U.S. dropped by 12%, from 36,500 to 32,100. The decline appears to be fueled in large part by fewer cases among young gay and bisexual men.

New HIV infections have been declining yearly since 2016 as a result of more widespread testing and increased access to treatments, as well as more education and use of pre-exposure prophylaxis (PrEP) medications, which can protect sexually active people at higher risk from getting infected. Among young gay and bisexual males in the U.S., 56% were aware of their HIV status in 2019, compared to 42% in 2017. And prescriptions for PrEP among sexually active 16 to 24-year olds—the age most at risk for new infections—increased from 8% in 2017 to 20% in 2021.

“The improved reach of testing, treatment, and PrEP is contributing to progress among the young,” said Dr. Jonathan Mermin, director of CDC’s National Center for HIV, Viral Hepatitis, STD [sexually transmitted diseases] and TB [tuberculosis] Prevention, during a briefing. “When evidence-based interventions are implemented, we see results.”

During the briefing, Mermin pointed to specific changes driving the decline in cases, including a collaboration between the CDC and Emory University to make HIV self-testing kits more available. The program hopes to distribute 200,000 tests this year and reach 1 million in five years, and it’s already on track to exceed those goals.

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The positive trends are still not evenly distributed among different racial and ethnic groups, however. Persistent disparities continue to be a challenge in the CDC’s goal of reducing new HIV infections by 90% by 2030. More young gay and bisexual males who are white are accessing treatment and prevention options like PrEP than their Hispanic and Black counterparts; 45% of white men in this group who test positive are getting PrEP or anti-HIV treatments, compared to 27% of Black men and 36% of Hispanic men. The disparities are especially stark when it comes to access to PrEP specifically. Overall, 30% of the estimated 1.2 million Americans who are at highest risk of HIV infections and eligible to get it were taking PrEP—but only 11% of those were Black and 21% were Hispanic, while 78% were white.

The discrepancy extends to other treatments as well. The latest data show that while 66% of HIV-positive people in 2021 controlled their infection with antiviral drugs, compared to 63% in 2017, only 62% of Blacks and 64% of Hispanics kept levels of their virus at undetectable levels, compared to 72% of whites.

“Deeply entrenched social determinants of health continue to affect HIV treatment and prevention outcomes,” said Dr. Robyn Neblett Fanfair, acting director of CDC’s Division of HIV Prevention. “Racism, systemic inequities, social marginalization, and long-standing barriers to care are key drivers to the disproportionate impact HIV has on some communities, including gay and bisexual men, and particularly Black women.”

Neblett Fanfair said the agency is targeting community-based campaigns to the populations and regions of the country with the lowest PrEP uptake, including among Black and Hispanic gay and bisexual men in the south. These campaigns educate people about PrEP by collaborating with local health care providers and clinics that treat sexually transmitted infections. The CDC is also planning to devote more funding to patient hotlines and other services to help communities expand access to HIV prevention and treatments.

While the Affordable Care Act mandated that insurers fully cover PrEP with no copays for those who need it, a recent decision by a Texas judge is jeopardizing that coverage by overturning the mandate and ruling that employers do not need to provide coverage for PrEP. The Biden Administration has appealed that ruling, but if the appeal isn’t successful, it could drive deeper divides between who is able to get the medication and who is not.

“While we are on the right track, progress is not happening quickly enough or equitably among all people or in all areas of the country,” said Mermin. And as encouraging as the declining infections are, the pace of improvement isn’t on track to meet the CDC’s ambitious goal. “We know the way, but does our nation have the will?”