HIV Prevention:A Winnable Battle Centers for Disease Control and Prevention
Burden of HIV in the United States 1.2 M ~50K 1.2 million people living with HIV Approximately 50,000 new infections annually 86% 4 in 10 3 in 10 86% of people living with HIV 4 in 10 people living with HIV 3 in 10 people living know their diagnosis are in HIV medical Care with HIV achieved viral suppression
HIV Prevalence and New Infections1980-2011 Number of people living with HIV has grown because incidence is relatively stable and survival has increased Hall HI et al. JAMA 2008 Aug 6;300(5):520-9; Prejean J et al PLoS One 2011;6(8):e17502; MMWR 2012 Mar 2;61(8):133-8
Burden of HIV in the United States Lifetime treatment costs of ~$400,000 ART People living with HIV who start antiretroviral treatment (ART) early are now expected to live at least an additional 39 years
Rates of Diagnoses of HIV Infection among People2011—United States and 6 Dependent AreasN = 50,007 Total Rate = 19.1 9.5 VT 2.3 4.5 • 22.5 14.0 14.2 21.1 16.7 36.4 177.9 NH MA RI CT NJ DE MD DC 2.6 5.2 2.6 8.0 7.2 5.7 3.8 3.0 30.1 9.6 3.4 5.0 14.3 5.1 17.7 12.6 4.3 20.0 9.5 9.6 19.2 6.6 6.2 11.2 16.2 9.4 20.8 17.3 10.7 13.3 10.0 22.0 8.6 25.3 20.9 31.4 24.5 36.6 4.6 Rates per 100,000 population 33.2 American Samoa & Guam Northern Mariana Islands Puerto Rico Republic of Palau U.S. Virgin Islands 6.8 <10.0 10.0 – 19.9 20.0 – 29.9 ≥30.0 0.0 0.0 5.3 28.6 0.0 39.5 Note. Data include persons with a diagnosis of HIV infection regardless of stage of disease at diagnosis. All displayed data have been statistically adjusted to account for reporting delays, but not for incomplete reporting.
Stark disparities in HIV and AIDS among different groups • 95% of people with HIV are men who have sex with men (MSM), African Americans, Latinos, or injection drug users (IDU) • MSM are >40 times more likely to have HIV than other men and women • African American men and women are 8 times more likely than whites to have HIV • Latino men and women are 3 times more likely to have HIV than whites CDC, HIV Surveillance Report,2008. Published June 2010. www.cdc.gov/hiv/surveillance/resources/reports MSM = Men having sex with men IDU = Intravenous drug users
Diagnoses of HIV Infection and Populationby Race/Ethnicity, 2013—United States Note. Data include persons with a diagnosis of HIV infection regardless of stage of disease at diagnosis. All displayed data have been statistically adjusted to account for reporting delays, but not for incomplete reporting. a Hispanics/Latinos can be of any race.
HIV prevention worksSaves lives and money • Collective prevention efforts have led to a dramatic reduction in HIV infections • 130,000 estimated new HIV infections per year in 1985 • 47,500 new HIV infections in 2010 • Conservative estimates are that prevention efforts have: • Averted more than 350,000 HIV infections in the United States • Saved more than $125 billion in medical costs • Reducing incidence by 25% • In 10 years would save 62,000 infections and $23 billion • In 5 years would prevent 109,000 infections and $42 billion Source: Holtgrave DR. Written testimony on HIV/AIDS incidence and prevention for the US House of Representatives Committee on Oversight and Government Reform. September 16, 2008.
The White House released the National HIV/AIDS Strategy (NHAS) on July 13, 2010, as a roadmap for all public and private stake-holders to align their efforts with the following goals: Decrease incidence of HIV Increase access to care and improve health outcomes for people with HIV Reduce HIV-related health disparities A National Call for HIV Prevention
High-Impact Prevention (HIP) To achieve the goals of NHAS, CDC and its partners are pursuing a high-impact prevention (HIP) approach to reduce new HIV infections by • using scientifically proven, cost-effective, and scalable interventions; and • targeting those interventions to the right populations (men having sex with men, African Americans, Hispanics/Latinos, Injection drug Users and Transgender individuals) in the right geographic areas. Available for download at: http://www.cdc.gov/hiv/policies/hip.html
HIV Prevention Interventions • HIV testing and linkage to care • Antiretroviral therapy • Access to condoms and sterile syringes • Prevention programs for people living with HIV and their partners • Prevention programs for people at high risk for HIV infection • Substance abuse treatment • Screening and treatment for other sexually transmitted infections
Testing and Diagnosis When people learn they are infected, they take steps to protect their own health and prevent HIV transmission to others. • 14% (168,000) of people with HIV are undiagnosed • 86% (1,032,000) have been diagnosed with HIV • More likely than undiagnosed to access prevention and treatment Sources: CDC National HIV Surveillance System and Medical Monitoring Project, 2011.
Linkage to and Engagement in Care • Linkage to care helps ensure people living with HIV receive life-saving medical care and treatment, and helps reduce their risk of transmitting HIV. • 40% of people living with HIV have received regular HIV medical care. • Once in medical care, people get HIV medicines and prevention services to help them stay healthy and protect their partners.
Antiretroviral Therapy • Treating people living with HIV early in their infection improves their health, prolongs their lives and dramatically reduces the risk of transmitting the virus to others. • Only 37% of people living with HIV are prescribed HIV medicines • Of patients in HIV medical care, 92% are prescribed HIV medicines • Only 30% of people living with HIV have achieved viral suppression • Of patients in HIV medical care, 76% achieve viral suppression • Antiretroviral drugs (ARVs): • Reduce risk of perinatal transmission • Reduce infectiousness • Keep immune systems functioning properly • Prevent opportunistic infections and • Slow down the progression of HIV to AIDS
Access to Condoms and Sterile Syringes • In order for HIV prevention efforts to work, people who are living with, or at risk for, HIV infection need access to effective prevention tools. • Research shows that increasing the availability of condoms and sterile syringes is associated with reductions in HIV risk.
Prevention Programs for People Living with HIV and their Partners • Individual and small-group interventions reduce risk behaviors among people living with HIV to help ensure they do not transmit the virus to others. • Partner services reduce the spread of HIV by confidentially identifying and notifying partners who may have been unknowingly exposed to HIV, providing them with HIV testing, and linking them to care.
Prevention Programs for High-Risk Populations • Individual, small-group, and community interventions for people who are at high risk of HIV infection can reduce risk behavior and play an important role in many HIV prevention strategies. • Support targeted efforts to prevent new infections in persons who are lesbian, gay, bisexual, transgender (LGBT), and other men who have sex with men (MSM), to ensure they are diagnosed early and remain in care, when infected.
Substance Abuse Treatment • Effective substance abuse treatment that helps drug users stop injecting eliminates the risk of HIV transmission through injection drug use.
STI Screening & Treatment Interventions • Many sexually transmitted infections (STIs) increase an individual's risk of acquiring and transmitting HIV, and STI treatment may reduce HIV viral load. • STI screening and treatment may reduce risk for HIV transmission.
New Powerful Prevention Tools • Pre-exposure prophylaxis (PrEP): • AllowsHIV-uninfected people who are at substantial risk of getting HIV to take a pill daily • Potential Users: sexual partner who has HIV, multiple partners, frequent STDs, or other evidence of high risk • Federal PrEP Guidelines issued May 2014 • Non-occupational Post-exposure prophylaxis (nPEP): • Involves taking medicines no more than 72 hours (3 days) after you may have been exposed to HIV
Act Against AIDS™ National Umbrella Program Partnerships & Community Engagement Provider Campaigns Consumer Campaigns • Increase information-seeking behaviors, knowledge and awareness about HIV • Increase targeted behavior change, including HIV prevention and testing, for high-risk populations and physicians who serve those populations • Provide national, credible leadership in HIV prevention
Raising Awareness • Campaign Materials • Awareness Day Materials • Websites • CDC Info • Weekly Electronic Publications • Conference Exhibiting
“The United States will become a place where new HIV infections are rare and when they do occur, every person, regardless of age, gender, race/ethnicity, sexual orientation, gender identity or socio-economic circumstance, will have unfettered access to high quality, life-extending care, free from stigma and discrimination.” —Vision of the National HIV/AIDS Strategy