How do we know our national efforts to fight HIV are working? One of the best measures for answering this question is the annual number of new HIV diagnoses, which provides a proxy for new HIV infections when interpreted along with other data. Preventing new HIV infections is our number one goal.
The National HIV/AIDS Strategy (NHAS) sets our target for reducing the number of new diagnoses by at least 25% to 32,855 or fewer newly diagnosed HIV infections by 2020. The Centers for Disease Control and Prevention's (CDC) Monitoring Report (PDF, 2.31MB) from July 2017 shows us that in 2014 there were 40,873 new HIV diagnoses. This exceeded the 2014 NHAS annual target of 41,068.
As we achieve our goals for HIV prevention, care, and treatment, then new diagnoses should fall, but data must be interpreted with consideration for trends in HIV testing, as changes in testing can lead to changes in diagnosis trends that are not related to trends in new infections. And falling rates of HIV diagnoses is exactly what we've seen. We've been able to change the course of the epidemic because we were able to implement advances in HIV prevention, testing, and treatment that have led to dramatic shifts not only in reducing diagnoses but among many of the other NHAS indicators as well.
In the Monitoring Report, progress for diagnoses is assessed for years that have at least 18 months of reporting delay and are considered final. The most recent year for which data are available only have 6 months of reporting delay so they are considered preliminary and progress is not assessed. As a result, 2014 data are reported as final, and 2015 is reported as preliminary.
The new final data show that from 2010 to 2014, the number of new HIV diagnoses decreased from 43,806 to 40,873. And while the annual target for 2014 (41,068) was met and exceeded, there was a slight increase in the number of new diagnoses from 2013 (40,628) to 2014 (40,873). While a slight increase, other factors such as testing would need to be considered to interpret this finding. Nevertheless, the trend of achieving the annual targets has continued as we head toward 2020.
While subgroup analysis is not available in the Monitoring Report, the Surveillance Report, Diagnoses of HIV Infection in the United States and Dependent Areas, 2015 (PDF, 3.90 MB) provides data for 2014 that show clear disparities among specific populations in America:
- Men make up more than 80% of new HIV diagnoses. Further, men who have sex with men (MSM) make up about 66% of all new diagnoses and 82% of all new diagnoses among men.
- People ages 20-39 years accounted for 60% of all new HIV diagnoses.
- Blacks made up about 44% of new HIV diagnoses while Hispanic/Latinos accounted for 24%.
- People living in the Southern United States made up nearly 50% of all new HIV diagnoses.
As a nation, we have seen reductions in annual newly diagnosed HIV infections both for the country as a whole, and among specific populations and geographic locations, but we've seen only stable rates and even increases in others. Diagnosis data corroborates what we are seeing in incidence data. And recent findings show that while HIV incidence and undiagnosed infection decreased from 2010 to 2014, there are different outcomes across states and regions. Both new HIV diagnoses and incidence are decreasing, but there are disparities.
Both incidence estimates and diagnoses data are important tools for planning and resource allocation, as well as monitoring progress against HIV and the impact of prevention and care programs. Incidence data help us understand trends in HIV transmission for both diagnosed and undiagnosed HIV, and the impact of prevention efforts. Diagnosis data can provide insight on the people who are known to be HIV positive and are in need of service including care and treatment and provide a way to assess whether a program is reaching its goals.
Despite this encouraging decline in new HIV diagnoses, far too many Americans continue to be diagnosed each year. Recent scientific advances make it possible to end new HIV infections and save lives if we act now to get them to the people who need them. In order to meet the 2020 NHAS goal we must emphasize proven, cost-effective and scalable interventions especially in communities experiencing a disproportionate burden of HIV.
Richard Wolitski, Ph.D., is director of the Office of HIV/AIDS and Infectious Disease Policy, U.S. Department of Health and Human Services.
[Note from TheBody.com: This article was originally published by HIV.gov on Sept. 1, 2017. We have cross-posted it with their permission.]