Public Health

HIV infections decline but most at-risk people don’t get PrEP

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New HIV infections declined modestly in the US over a four-year period but the nation is far from reaching its goal of ending the epidemic, according to the most recent data published by the Centers for Disease Control and Prevention on Tuesday.

The overwhelming majority of people who face a high risk from the virus are not receiving key medications to prevent infection due to deep racial disparities in access to treatment, according to the CDC report.

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Infections declined 12% from 36,500 in 2017 to about 32,100 in 2021, the report said. The decline was driven by a 34% drop in new HIV infections among 13- to 24-year-olds, according to the data.

The US has set a national goal to end the HIV epidemic by reducing new infections 90% by 2030.

But the nation is not on track to meet that goal if progress continues at the current pace, Dr. Jonathan Mermin, head of the CDC’s national center for HIV and STD prevention, told reporters on a call Tuesday.

Gay and bisexual men as well as Black and Hispanic communities face a higher risk of infection due to racism, economic inequality, social marginalization and residential segregation, said Dr. Robyn Neblett Fanfair, a senior official in the CDC’s HIV prevention efforts.

About two-thirds of new HIV infections reported in 2021 were among gay and bisexual men, with members of Black and Hispanic communities making up the overwhelming majority of new cases in this group. About 40% of new infections within the gay community were among Black men and 35% were among Hispanic men, according to the data.

Among heterosexual women, 60% of new infections were among Black women. Among heterosexual men, about 61% of new infections were among Black men, according to the CDC. About 60% of intravenous drug users who were diagnosed with HIV in 2021 were white.

More than half of new infections, 52%, were reported in the South.

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Strong disparities in treatment

Only 30% of the 1.2 million people who faced the highest risk of HIV in 2021 took drugs to prevent infection called pre-exposure prophylaxis, according to the CDC report. That percentage of people taking PrEP increased substantially, however, from 13% of the at-risk population in 2017.

US health officials want to increase the number of people taking PrEP to at least 50% of the at-risk population by 2025, but there are strong racial disparities in treatment that have to be addressed in order to meet that goal.

Only 11% of Black people and 21% of Hispanics who are at risk of HIV infection received PrEP in 2021. By contrast, 78% of white people at risk were taking medication to prevent infection that same year.

The CDC is launching a campaign in the South focused on Black and Hispanic gay and bisexual men in an effort to help close the gap on PrEP coverage, Neblett Fanfair said.

Access to PrEP is threatened by a recent ruling by a federal judge in the US Northern District of Texas that struck down an Obamacare requirement that most private insurance plans cover the medication. A federal appeals court has put that ruling on hold for now and temporarily reinstated coverage of these services.

Mermin declined to comment directly on the case but said he is worried about any situation that makes it harder for people to get HIV prevention services.

President Joe Biden has called on Congress to pass $850 million to support efforts to end the HIV epidemic in the US, a 48% increase over 2023 funding for the effort. Biden’s request includes $237 million for a national PrEP program.

Preventing HIV infection is further complicated by the fact that about 1 in 8 people who have the virus don’t know they’ve been infected, according to the CDC.

Health officials aim by 2025 for 95% of people diagnosed with HIV to have reduced their viral load to undetectable levels through effective treatment. People diagnosed with HIV who are virally suppressed can live healthy lives and won’t transmit the virus to their sex partners, according to the CDC.

Overall, 66% of people in 2021 diagnosed with HIV had suppressed the virus through treatment, but there again remain strong racial disparities.

While 72% of white people diagnosed with HIV were virally suppressed, 62% of Black people and 64% of Hispanics diagnosed with HIV were virally suppressed.

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