Pandemic disrupted HIV prevention efforts, CDC report says

The COVID-19 pandemic severely hampered HIV testing in the U.S., leading to a significant drop-off in the number of diagnosed infections from 2019 to 2020, according to a new Centers for Disease Control and Prevention (CDC) report.

The agency’s annual HIV Surveillance Report found infections decreased 17 percent in 2020, from 36,940 to 30,635. But rather than good news, the numbers likely show an underdiagnosis because of a decrease in testing. It’s possible the number of infections is actually increasing. 

“Though I would love to be optimistic and say that we saw a decrease in HIV diagnoses because of great progress in HIV prevention, I think it’s more of an artifact of the fact that there were care interruptions, and that people weren’t seeking out testing as frequently,” said Demetre Daskalakis, director of the CDC’s Division of HIV/AIDS Prevention.

The report pointed to disruptions in clinical care services, patient hesitancy in accessing clinical services because of stay-at-home orders and shortages in HIV testing materials.

Although state and local health departments developed innovative strategies for HIV-related testing during the pandemic, like self-tests and telehealth services, “these strategies did not make up for declines in laboratory reporting because self-test results are not routinely reported to health departments or CDC,” the report noted.

Early diagnosis is key, Daskalakis said. If somebody is diagnosed early with HIV, they can start medication soon enough that their immune system stays more intact, and their outcomes tend to be better. Antiretrovirals can also suppress the virus to undetectable levels and prevent it from spreading. 

“So I think that the reality of a delayed diagnosis could mean potentially worse health outcomes for some people, which is why I think catching up to what was lost, now that health care is sort of able to be resilient enough to allow for testing, getting self-testing out there is going to be really important for us to move forward,” Daskalakis said. 

Daskalakis said it’s too soon to assess the full impact of the damage done by the pandemic to the U.S. effort to end the HIV epidemic. The agency discouraged using the 2020 data to draw any conclusions about trends in HIV diagnoses, deaths and prevalence.

The key to moving forward, he said, is the “Ending the HIV Epidemic in the U.S.” initiative.

Launched in 2019, the program aimed to reduce new HIV infections to under 3,000 by 2030. The program’s implementation took a hit in 2020 as community-based organizations and local health departments shifted to prioritize COVID-19, and subsequently dealt with staffing shortages and burnouts. 

Making sure the program is adequately funded will be key in the years ahead 

“I think we also have to think about the fact that these resources need to really be pushed forward so that we can continue to move the needle and do some of the catchup that we need to do to achieve our goals,” Daskalakis said.

“As we normalize COVID more, I think we’ll be in a new place that will be resilient, and be able to move us forward. But I don’t think that the path is really that easy.”