New HIV infection rates drop thanks to progress in young people, but US still not on track

The rate of new HIV infections in the U.S. dropped dramatically between 2017 and 2021, according to new data released by the Centers for Disease Control and Prevention (CDC) on Tuesday, with much of this advancement owed to significant declines among young people.

Annual new HIV infections fell 12 percent over that period, from about 36,500 to 32,100. According to CDC officials, this downward trend was consistent across the four intervening years.

The CDC said a large part of this came from a 34 percent decrease in new infections among people ages 13 to 24. In this demographic, new annual infections fell from 9,300 to 6,100 in the four years that were observed. 

These inroads were credited to improvements in HIV testing and treatments, as well as preexposure prophylaxis (PrEP). Among young people, knowledge of their HIV status and the number of prescriptions for PrEP all rose by more than 10 percent. When it came to young people who were HIV positive, the rate of those who were virally suppressed also rose by 8 percent.

“In prevention, patience is not a virtue,” said Jonathan Mermin, director of the CDC’s National Center for HIV, Viral Hepatitis, STD, and TB Prevention.

“Decreasing HIV incidence among youth, including young gay and bisexual males, shows us what is possible,” Mermin said. “But ending the HIV epidemic and achieving equity requires we expand this progress to all.”  

As of 2021, an estimated 1.2 million people in the U.S. have HIV, of which about 87 percent are believed to have received a diagnosis, meaning about 1 in 8 is unaware they are HIV positive.

Regionally, 52 percent of new HIV infections in 2021 came from the South, but it was also the only region in the U.S. that saw a significant decline in cases.

Officials acknowledged in a press call on Tuesday that despite the progress that’s been made, the U.S. is still not on track to meet its goals for the HIV epidemic. The federal Ending the HIV Epidemic in the U.S. initiative aims to reduce new HIV infections in the U.S. by 90 percent from 2017 by 2030.

“These numbers show that progress is possible, but we are not on track to meet the goals of ending the HIV epidemic if we continue at this rate,” Mermin said. He encouraged people to get tested by finding a location at gettested.cdc.gov, as an “essential step” in HIV prevention and care.

The agency also noted in its data that improvements were not equitable across all demographics.

Declines in estimated new infections among young people were smaller among Black and Hispanic males who were gay and bisexual — 27 and 36 percent respectively — when compared to their white counterparts, who saw nearly half the rate of new infections with a decrease of 45 percent.

“It appears that our investments in HIV prevention are providing some positive results, but the persistent high number of new diagnoses and the low usage of PrEP among the communities most impacted by HIV point to the need for increased resources, particularly for a national PrEP program,” Carl Schmid, executive director of the HIV+Hepatitis Policy Institute, said in a statement.

The CDC said this data suggests “HIV prevention and treatment are not reaching everyone in this group equitably — and reflecting broader disparities that hinder HIV prevention.”

In the press call Tuesday, CDC officials said the agency is planning a campaign focused on reaching Black and Latino men who are gay or bisexual and live in the South to “help increase awareness and access to PrEP.”

Overall, 78 percent of white people who could benefit from PrEP were prescribed the medicine in 2021, compared to 11 percent of Black people who could benefit, 20 percent of Hispanic/Latino people and 12 percent from other ethnicities.

“Deeply entrenched social determinants of health continue to drive these disparities and their outcomes,” the CDC said. “Most new HIV infections in 2021 were among gay and bisexual men, the majority of whom were Black or Hispanic/Latino. About one-fifth of new HIV infections in 2021 were among women, and over half of those were among Black women.”