Division of HIVAIDS Prevention Centers for Disease Control and Prevention Burden of HIV in the United States 12 M 50K 12 million people living with HIV Approximately 50000 new infections annually ID: 734612
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Slide1
HIV Prevention:A Winnable Battle
Division of HIV/AIDS Prevention
Centers for Disease Control and PreventionSlide2
Burden of HIV in the United States 1.2 M ~50K
1.2 million people living with HIV Approximately 50,000 new infections annually
87.2% 4 in 10 3 in 1087.2% 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 Slide3
HIV Prevalence, United States, 1985-2012MMWR Morb Mortal Wkly Rep. 2012 Mar 2;61(8):
133-8.CDC
. Monitoring selected national HIV prevention and care objectives by using HIV surveillance data—United States and 6 dependent areas—2013. HIV Surveillance Supplemental Report 2015;20(No. 2).Slide4
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 Slide5
Rates of Diagnoses of HIV Infection among Adults and Adolescents, 2014—United States and 6 Dependent AreasN = 44,609 Total Rate = 16.6
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.Slide6
Stark disparities in HIV and AIDS among different groups95% 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 menIDU = Intravenous drug usersSlide7
Diagnoses of HIV Infection among Adults and Adolescents, by Transmission Category, 2010–2014, United States and 6 Dependent Areas
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 and missing transmission category, but not for incomplete reporting.
a Heterosexual contact with a person known to have, or to be at high risk for, HIV infection. b Includes hemophilia, blood transfusion, perinatal exposure, and risk factor not reported or not identified. Slide8
Diagnoses of HIV Infection among Adults and Adolescents, by Sex and Race/Ethnicity, 2014—United States and 6 Dependent Areas
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. Slide9
HIV prevention worksSaves lives and moneyCollective prevention efforts have led to a dramatic reduction in HIV infections130,000 estimated new HIV infections per year in 1985 40,628 new HIV diagnoses in 2013
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 billionSources: 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 and Farnham
PG, Holtgrave DR, Sansom SL, Hall HI. Medical Costs Averted by HIV Prevention Efforts in the United States, 1991-2006. JAIDS 2010; 54: 565-567.Slide10
What can be done to reduce HIV
infections? Slide11
A National Call for HIV PreventionThe 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 HIVReduce HIV-related health disparitiesSlide12
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 Slide13
HIV Prevention InterventionsHIV testing and linkage to careAntiretroviral therapyAccess to condoms and sterile syringesPrevention programs for people living with HIV and their partnersPrevention programs for people at high risk for HIV infectionSubstance abuse treatmentScreening and treatment for other sexually transmitted infectionsSlide14
HIV Care Continuum Shows Improvements are Needed
National HIV Surveillance
System
:
Estimated number of persons aged ≥13 years living with diagnosed or undiagnosed HIV infection (prevalence) in the United States at the end of 2012. The estimated number of persons with diagnosed HIV infection was calculated as part of the overall prevalence estimate.Medical Monitoring Project: Estimated number of persons aged ≥18 years who received HIV medical care during January to April of 2012, were prescribed ART, or whose most recent VL in the previous year was undetectable or <200 copies/mL—United States and Puerto Rico.
Persons Living with
Diagnosed or Undiagnosed HIV Infection, HIV C
are Continuum Outcomes, 2012 – United States and Puerto RicoSlide15
Testing and DiagnosisWhen people learn they are infected, they take steps to protect their own health and prevent HIV transmission to others.12.8% (156,300) of people with HIV are undiagnosed 87.2% (1,062,100) have been diagnosed with HIVMore likely than undiagnosed to access prevention and treatment
Sources: CDC National HIV Surveillance System and Medical Monitoring Project, 2011.Slide16
Linkage to and Engagement in CareLinkage to care helps ensure people living with HIV receive life-saving medical care and treatment, and helps reduce their risk of transmitting HIV.39% 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.Slide17
Antiretroviral TherapyTreating 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 36% of people living with HIV are prescribed HIV medicinesOf patients in HIV medical care, 94% are prescribed HIV medicinesOnly 30% of people living with HIV have achieved viral suppression
Of patients in HIV medical care, 80% achieve viral suppression
Antiretroviral
drugs (ARVs):
Reduce risk of perinatal transmissionReduce infectiousnessKeep immune systems functioning properlyPrevent opportunistic infections and Slow down the progression of HIV to AIDS Slide18
Access to Condoms and Sterile SyringesIn 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.Slide19
Prevention Programs for People Living with HIV and their PartnersIndividual 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.Slide20
Prevention Programs for High-Risk PopulationsIndividual, 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
.Slide21
Substance Abuse TreatmentEffective substance abuse treatment that helps drug users stop injecting eliminates the risk of HIV transmission through injection drug use.Slide22
STI Screening & Treatment InterventionsMany 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. Slide23
New Powerful Prevention ToolsPre-exposure prophylaxis (PrEP):Allows
HIV-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 riskFederal PrEP Guidelines issued May 2014Non-occupational Post-exposure prophylaxis (nPEP):Involves taking medicines no more than 72 hours (3 days) after you may have been exposed to HIVSlide24
Act Against AIDS™ National Umbrella Program
Provider
Campaigns
Consumer
CampaignsPartnerships & Community Engagement
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 populationsProvide national, credible leadership in HIV preventionSlide25
Raising AwarenessCampaign MaterialsAwareness Day Materials
WebsitesCDC
Info
Weekly Electronic Publications
Conference ExhibitingSlide26
“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