Only a quarter of all Americans with HIV have their virus under control, and African Americans and younger people are least likely to receive ongoing care and effective treatment, according to an analysis by the Centers for Disease Control and Prevention.
CDC researchers said the study is the first national look at the proportion of HIV-infected Americans — by race/ethnicity, age, risk group and gender — who have a suppressed viral load.
Using data from CDC surveillance systems, researchers examined the proportion of HIV-infected individuals in various subgroups who are engaged at each stage of care: testing, linkage to care, remaining in care, prescribed treatment and having a suppressed viral load.
“Despite progress, most people living with HIV in America today are not getting the treatment they need for their health and to protect their partners,” CDC Director Thomas R. Frieden, MD, MPH, said in a news release. “Although this is especially the case among African Americans and younger people, well under half of the people in every group who need treatment are receiving it. We need to change this reality so that far more people living with HIV are able to stay healthy and reduce their chance of spreading the virus to others.”
Few Americans with HIV have their virus under control, with only 25% attaining viral suppression, according to the study.
By race/ethnicity, African Americans are least likely to be in ongoing care and to have their virus under control. Only 34% of African Americans were in ongoing care, compared with 37% of Latinos and 38% of whites. And 21% of African-Americans were virally suppressed, compared with 30% of whites and 26% of Latinos.
By age, younger Americans are less likely to be in ongoing care and successfully treated, with HIV care and viral suppression generally improving with age. For example, 15% of those ages 25 to 34 were virally suppressed, compared with 36% of those ages 55 to 64. In terms of ongoing care, 28% of those ages 25 to 34 were retained in care, compared with 46% of those ages 55 to 64.
By risk, although there were some variations across each stage of care, viral suppression was low across all groups. There were no notable differences based on gender.
Research suggests that many of the same social and environmental factors that fuel racial disparities in HIV infection also contribute to gaps in treatment and care, the researchers noted. These gaps include poverty, stigma and poor access to healthcare. Researchers believe a combination of factors likely contributes to the disparities in HIV diagnosis among younger Americans, including lower rates of HIV testing and a reduced sense of urgency about the need for care among those who are positive.
“We know that testing and effective treatment offer powerful tools for HIV prevention, but to realize the full potential of using treatment as prevention, we must first overcome barriers to reaching those at greatest risk,” said Kevin Fenton, MD, director of the CDCs National Center for HIV/AIDS, Viral Hepatitis, STD and Tuberculosis Prevention.
“Increasing HIV testing, strengthening care for all people with HIV and reducing these disparities in treatment are critical to achieving the goal of an AIDS-free generation in America.”
To reduce the impact of HIV in the United States, the CDC calls for improvements at each stage of the process, beginning with expanding HIV testing to identify the more than 200,000 Americans living with HIV who do not know they have it, a group representing nearly one in five of all people with the infection. In addition, ensuring that people have access to care, stay in care and remain on treatment will increase the proportion of HIV-infected people who achieve and maintain viral suppression, which is critical to improve health and fully realize the potential prevention benefits of treatment, the researchers said.
The study was presented July 27 by CDC epidemiologist Irene Hall, PhD, at the XIX International AIDS Conference in Washington, D.C. More information is available in a CDC fact sheet at http://1.usa.gov/LS7mRj (PDF format).