Kevin Fenton, MD, PhD

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Update on the US HIV/AIDS Crisis Current Trends,
Future Challenges
Kevin Fenton, MD, PhD National Center for
HIV/AIDS, Viral Hepatitis, STD, and TB
Prevention August 5, 2008
XVII International AIDS Conference
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Overview

• The HIV epidemic in the United States
• HIV Incidence
• HIV Prevalence
• Implications for HIV Prevention
• Summary

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The HIV epidemic in the United States
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Historical Context

• Earlier estimates of HIV incidence were based on
  indirect methods
• 40,000 80,000 in 1987-1992 (Rosenberg, 1995)
• 40,000 new HIV infections (Karon, 2001)

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New methods for HIV incidence

• Stratified Extrapolation Approach
• Based on surveillance information, standard HIV
  testing, and new HIV testing technology
• Used STARHS approach to distinguish recent from
  long-standing infections
• Applied to a sample of newly HIV diagnosed
  individuals from 22 states in 2006
• Extended back calculation approach
• Enabled a retrospective view of the evolution of
  HIV incidence since 1977
• Incorporates AIDS, HIV and HIV testing data from
  routine surveillance

Hall et al. JAMA. Vol 300, No5. 2008
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In 2006, an estimated 56,300 (95CI
48,200-64,500) new HIV infections occurred in the
United States.
Data from the Stratified Extrapolation Approach
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Estimated percentage of new HIV Infections, by
Sex, 2006
N56,300
Women 27
Men,73
50 States and District of Columbia
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Estimated number of new HIV infections, by sex,
1977-2006
50 States and District of Columbia
Total
Males
Females
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Estimated percentage of new HIV Infections, by
Transmission Category, 2006
N56,300
Heterosexual contact,31
Men who have sex with men, 53
Men who have sex with men and inject drugs, 4
Injection drug users, 12
50 States and District of Columbia
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Estimated number of new HIV infections by
transmission category, 1977-2006
50 States and District of Columbia
MSM
IDU
HET
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Estimated percentage of new HIV Infections, by
Race/Ethnicity, 2006
Asian/Pacific Islander, 2
American Indian/Alaska Native, 1
Hispanic 17
White35
Black45
N56,300
50 States and District of Columbia
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Estimated rates of new HIV Infections, 2006
Total Male 34.3 per 100,000 Total female 11.9
per 100,000
50 States and District of Columbia
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Estimated number of new HIV infections, by
race/ethnicity, 1977-2006
50 States and District of Columbia
White
Black
Hisp.
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Estimated number of new HIV infections, by
race/ethnicity, 1977-2006
A/PI
AI/AN
50 States and District of Columbia
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Estimated percentage of new HIV Infections, by
Age, 2006
50-99, 10
N56,300
13-29
13-29, 34
40-49, 25
30-39, 31
50 States and District of Columbia
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Estimated rates of new HIV Infections, by age,
2006
50 States and District of Columbia
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Prevalent HIV infections

• Number HIV infected 1,039,000
  1,185,000
• Number unaware of their HIV infection252,000 -
  312,000 (24-27)

Source Glynn M, Rhodes P. 2005 HIV Prevention
Conference
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HIV Infection in the United States Household
Population Aged 1849 Years 19992006
Mexican American
NH Black1
NH white
40-49 years2
30-39 years
18-29 years
Female
Male3
All
Note Nationally representative sample of the
civilian, non-institutionalized household
population. Source CDC, NCHS, National Health
and Nutrition Examination Survey, 1999-2006.
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AIDS Diagnoses and Deaths

• Cumulative AIDS deaths 565,000
• 2006 AIDS deaths 14,000
• AIDS diagnosis within one year of HIV diagnosis
  (33 states) 38

Source CDC. HIV/AIDS Surveillance Report. 2007.
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Implications for prevention
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HIV/AIDS Prevention in the United States
Challenges

• One quarter of those with HIV infection
  undiagnosed
• MSM remain at increased HIV risk new infections
  increasing
• African Americans and Hispanics bear heaviest
  burden
• Limited access to effective prevention
• Concern that the availability of effective
  treatments has led to complacency about HIV risk

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HIV/AIDS Prevention in the United States
Challenges

• HIV/AIDS stigma persists
• Changing patterns and distribution of substance
  abuse (e.g., meth)
• Internet as means for meeting partners
• Need more culturally competent interventions
• Structural factors poverty, homelessness,
  racism, homophobia

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HIV/AIDS Prevention in the United States CDC
Response

• Expanding HIV testing
• Expanding access to effective programs
• Mobilizing at risk communities
• Reassessing efforts for MSM, and other hardest
  hit communities
• Conducting research on new interventions

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HIV/AIDS Prevention in the United States CDC
response

• CDC is supportive of calls for a comprehensive
  national HIV plan.
• Critical review of CDCs HIV prevention portfolio
  by an independent panel of national experts.
• Develop a strategic road map for HIV prevention,
  with measurable objectives, to 2020.

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Summary

• HIV/AIDS continues to evolve in the US with a
  high burden among MSM of all races and African
  Americans, Hispanics.
• Major challenges remain in meeting unmet need,
  increasing coverage of effective prevention
  interventions, and expanding the cadre of
  culturally competent interventions.
• Renewed commitment to mobilizing communities, HIV
  testing, intensifying and targeting prevention
  efforts needed.

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Thank You
National Center for HIV/AIDS, Viral Hepatitis,
STD, and TB Prevention www.cdc.gov/nchhstp