Dear Colleague Letter: Vital Signs December 2019

Dear Colleague,

Today, the Centers for Disease Control and Prevention (CDC) released a new Vital Signs report on ending HIV transmission in the United States. The findings show that progress in reducing new HIV infections in the United States has stalled in recent years and that too many Americans with HIV are unaware that they have it. The analyses also show too few have the virus under control through effective treatment, and too few are taking pre-exposure prophylaxis or PrEP—a daily pill that prevents HIV.

According to the Vital Signs report:

• About 154,000 people with HIV (14%) don’t know it and need testing so that they can benefit from HIV medicine that allows them to stay healthy; control the virus; and prevent transmitting HIV to others.
• About 37% of those who know they have HIV don’t have the virus under control through effective treatment. Young people and African Americans were least likely to have the virus under control.
• 82% (4 in 5 people) who could benefit from PrEP aren’t getting it. This is especially true for young people and racial/ethnic minorities. PrEP coverage for whites is 4 to 7 times as high as for Latinos and blacks, respectively.

CDC estimates that new HIV infections remained relatively stable, at about 38,000 per year, from 2013 to 2017. To end HIV transmission in the United States, a scale-up of HIV testing, treatment, and prevention is required, in addition to addressing health disparities. The HHS-led Ending the HIV Epidemic initiative, proposed earlier this year, would leverage critical scientific advances by coordinating highly successful federal programs with agency resources. The initiative would substantially increase resources, technology, and expertise where they’re needed most, with the goal of reducing new HIV infections by at least 90% by 2030.

To achieve maximum impact, the initiative would focus first on 50 areas that account for over half of new HIV diagnoses (48 counties; San Juan, Puerto Rico; and Washington, D.C.), and seven states with a substantial rural burden. The initiative would scale up four evidence-based strategies that can end the epidemic:

• Diagnose all people with HIV as early as possible, with a target of diagnosing at least 95% of HIV infections.
• Treat people with HIV rapidly and effectively to reach sustained viral suppression, with a target of at least 95% of people with diagnosed HIV maintaining viral suppression.
• Prevent new HIV transmissions by using proven interventions, including PrEP, syringe services programs (SSPs), and condoms. For PrEP, the target is for at least 50% of people who could benefit from it to receive a prescription.
• Respond quickly to potential HIV outbreaks to get prevention and treatment services to people who need them.

Through the Ending the HIV Epidemic initiative, CDC would work closely with other HHS agencies, local and state governments, communities, and people with or at risk for HIV to coordinate efforts to expand key HIV prevention strategies. The initiative would first focus on geographic areas that are hardest hit by the HIV epidemic to achieve the most impact, then to expand nationwide. For more information about CDC’s role under the proposed initiative, visit: www.cdc.gov/endhiv.

Thank you for your continued hard work and ongoing collaboration. Please visit the Vital Signs website to learn more about how we can stop HIV together and end the HIV epidemic in America. We also encourage you to share these materials with your colleagues.

Sincerely,

/Eugene McCray/

Eugene McCray, MD
Director
Division of HIV/AIDS Prevention
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
Centers for Disease Control and Prevention
www.cdc.gov/hiv

/Jonathan Mermin/

Jonathan H. Mermin, MD, MPH
Rear Admiral and Assistant Surgeon General, USPHS
Director
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
Centers for Disease Control and Prevention
www.cdc.gov/nchhstp