Decline in HIV Infections Among Young People Contributes to Overall Decrease

Annual new HIV infections have dropped by 12% overall and by 34% among young people between 2017 and 2021, according to a CDC press release.

The CDC published new data indicating a decrease in annual new HIV infections in 2021 compared with 2017. The estimated number of overall infections dropped from about 36,500 to about 32,100, representing a 12% decline. According to the report, this decrease can be attributed to a significant 34% reduction in new HIV infections among younger individuals aged 13 to 24 years.

Among the younger age group, annual HIV infections decreased from 9300 in 2017 to 6100 in 2021. This decline was particularly seen among young gay and bisexual men who have sex with men (MSM), who account for approximately 80% of new HIV infections in this age group. The number of infections among young MSM decreased from an estimated 7400 to about 4900 between the 2 years.

In 2021, about two-thirds of new overall HIV infections occurred among MSM. By age group, the majority of new infections were reported among individuals aged 25 to 34 years (~9100), followed by younger MSM aged 13 to 24 years (~4900), and then slightly older MSM aged 35 to 44 years (~4000).

Although progress has been made, there is still a need for increased investments, innovation, and a focus on equity to effectively combat the HIV epidemic and achieve national goals.

“Our nation’s HIV prevention efforts continue to move in the right direction,” said Rochelle P. Walensky, MD, MPH, director of the CDC. “Longstanding factors, such as systemic inequities, social and economic marginalization and residential segregation, however, stand between highly effective HIV treatment and prevention and people who could benefit from them. Efforts must be accelerated and strengthened for progress to reach all groups faster and equitably.”

Data indicate that increased availability and utilization of HIV testing, treatment, and pre-exposure prophylaxis (PrEP) have played a role in the advancement of HIV prevention among young MSM.

“In prevention, patience is not a virtue,” said Jonathan Mermin, MD, MPH, 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. But ending the HIV epidemic and achieving equity requires we expand this progress to all.”

It is also important to note that declines in annual HIV infections among young MSM were not evenly distributed across all racial and ethnic groups. Decreases were less significant among young Black or African American and Hispanic or Latino MSM compared with their White counterparts, indicating existing disparities that hinder HIV prevention and treatment efforts.

Among key HIV prevention indicators, the greatest improvement was seen in the number of people taking PrEP to prevent HIV. In 2021, about 30% of 1.2 million individuals who could benefit from PrEP were prescribed it, marking a notable improvement compared with about 13% prescribed PrEP in 2017. However, even though most people who could benefit from PrEP are Black, Hispanic, or Latino, estimates suggest less than a quarter of people in these racial and ethnic groups who could benefit from PrEP were actually prescribed it.

The CDC noted that additional data on PrEP prescriptions by race and ethnicity are limited, and these findings are estimated.

Significant progress was also made in reducing perinatal HIV between 2010 and 2019, with a continued decline in 2021. The rate of perinatal HIV cases per 100,000 live births decreased to 0.6 in 2021, down from 1.9 cases per 100,000 live births in 2010.

There were also slight increases in other key prevention measures, but they were not sufficient to meet national goals. In 2021, a higher percentage of people with HIV were aware of their status, although this percentage only jumped from 86% in 2017 to 87% in 2021.

Additionally, the proportion of people with an HIV diagnosis who achieved viral suppression through effective treatment slightly increased from 63% to 66%. However, viral suppression rates remained lower among Black, Hispanic, and Latino individuals compared with White individuals.

The persistence of deeply rooted social determinants of health contributes to these disparities. In 2021, most new HIV infections were among MSM, with a significant portion occurring among Black and Hispanic or Latino individuals. Additionally, about a fifth of new HIV infections were among women, with over half of those cases affecting Black women.

“At least 3 people in the US get HIV every hour—at a time when we have more effective prevention and treatment options than ever before," said Robyn Neblett Fanfair, MD, MPH, acting director of the CDC’s Division of HIV Prevention. “These tools must reach deep into communities and be delivered faster to expand progress from some groups to all groups.”

More than half (52%) of new HIV infections in 2021 were concentrated in the South, which also saw a decline of 12% in overall estimated new infections compared with 2017. However, the rates in 2021 are still high and vary by region, with 16,700 new cases in the South, 6600 in the West, 4400 in the Northeast, and 4400 in the Midwest.

To successfully end the HIV epidemic, the CDC highlighted a few main actions:

• Increased investments in proven HIV prevention programs through the Ending the HIV Epidemic in the US initiative
• Expansion of HIV self-testing and the inclusion of various settings to increase access to HIV services, such as sexually transmitted infection clinics
• Prioritization of equity as a central aspect of all HIV prevention interventions to ensure effective reach among disproportionately affected populations

“Tools to end the HIV epidemic in the US are available now, but our nation will not succeed until they equitably reach the people who need them to stay healthy,” the CDC report said.