CDC Releases HIV Surveillance Report for 2020

Last week, the Centers for Disease Control and Prevention (CDC) released a new HIV surveillance report for 2020: Diagnoses of HIV Infection in the United States and Dependent Areas, 2020 and a new HIV supplemental surveillance report: Monitoring Selected National HIV Prevention and Care Objectives by Using HIV Surveillance Data, United States and 6 Dependent Areas, 2020. The significance of these particular surveillance reports is that they’re the first ones to be released since the onset of the COVID-19 pandemic. The data supports much of the anecdotal evidence Academy members have been sharing over the past two years.

While these data show a significant decrease in the number of HIV diagnoses in the U.S. in 2020 (17 percent lower than 2019), they also show a significant interruption in testing and care. In fact, the CDC warns against drawing conclusions about trends from these reports, and Dr. Demetre Daskalakis, Director of the Division of HIV/AIDS Prevention said in a press interview, “I don’t want to say that 2020 was a lost year, but really, parts of it were.”

The CDC attributes much of this drop in recorded infections to declines in testing caused by less frequent visits to health centers, reduced outreach services and shifting of public health staff to COVID-19 response activities.  Many Academy members experienced this first-hand. These disruptions in clinical care services, patient hesitancy in accessing clinical services, shortages in HIV testing reagents and materials, shifting of partner services staff to COVID-19 activities and disruptions in services provided by community-based organizations in 2020 is what CDC attributes to an underdiagnosis of HIV in the U.S. Even though many providers, health departments and community-based organizations quickly pivoted to telehealth and self-testing, CDC has stated these strategies still did not make up for declines in laboratory-based HIV testing. Further, the HIV surveillance supplemental report Estimated HIV Incidence and Prevalence in the U.S., which provides data on estimated incidence, prevalence, and knowledge of status in the U.S., was not published this year because the CDC has deemed any estimation of incidence, prevalence and knowledge of status unreliable.

With all those caveats about data reliability, here are some key datapoints from the reports:

• HIV diagnosis percentages and rates were highest among gay, bisexual, and other men who have sex with men
• highest among persons aged 25–34 years
• Black/African American persons,
• and persons residing in the South

Nearly half (47 percent) of diagnoses among persons who inject drugs were among White persons and occurred in the South (44 percent). In 46 U.S. jurisdictions with complete reporting of laboratory results, approximately 82 percent of people with HIV diagnosed during 2020 were linked to care within one month of diagnosis, and among all persons with diagnosed HIV in the areas, 65 percent had viral suppression.

Data on PrEP coverage show that in 2020, 25 percent of people eligible for PrEP received a prescription. However, Black/African American persons and males who inject drugs had the lowest percentages.

Those furthest from the Ending the HIV Epidemic in the U.S. Initiative (EHE) target goals of 95 percent:

• linkage to care: Black/African American persons – 80 percent; males who inject drugs – 78 percent
• viral suppression: Black/African American persons – 60 percent; males who inject drugs – 52 percent

Those furthest from the EHE target goal of 50 percent for PrEP coverage:

• Black/African American persons – nine percent

Essentially, even if these data are somewhat unreliable for trend purposes, they certainly tell us that an aggressive ramp-up in all EHE activities is necessary to achieve an end to the HIV epidemic. Part of that ramp-up is additional funding, which is precarious during an election year and particularly so when Congressional appropriators already have predicted an austere funding environment. As such, ongoing advocacy is needed, and the Academy will continue its efforts to maximize federal funding for ending the HIV epidemic activities, regardless of the political pressures for austerity.