Where Things Stand: HIV in the United States

Vision: Our vision for a national strategy is a concise plan for moving the country forward. Predicated on building on what we are currently doing, it will identify a small number of high payoff action steps that need to be taken to achieve each of the President’s goals. We envision the strategy being a document that provides a roadmap for policymakers and the general public. We anticipate that the strategy will clearly describe the areas that require the most immediate change, the specific action steps that must be taken by the Federal Government and a variety of stakeholders, and specific targets for measuring our progress toward achieving the President’s goals.

 

Reducing New HIV Infections

MORE must be done to ensure that new prevention methods are identified and that prevention resources are more strategically concentrated in specific communities at high risk for HIV infection. Almost half of all Americans know someone living with HIV (43% in 2009) Our national commitment to ending the HIV epidemic, however, cannot be tied only to our own perception of how closely HIV affects us personally. Just as we mobilize the country to support cancer prevention and research whether or not we believe that we are at high risk of cancer, or just as we support investments in public education whether or not we have children, success at fighting HIV calls on all Americans to help us sustain a long-term effort against HIV. While anyone can become infected with HIV,, some Americans are at greater risk than others. This includes gay and bisexual men of all races and ethnicities, Black men and women, Latinos and Latinas, people struggling with addiction, including injection drug users, and people in geographic hot spots, including the United States South and Northeast, as well as Puerto Rico and the U.S. Virgin Islands. By focusing our efforts in communities where HIV is concentrated, we can have the biggest impact in lowering all communities' collective risk of acquiring HIV.

We must also move away from thinking that one approach to HIV prevention will work, whether it is condoms, pills, or information. Instead, we need to develop, evaluate, and implement effective prevention strategies and combinations of approaches including efforts such as expanded HIV testing (since people who know their status are less likely to transmit HIV), education and support to encourage people to reduce risky behaviors, the strategic use of medications and biomedical interventions (which have allowed us, for example, to nearly eliminate HIV transmission to newborns), the development of vaccines and microbicides, and the expansion of evidence-based mental health and substance abuse prevention and treatment programs. It is essential that all Americans have access to a shared base of factual information about HIV. The Strategy also provides an opportunity for working together to advance a public health approach to sexual health that includes HIV prevention as one component. To successfully reduce the number of new HIV infections, there must be a concerted effort by the public and private sectors, including government at all levels, individuals, and communities to:

• Intensify HIV prevention efforts in communities where HIV is most heavily concentrated.
• Expand targeted efforts to prevent HIV infection using a combination of effective, evidence-based approaches.
• Educate all Americans about the threat of HIV and how to prevent it.

Where Things Stand: HIV in the United States

Although the United States has accomplished many successes in fighting HIV, much more needs to be done to curb the epidemic. Research has produced a wealth of information about HIV disease, including a number of critical tools and interventions to diagnose, prevent, and treat HIV infection. HIV transmission rates have been dramatically reduced in the United States and people with HIV are living healthier and more productive lives than ever before. Nevertheless, much more needs to be done. With more than one million Americans living with HIV, there are more people in need of testing, prevention, and treatment services than at any point in history, and ongoing research efforts are needed to find a cure for HIV/AIDS and continue to develop improved prevention tools and effective treatments. The Strategy cannot succeed without continued and sustained progress in biomedical and behavioral research.

 

The challenges we face are sobering:

• Approximately one in five people living with HIV are unaware of their status, placing them at greater risk for spreading the virus to others.
• Roughly three-fourths of HIV/AIDS cases in the United States are among men, the majority of whom are gay and bisexual men.
• One-fourth of Americans living with HIV are women, and the disease disproportionately impacts women of color. The HIV diagnosis rate for Black women is more than 19 times the rate for White women.
• Racial and ethnic minorities are disproportionately represented in the HIV epidemic and die sooner than Whites.
• The South and Northeast, along with Puerto Rico and the U.S. Virgin Islands, are disproportionately impacted by HIV.
• One quarter of new HIV infections occur among adolescents and young adults (ages 13 to 29).
• Twenty-four percent of people living with HIV are 50 or older, and 15% of new HIV/AIDS cases occur among people in this age group.