PrEP is helping bring down HIV infections – but a major hurdle still remains

The CDC says the HIV transmission rate among gay and bi men is continuing to fall in the US, thanks largely to drugs like PrEP and the science of U=U (Undetectable=Untransmittable). However, persistent health inequalities across the country are slowing progress.

There were 32,000 HIV diagnoses in the US in 2021, which represents a 12% drop from 2017. The figure was even more startling in young gay men. Those aged between 13 and 24 showed a 34% reduction in transmission rates.

The 2021 figure was an increase on 2020. However, experts think the 2020 figures were likely impacted by the Covid pandemic. They suggest some of those who might otherwise have been diagnosed in 2020 didn’t get tested until 2021.

However, there was a glaring disparity in the figures. Black and Hispanic gay men are far less likely to be prescribed PrEP.

Only 11% of Black people who could benefit from PrEP were prescribed it, compared with 20% of Hispanic people and 78% of White people.

The CDC notes, “The greatest improvement was in the number of people taking PrEP to prevent HIV. In 2021, about 30% of the 1.2 million people who could benefit from PrEP were prescribed it—a notable improvement compared to about 13% prescribed PrEP in 2017.”

Of the new HIV diagnoses in 2021, 40% were in Black/African American communities, 29% in Hispanic communities, and 20% in white communities. Multiracial, Asian and indigenous populations made up the remaining 6%.

Southern States accounted for 52% of all new HIV diagnoses.

“Expand progress from some groups to all groups”

Commenting on the figures, CDC Director Rochelle P. Walensky said, “Our nation’s HIV prevention efforts continue to move in the right direction.

“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.”

Walensky’s words were echoed by Robyn Neblett Fanfair, Acting Director of CDC’s Division of HIV Prevention.

“At least three people in the U.S. get HIV every hour—at a time when we have more effective prevention and treatment options than ever before,” she said. “These tools must reach deep into communities and be delivered faster to expand progress from some groups to all groups.”

The CDC estimates that around 1 in eight people with HIV are still unaware. It urges people to get tested and know their status.

Calls for more funding

“It appears that our investments in HIV prevention are providing some positive results, but the persistent high number of new diagnoses and the low usage of PrEP among the communities most impacted by HIV point to the need for increased resources, particularly for a national PrEP program,” commented Carl Schmid, executive director of the HIV+Hepatitis Policy Institute in a statement about the new figures.

“Both Presidents Trump and Biden have put forth initiatives to end HIV with calls for increased funding for testing, treatment, and prevention, including for PrEP. However, it is necessary for Congress to commit to the investments as well.”