HIV infections continued to slow nationwide in 2021, CDC reports

The pace of new HIV infections in the U.S. continued to slow in 2021, the Centers for Disease Control and Prevention said in a new annual report Tuesday, suggesting trends that had already begun to dip before the COVID-19 pandemic are continuing to improve in its wake. 

Around 32,100 Americans were newly infected by HIV — the virus that causes AIDS — in 2021, the CDC estimated, dropping 12% from about 36,500 infections in 2017.

The figures come from the agency’s National HIV Surveillance System, which analyzes data collected from local health departments on routine testing.

After years of stalled progress in combating the epidemic, officials had hailed signs of a slowdown in annual HIV infections for 2019. But HIV testing then dropped sharply in 2020 amid the first year of COVID-19, raising concerns of missed diagnoses that need to be caught up.

“The ongoing impact of the pandemic on HIV testing, diagnoses, and treatment has varied by jurisdiction, with some recovering more slowly than others. In 2021, some jurisdictions’ levels of HIV testing, diagnoses, and treatment remained below pre-COVID–19 levels,” the CDC said in its report.

Behind the decrease

The agency estimates that the decline was driven largely by a slowdown in new infections of young gay and bisexual males. Some 6,100 teens and young adults, ages 13 to 24 years old, were infected in 2021. That is down from 9,300 in 2017.

Within this group, HIV infections also declined across multiple racial and ethnic groups. However, annual estimates of infections were still larger among Black and Hispanic young gay and bisexual males in 2021 compared to their White peers.

“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,” Dr. Jonathan Mermin, head of CDC’s National Center for HIV, Viral Hepatitis, STD and TB Prevention, said in a statement.

Rates of new HIV infections remain highest among Americans ages 25 to 34 years old, followed by those 35 to 44 years old. Both groups did not see large enough changes from 2017 to reach a statistically significant difference. 

Among all ages examined in the report, the rate of new infections declined among Black people but still remained far higher than those seen in Latino, White or Asian people. 

“In 2021, Black/African American persons made up approximately 12% of the population of the United States but accounted for 40% of new HIV infections. White persons made up 61% of the population of the United States but accounted for 26% of new HIV infections,” the report’s authors said.

Gaps in care and prevention

A separate CDC report released Tuesday looked at trends in care for people living with HIV, analyzed from a range of databases, which show progress is continuing to fall short of federal goals. 

Close to 1 in 5 Americans newly diagnosed with HIV are not linked to further medical care for their infection within a month of their results. 

Among those living with HIV at the end of 2021, more than a third did not have viral suppression, meaning they are not getting treatment to reach undetectable levels of virus in their body.

An estimated 1.2 million Americans are also in one of the risk groups the CDC says could benefit from pre-exposure prophylaxis, or PrEP, drugs to head off catching HIV from sex or injecting drugs. Of them, only 30% are being prescribed PrEP.

This is more than double the levels recorded in 2017, when only around 13% of people who might benefit from PrEP had received prescriptions, but well below the 50% target authorities set out for 2025.

Gaps in prescriptions are also continuing to persist by race and ethnicity. An estimated 11% of Black people and 20% of Latino people who could benefit from PrEP were prescribed the drugs, compared to 78% of White people.

“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,” Dr. Robyn Neblett Fanfair, acting head of the CDC’s Division of HIV Prevention, said in a statement.