Kevin Fenton, MD, PhD National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention August 5, 2008

1. Update on the US HIV/AIDS Crisis: Current Trends, Future Challenges Kevin Fenton, MD, PhD National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention August 5, 2008 XVII International AIDS Conference

2. Overview • The HIV epidemic in the United States • HIV Incidence • HIV Prevalence • Implications for HIV Prevention • Summary

3.  The HIV epidemic in the United States

4. Historical Context • Earlier estimates of HIV incidence were based on indirect methods • 40,000 – 80,000 in 1987-1992 (Rosenberg, 1995) • 40,000 new HIV infections (Karon, 2001)

5. New methods for HIV incidence • Stratified Extrapolation Approach • Based on surveillance information, standard HIV testing, and new HIV testing technology • Used STARHS approach to distinguish recent from long-standing infections • Applied to a sample of newly HIV diagnosed individuals from 22 states in 2006 • Extended back calculation approach • Enabled a retrospective view of the evolution of HIV incidence since 1977 • Incorporates AIDS, HIV and HIV testing data from routine surveillance Hall et al. JAMA. Vol 300, No5. 2008

6. In 2006, an estimated 56,300 (95%CI 48,200-64,500) new HIV infections occurred in the United States.* * Data from the Stratified Extrapolation Approach

7. Estimated percentage of new HIV Infections, by Sex, 2006 N=56,300 Women 27% Men,73% *50 States and District of Columbia

8. Estimated number of new HIV infections, by sex, 1977-2006* *50 States and District of Columbia Total Males Females

9. Estimated percentage of new HIV Infections, by Transmission Category, 2006* N=56,300 Heterosexual contact,31% Men who have sex with men, 53% Men who have sex with men and inject drugs, 4% Injection drug users, 12% *50 States and District of Columbia

10. Estimated number of new HIV infections by transmission category, 1977-2006 *50 States and District of Columbia MSM IDU HET

11. Estimated percentage of new HIV Infections, by Race/Ethnicity, 2006* Asian/Pacific Islander, 2% American Indian/Alaska Native, 1% Hispanic 17% White35% Black45% N=56,300 *50 States and District of Columbia

12. Estimated rates of new HIV Infections, 2006* Total Male: 34.3 per 100,000 Total female: 11.9 per 100,000 *50 States and District of Columbia

13. Estimated number of new HIV infections, by race/ethnicity, 1977-2006* *50 States and District of Columbia White Black Hisp.

14. Estimated number of new HIV infections, by race/ethnicity, 1977-2006* A/PI AI/AN *50 States and District of Columbia

15. Estimated percentage of new HIV Infections, by Age, 2006* 50-99, 10% N=56,300 13-29 13-29, 34% 40-49, 25% 30-39, 31% *50 States and District of Columbia

16. Estimated rates of new HIV Infections, by age, 2006* *50 States and District of Columbia

17. Prevalent HIV infections • Number HIV infected 1,039,000 – 1,185,000 • Number unaware of their HIV infection252,000 - 312,000 (24%-27%) Source: Glynn M, Rhodes P. 2005 HIV Prevention Conference

18. HIV Infection in the United States Household Population Aged 18–49 Years: 1999–2006 Mexican American* NH Black1 NH white 40-49 years2 30-39 years 18-29 years Female Male3 All Note: Nationally representative sample of the civilian, non-institutionalized household population. Source: CDC, NCHS, National Health and Nutrition Examination Survey, 1999-2006.

19. AIDS Diagnoses and Deaths • Cumulative AIDS deaths: 565,000 • 2006 AIDS deaths: 14,000+ • AIDS diagnosis within one year of HIV diagnosis (33 states): 38% Source: CDC. HIV/AIDS Surveillance Report. 2007.

20.  Implications for prevention

21. HIV/AIDS Prevention in the United States: Challenges • One quarter of those with HIV infection undiagnosed • MSM remain at increased HIV risk; new infections increasing • African Americans and Hispanics bear heaviest burden • Limited access to effective prevention • Concern that the availability of effective treatments has led to complacency about HIV risk

22. HIV/AIDS Prevention in the United States: Challenges • HIV/AIDS stigma persists • Changing patterns and distribution of substance abuse (e.g., meth) • Internet as means for meeting partners • Need more culturally competent interventions • Structural factors: poverty, homelessness, racism, homophobia

23. HIV/AIDS Prevention in the United States: CDC Response • Expanding HIV testing • Expanding access to effective programs • Mobilizing at risk communities • Reassessing efforts for MSM, and other hardest hit communities • Conducting research on new interventions

24. HIV/AIDS Prevention in the United States: CDC response • CDC is supportive of calls for a comprehensive national HIV plan. • Critical review of CDC’s HIV prevention portfolio by an independent panel of national experts. • Develop a strategic road map for HIV prevention, with measurable objectives, to 2020.

25. Summary • HIV/AIDS continues to evolve in the US with a high burden among MSM of all races and African Americans, Hispanics. • Major challenges remain in meeting unmet need, increasing coverage of effective prevention interventions, and expanding the cadre of culturally competent interventions. • Renewed commitment to mobilizing communities, HIV testing, intensifying and targeting prevention efforts needed.

26. Thank You National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention www.cdc.gov/nchhstp