1. Kevin Fenton, MD, PhD National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention August 5, 2008 Update on the US HIV/AIDS Crisis: Current Trends, Future Challenges 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 Men, 73% Women 27% N=56,300 *50 States and District of Columbia

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

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

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

11. Estimated percentage of new HIV Infections, by Race/Ethnicity, 2006* White 35% Black 45% Hispanic 17% American Indian/Alaska Native, 1% Asian/Pacific Islander, 2% 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* White Black Hisp. *50 States and District of Columbia

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* 13-29 13-29, 34% 30-39, 31% 40-49, 25% 50-99, 10% *50 States and District of Columbia N=56,300

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

17. Source: Glynn M, Rhodes P. 2005 HIV Prevention Conference Prevalent HIV infections  Number HIV infected 1,039,000 – 1,185,000  Number unaware of their HIV infection 252,000 - 312,000 (24%-27%)

18. HIV Infection in the United States Household Population Aged 18–49 Years: 1999–2006 Note: Nationally representative sample of the civilian, non-institutionalized household population. Source: CDC, NCHS, National Health and Nutrition Examination Survey, 1999-2006. Female 40-49 years 2 18-29 years 30-39 years All Male 3 NH white NH Black 1 Mexican American *

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