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HIV diagnoses plummet in a decade in the US

But infection rates rising fast among young men who have sex with men

Louise Prime

Tuesday, 22 July 2014

Rates of HIV diagnosis have plummeted by a third over the past decade in the US, it has emerged. But researchers warn in JAMA’s theme issue on HIV and AIDS this week that among men who have sex with men – and especially in adolescent and younger men – rates of infection with the human immunodeficiency virus have risen dramatically. They call for much greater effort to combat the risk of new infection in this group.

US researchers analysed Centers for Disease Control data, collected through its National HIV Surveillance System, to look for trends in new diagnoses of HIV among different groups of people from 2002 to 2011.

During that time, 493,372 people (aged at least 13 years) were newly diagnosed with HIV across the whole of the US. The overall rate of annual diagnosis fell by almost a third (33.2%) over the decade, from 24.1 per 100,000 population in 2002 to 16.1 per 100,000 in 2011.

The rate of new diagnoses fell significantly in nearly all population groups, except for Asians or Native Hawaiians/other Pacific Islanders, in whom it was unchanged; declines were particularly marked among women overall, people aged 35-44 years and people of mixed race. The number of HIV infections attributed to use of injected drugs and to heterosexual contact also fell.

However, rates of HIV infection attributed to male-male sexual contact generally remained stable, and fell only among 35-44 year olds. Rates rose among men aged 13-24, 45-54 and ≥55 – especially in the 13-24-year-old group, in whom they rose by 132%.

Authors of the research letter* pointed out that the temporal trends they report, as well as the variation between groups, might reflect earlier changes in HIV incidence, because of delays in diagnosis. They wrote: “The HIV testing services were expanded during the analysis period and early outcomes of testing initiatives often indicate increases in diagnoses until some level of testing saturation occurs. Our study found overall decreases in annual diagnosis rates despite the implementation of testing initiatives during the period of analysis.”

Nevertheless, they called for measures to address rising infection rates among those men at greatest risk. They concluded: “Among men who have sex with men, unprotected risk behaviours in the presence of high prevalence and unsuppressed viral load may continue to drive HIV transmission. Disparities in rates of HIV among young men who have sex with men present prevention challenges and warrant expanded efforts.”

* Johnson A S, et al. Trends in Diagnoses of HIV Infection in the United States, 2002-2011. JAMA. 2014;312(4):432-434. doi:10.1001/jama.2014.8534.

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