The window from HIV infection to diagnosis is closing.
That was the big news released Tuesday in a teleconference with doctors at the Centers for Disease Control about the agency’s latest Vital Signs report.
The estimated median time from infection to diagnosis dropped to three years in 2015 from a high of three years and seven months just four years earlier.
That means 85 percent of the estimated 1.1 million people living with HIV in 2014 knew their HIV status. That’s important because CDC estimates about 40 percent of new infections originate from people who don’t know they have HIV.
Anyone following the epidemic knows that’s encouraging news, but it is of little comfort in the South.
The greatest burden of HIV infection, illness and deaths remains in Southern states like Georgia. That’s been true for years and it hasn’t changed.
Despite having only about one-third of the overall U.S. population, Southern states account for an estimated 44 percent of all people living with an HIV diagnosis, and that’s not all. Eight in 10 states with the highest rates of new HIV diagnoses are in the South, as are the 10 metropolitan statistical areas with the highest rates.
That’s bad any way you look at it, but when it comes to race, particularly black men, it gets even worse, a point explored recently in a five-part AJC series.
In 2014, African-Americans accounted for 54 percent of new HIV diagnoses, and black men who have sex with men comprised 59 percent of all HIV diagnoses among African-Americans in the South. Black women face an equally disproportionate burden of the disease, accounting for 69 percent of all HIV diagnoses among women in the South.
If current diagnosis trends continue, maybe those numbers will begin a downward trend soon, too. We can hope.
“These findings are more encouraging signs that the tide continues to turn on our nation’s HIV epidemic,” said CDC Director Brenda Fitzgerald. “HIV is being diagnosed more quickly, the number of people who have the virus under control is up, and annual infections are down. So while we celebrate our progress, we pledge to work together to end this epidemic forever.”
Nicole Roebuck, executive director of the non-profit AID Atlanta, was unimpressed.
“I’m not sure we should be throwing a ticker tape parade for reducing the time seven months,” she said. “Living undiagnosed with HIV for four years five months is no better in my opinion than living with it for five years undiagnosed.The faster that someone gets diagnosed, the faster we can get them into care and leading a healthy life ”
Still, Roebuck said, the greatest takeaway from the CDC report is that testing works.
The report also supports the need for continued funding for targeted HIV testing, increased funding and access to free HIV testing and increased regularity of HIV testing for everyone, but especially those in targeted, high risk populations, she said.
CDC funding supports more than 3 million tests across the country each year that identify on average more than 12,000 people with HIV who were not previously diagnosed — accounting for one-third of all HIV diagnoses a year in the United States.
“It’s great that those 12,000 individuals have been identified and are hopefully in care, but if you do the math, that’s less than a percent positivity rate,” Roebuck said. “At AID Atlanta, we historically have a 3.5 percent positivity rate. That’s important because it actually shows we are testing the right people. You can test the entire world but you need to be testing the right folk, the people who are at highest risk. So when funding is cut in agencies like AID Atlanta that have a proven record for hitting the right population, testing efforts are compromised.”
In April, despite having just congratulated AID Atlanta for its fight against the epidemic among black gay men, the community hit hardest by HIV/AIDS, the CDC denied the non-profit's request for a half-million in funding. It was the first time in 14 years the CDC denied funding to AID Atlanta.
CDC spokesman Paul Fulton said at the time that community-based organizations like AID Atlanta have been vital to the nation’s HIV prevention efforts and the agency values its partnerships with the organization. But Because of limited funding, he said the CDC had to make some tough choices.
As a result, AID Atlanta had to halt its Evolution program, focused on prevention and testing of black gay and bisexual men, and lay off its four staff members.
In May, AID Atlanta filed suit against the CDC in the United States District Court for the District of Columbia, claiming the federal agency’s decision to defund it threatens the delivery of HIV testing and prevention services to the community most at risk of getting the deadly virus — young, black gay and bisexual men.
The CDC recommends testing all people ages 13-64 for HIV at least once in their lifetime, and people at higher risk for HIV at least annually. Sexually active gay and bisexual men should get tested more frequently — every three to six months.
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Despite the progress that has been made, too few are being tested, said Dr. Jonathan Mermin, director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention.
He cited a multi-city study in which 29 percent of the gay and bisexual men polled had not had an HIV test in the past year. The same study found that seven in 10 people at high risk for HIV who were not tested in the past year saw a health care provider during that time — signaling a missed opportunity to get high-risk individuals tested as frequently as needed.
“Ideally, HIV is diagnosed within months of infection, rather than years later,” said Dr. Eugene McCray, director of CDC’s Division of HIV/AIDS Prevention. “Further increasing regular HIV testing and closing testing, diagnoses and treatment gaps is essential to stopping HIV in our communities.”
If you’re wondering why this is so important, the CDC has your answer. Getting an HIV test is the first step to learning how to reduce the risk of infecting others, starting treatment and getting the virus under control.
People who take HIV medicine as prescribed not only live longer and have healthier lives, they protect their partners from acquiring the HIV virus.
“If you are at risk for HIV, don’t guess,” Mermin said. “Get a test. The benefits are clear. Prompt diagnosis is prevention.”
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