The report suggests that 2020 was a “lost year” in the fight against HIV, thanks to Covid.

Faced with the Covid-19 pandemic, Dr. Anthony Fauci’s ambitious new federal plan to accelerate the fight against the stubborn HIV epidemic in the United States makes a markedly disappointing debut. It seems to have been done.

Annual of Centers for Disease Control and Prevention HIV monitoring reportPublished on Tuesday, the first Major bird’s-eye view On the turn of the country’s 40-year-old epidemic after the coronavirus disrupted society. This report, which includes 2020 data, follows an earlier disturbing finding that HIV testing plummeted in March 2020 as a stay-at-home order swept the country.

CDC officials have expressed concern that the extraordinary disruption that the country’s Covid response has caused to HIV-related services has caused incidental damage that can take years to undo. doing. After decades of severe decline, HIV prevalence across the country may even have risen again.

“We definitely hit from Covid-19,” said CDC director Dr. Demetre Daskalakis. HIV / AIDS Prevention Department.. He called 2020 the “lost year” of the HIV battle. Start of federal plan Called End the HIV epidemic in the United States, Or EHE. “I don’t really know where the HIV infection will reach, but that’s clearly what we’re concerned about,” he added.

Epidemiologists could also exacerbate the severe disparities that have long plagued the country during the HIV epidemic, including those based on race, sexual orientation, gender identity, and region, only in the chaotic Covid era. I’m afraid to have sex.

According to the CDC report, HIV diagnosis decreased by 17% from 2019 to 2020, with a new positive test result of 30,403, after a decrease of only 3% each year since 2016.

Experts say it’s a sign of a sign.

“I think there are far more undiagnosed people than we have in recent years,” he said. Dr. Hansel Tookes, an infectious disease department infectious disease department at the University of Miami Miller School of Medicine. He warned that delays in HIV diagnosis “will, of course, cause an increase in infection.”

According to Touks, people who have recently been infected with HIV tend to have very high viral load, making the virus much more infectious. Conversely, researchers have found that limiting HIV to undetectable levels with antiretroviral therapy not only brings life expectancy closer to normal. Eliminate the risk of sexual transmission of the virus.

According to the HIV Surveillance Report, about 1.1 million people will be diagnosed with HIV in the United States in 2020. Based on 2019 data, the CDC previously estimated that 1.2 million Americans, including those who have not been diagnosed, are infected with HIV. The agency was unable to update that number due to insufficient data for 2020.

A study published at The Lancet in December analyzed data from four major healthcare systems in the United States and compared it to 2019. Weekly HIV test rate During the state’s first Covid-19 home stay in 2020, it was 68% to 97% lower. During the same year with less social restrictions, this rate dropped from 11% to 54%.

Similarly, in recent CDC analysis, HIV testing funded by CDC What was implemented by the national health sector plummeted from 2.3 million to 1.2 million between 2019 and 2020 by almost half.

The plunge, along with other interruptions in clinical service of the virus, jeopardized the accuracy of authorities in assessing the dynamics of the HIV epidemic. As a result, the CDC was unable to issue an annual update estimate for recent transmission rates. Therefore, the true course of the epidemic is likely to remain vague for some time, Daskalakis said, hampering public health authorities’ ability to respond in kind.

Ethan Moitra, the lead author of the Lancet newspaper and a professor of psychiatry and human behavior at Brown University, appears to have remained largely undiminished in promoting HIV transmission, including sexual risk-taking, during the Covid era. Said. The use of substances that can contribute to the spread of HIV is also increasing.

The CDC last month, despite fewer tests Most sexually transmitted diseases rose to record highs in 2020..

The dawn of the new decade was supposed to be a major turning point in the HIV epidemic in the United States. Fauci, a longtime director of the National Institute of Infectious Diseases, and his colleagues at the Ministry of Health and Social Welfare have secured President Donald Trump’s blessing for a significant increase in federal HIV funding.The goal is finally Retreat the virus..

Congress has allocated $ 267 million New fundsHas spread to several federal health agencies to end the HIV epidemic in the 2020 US initiative. CDC’s HIV Prevention InitiativesIn particular, we will increase our budget by 18% from $ 788 million to $ 928 million. The overall EHE allocation has risen to $ 405 million in 2021 and $ 473 million in 2022.

Given the improper timing of the start, the program “clearly got off to a rough start,” Touks said.

Daskalakis said the implementation of the EHE program was a significant compromise given that since 2020, state and local health sectors, and community-based organizations focused on HIV have shifted their focus to the fight against Covid. Said that he did. There was a lot of staff shortages and burnout.

Fauci, who led the country’s Covid response, declined the interview because he hadn’t seen the new CDC report yet.

James Clerenstein, co-founder of the activist group PrEP4AllArgued that the stated goals of the EHE program (reducing new HIV infections by 75% by 2025 and at least 90% by 2030) have always been very ambitious. Achieving such a goal would require unprecedented dramatic changes in the epidemic process, he said. CDC will be available from 2015 to 2019 HIV infection rate has decreased Only 8% from 37,800 to 34,800 new cases.

“The real question about this program was how to achieve one of these goals,” Krelenstein said. “For the past decade, the United States has set unprecedented ambitious goals for the treatment and prevention of HIV, but we rarely achieve them. The current state of failure in the treatment and prevention of HIV. To break through, we need real innovation. ”

The Covid-19 pandemic also seems to have stagnated significant progress in pre-exposure prophylaxis or scaling up the daily prescription drug PrEP. Approved for HIV prevention in 2012.. According to CDC estimates, the proportion of people at high risk for viruses receiving PrEP jumped from 13% to 23% between 2017 and 2019. However, in 2020 it was only 25%.

It’s awkward news for fighting efforts Gay and bisexual male HIV, The majority of PrEP users, accounting for two-thirds of new HIV infections (and perhaps just two percent of the US population). From 2010 to 2019, the number of new HIV-infected persons in this population decreased slightly from 25,100 to 23,100, according to a December CDC report. This was also not statistically significant.

The main reason PrEP hasn’t had a significant impact in the United States is that men with the highest HIV prevalence, namely homosexual and bisexual men, have badly enough medication, despite having about 300,000 users. I’m not using it. Especially people living in the south, About half of new HIV infections occur. Instead, the use of PrEP is largely entrusted to white gay men and bimen, who have long reduced HIV prevalence.

PrEP has proven its potential to succeed at the national level, overseas. Thanks in part to the introduction of PrEP, the number of new HIV-infected gay and bimen in the UK plummeted 71% between 2012 and 2018. HIV prevalence in Australia Demographics show a decrease of about 69% in the 2010s. Even in US cities, such as New York and San Francisco, where the use of PrEP is particularly well-established within the gay community. Rapid decrease in HIV The last 10 years.

Wealthy foreign countries may have made greater progress in controlling infections because of their much more successful efforts to treat HIV to prevent infections.

Percentage of people with HIV Completely suppressed viral load It is approaching 90% in the UK, Australia, Norway, Switzerland and Sweden.new CDC analysis Of the 45 jurisdictions in the United States, the US tax rate in 2020 is estimated to be only 68%, placing the United States near the bottom of the developed world rankings. The advantage is that even in the face of Covid’s pandemic, US figures have risen from 66% in 2019.

The CDC partially stabilizes the apparent relative stability of US virus suppression rates Extensive innovation in delivering healthcare servicesIt helped maintain medical care for people living with HIV in the face of Covid-related limitations, such as the use of telemedicine.

Dr. Kenneth Mayer, director of medical research at Fenway Health in Boston, said the enthusiastic adoption of telemedicine in his clinic over the past two years has been a godsend for HIV-positive patients. Still, he questioned the reliability of the CDC’s 2020 virus suppression levels and estimated that viral load tests had declined nationwide. This suggests that true statistics may be low.

Touks, who cares for a particularly vulnerable HIV population in Miami, has many of his patients quit medical care after Covid’s attack, but has only recently returned and is devastating with a diagnosis that defines multiple AIDS. I reported that I had a serious illness.

Throughout its 40-year history, HIV has exposed and abused social fault lines. Covid’s time seems to have only exacerbated inequality.

“Telemedicine was certainly a big revolution,” Mayer said. “It works well for many people. But the concern is the digital divide. Who doesn’t have a stable broadband internet connection and how are they engaged?”

HIV continues to disproportionately devastate the South, with most state governments in the region Expand access to Medicaid under affordable care.. Overall, the CDC reported that the diagnostic rate in the South was twice that in the Midwest in 2020. Georgia, home of the CDC itself, was awesome HIV diagnosis rate for the year — With a diagnosis of 22 per 100,000, compared to just 12 per 100,000 in Newyork and California.

The virus is also at stake for African-Americans, who have eight times the diagnosis rate of whites, even though 13% of the US population accounted for 42% of diagnoses in 2020.Black gay and bisexual men and transgender women Surprisingly high HIV infection rate..

Daskalakis says that after decades of decline, new HIV cases among people injecting drugs appear to have leveled off in recent years, The opioid epidemic only worsens during the Covid era.. He said the recent outbreak of HIV caused by the sharing of drug needles in West Virginia and Boston was a “coal mine canary.”

Faced with a number of challenges to the fight against HIV in the United States, Carl Schmitt, Managing Director of the HIV + Hepatitis Policy Institute in Washington, wants to see a silver lining.

“It could have been worse,” he said of the findings in the CDC report. “And despite Covid, there are elements that show progress.”

Schmidt said he is looking forward to a future edition of the report that reflects the impact of expanded federal HIV spending.

“I think it shows that we are on the right track.”

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