New HIV cases are slowing, but there are clear racial and geographic disparities
AYESHA RASCOE, HOST:
The U.S. is making progress in controlling the HIV epidemic. New cases are slowing down, according to a report released this week by the Centers for Disease Control and Prevention. It's encouraging news, but the numbers also show that not everyone is benefiting from those improvements. NPR's Will Stone joins us now to explain. Hi, Will.
WILL STONE, BYLINE: Hi there.
RASCOE: Let's start with the good news. How big of an improvement are we talking about here?
STONE: Well, the CDC found that new cases of HIV were 12% lower in 2021 as compared to 2017. So that's a real and meaningful step in the right direction. And it's primarily because infections fell substantially in young people. There was actually a 34% decrease in cases among teenagers and those in their early 20s. And here we're primarily talking about gay and bisexual men, who account for the majority of new cases in this age group and more broadly in the U.S.
RASCOE: And do we have a sense of why that is?
STONE: There are a number of factors. The biggest, though, is clearly PrEP, and that's the medication you take to prevent HIV infections. The percentage of people who would benefit from PrEP and are being prescribed it more than doubled since 2017. I spoke to Patrick Sullivan, who's an epidemiologist at Emory University.
PATRICK SULLIVAN: We now have a generation of younger gay and bisexual men who've really grown up and become sexually active at a time when PrEP was available. The one thing that I think we still have to really pay attention to in the data that were just released - it wasn't really realized evenly across the racial and ethnic groups.
STONE: And that last point is really the other side of this seemingly positive news - that some long-entrenched disparities actually appear to be growing.
RASCOE: So what are we seeing along those lines?
STONE: It's pretty stark in this new data. If you look at white people, it's estimated close to 80% who would benefit from PrEP are being prescribed it. But for those who are Hispanic and Latino, that number drops down to 21%, and it's only 11% among Black people. So it's really not a surprise that new HIV infections are disproportionately affecting these groups. You also see disparities play out geographically.
RASCOE: So you're saying that some parts of the U.S. are being more affected by HIV than others?
STONE: That's right. At this point, actually, more than half of new infections are happening in the South. I spoke to Will Ramirez about this. He's with the Southern AIDS Coalition.
WILL RAMIREZ: Raising awareness that PrEP exists does not automatically trigger demand and use. There's still things that they have to contend with, especially here in the South - anti-HIV sentiment, anti-gay stigma. And then many people who are eligible for PrEP - they don't access it.
STONE: Ramirez says one clear barrier is simply not having health coverage. Many states in the South haven't expanded Medicaid. They don't necessarily have programs that cover the cost of labs and visits. And on top of that, you need to find a doctor who's willing to prescribe the drug.
RASCOE: What does this mean looking forward? Didn't the U.S. set a goal of reducing new HIV infections by 90% by the end of this decade?
STONE: Well, it's not going to achieve that if these big gaps remain, especially when it comes to PrEP. Nina Harawa is a professor of medicine and epidemiology at UCLA, and she points out that prevention efforts can't only focus on gay and bisexual men. About one-fifth of new cases of HIV affect women. There's also more outreach that can be done for people who inject drugs and are at risk. And Harawa believes that improving access to PrEP, while still very important, can't be the only solution here.
NINA HARAWA: Concern people have about taking a medication when they're not sick - I think some of that is cultural. And I'm somewhat concerned that the HIV prevention strategy has been so shaped around PrEP because I think that kind of resistance to taking something when you're not sick is stronger among people of color.
STONE: Which is why she thinks there also needs to be attention to other forms of prevention, like condom use, early testing, and ultimately to the root causes that contribute to the racial disparities in HIV.
RASCOE: NPR's Will Stone, thank you so much for joining us.
STONE: Thank you.
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