People unaware of their human immunodeficiency virus (HIV) infection contribute nearly one third of ongoing transmissions in the United States. Among the estimated 1.2 million persons living with HIV in the United States in 2011, 14% had undiagnosed infections. To accelerate progress toward reducing undiagnosed HIV infection, the CDC and its partners have pursued an approach that includes expanding HIV testing in communities with high HIV infection rates.
HIV diagnosis is the essential first step in the HIV care continuum. Diagnosis allows persons to receive care and treatment to reduce viral load, increase immune function, and thereby reduce risk for transmission, morbidity, and mortality. Persons who are aware of their infection can also make behavioral changes to reduce transmission. The CDC recommends that adolescents and adults be tested for HIV infection at least once and persons at increased risk for HIV infection (including men who have sex with men and persons who inject drugs) be tested at least annually. Decreases in undiagnosed HIV infection in recent years might be attributable to intensified testing efforts. Evidence suggests that the percentage of persons ever tested for HIV infection has increased and the time from infection to diagnosis has decreased.
In 42 jurisdictions with numerically stable estimates, HIV prevalence in 2012 ranged from 110 per 100,000 persons (Iowa) to 3,936 per 100,000 (DC). The percentage of persons living with HIV who have received a diagnosis of HIV infection varied by jurisdiction. At the end of 2012, five jurisdictions (Colorado, Connecticut, Delaware, Hawaii, and New York) met the National HIV/AIDS Strategy objective to increase the percentage of persons living with HIV who know their serostatus to at least 90%, a critical component of the strategy to meet the goal of reducing new HIV infections in the United States.
In 2013, the percentage of newly identified HIV-positive persons varied widely among sites in health care settings (e.g., STD clinics [0.8%] compared with other sites [0.2%–0.5%]). In non–health care settings, HIV counseling and testing sites conducted the most HIV testing and identified the largest number of new positives (3,860), for a positivity percentage of 1.0%.
To achieve the National HIV/AIDS Strategy's objective to increase the percentage of persons living with HIV who know their serostatus to at least 90% of those living with HIV, sustained efforts are needed to fully implement routine HIV testing. The percentage of persons with undiagnosed HIV varies by geographic area, and efforts tailored to each area's unique needs and situations will be needed to increase the percentage of persons aware of their infection.
As part of its effort to provide HIV testing to those at high risk in order to increase the proportion of people who are aware of their HIV status, the CDC has awarded $216 million over five years to 90 community-based organizations (CBOs) nationwide. The awards are to help CBOs deliver effective HIV prevention strategies to those at greatest risk, including people of color, men who have sex with men, transgender individuals, and people who inject drugs.
“Community-based organizations have been vital to our nation’s HIV prevention efforts since the earliest days of the epidemic,” said Jonathan Mermin, M.D., director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and Tuberculosis Prevention. “The organizations we’re funding have a strong foothold in the hardest-hit communities. They have the credibility and experience needed to deliver the most effective HIV prevention strategies to those who need them most.”
CBOs will use the new funding to deliver high-impact HIV prevention strategies, including:
- Providing HIV testing to those at high risk to increase the proportion of people who are aware of their HIV status
- Engaging HIV-positive people in ongoing care and treatment, helping them adhere to antiretroviral therapy, and ensuring they receive prevention and support services
- Ensuring high-risk, HIV-negative individuals have access to prevention and support services such as pre-exposure prophylaxis, post-exposure prophylaxis, high-impact behavioral interventions, and screening for sexually transmitted infections
- Distributing condoms to HIV-positive and high-risk, HIV-negative individuals
“It’s clear that we need to focus our limited resources on strategies that can have the greatest possible impact,” said Eugene McCray, M.D., director of the CDC’s Division of HIV/AIDS Prevention. “This funding targets local communities to help maximize the impact of every federal prevention dollar. By delivering powerful prevention tools where they’re needed most, we can have a transformative impact on the epidemic.”
The funded organizations are in the 50 geographic areas that reported the highest number of HIV diagnoses in 2011. Each organization has demonstrated experience and expertise working with the populations most affected by the epidemic. Of the 90 directly-funded CBOs, 67 (74.4 percent) primarily serve African Americans and 15 (16.7 percent) primarily serve Hispanics; 64 (71.1 percent) primarily serve men who have sex with men.
Moving forward, the CDC will provide technical assistance and support – directly and through funding for its capacity-building partners – to help ensure funded CBOs are successful in meeting key goals associated with the funding, such as increasing HIV testing among those at-risk and increasing the number of people with HIV who are linked to medical care. Funded CBOs will be required to monitor program impact and behavioral outcomes.
“Birmingham AIDS Outreach has been working since 1985 to reverse the devastating impact of HIV in our community – and now, with this new funding from the CDC, we can do even more, along with our community partners AIDS Alabama and the Aletheia House,” said Karen Musgrove, executive director of Birmingham AIDS Outreach. “We’re grateful for and excited about the opportunity to invest in delivering the cutting edge of HIV prevention to those who need it most across the state of Alabama.”
Nationally, the CDC’s approach to HIV prevention primarily focuses on:
- Identifying undiagnosed HIV infections through increased testing
- Ensuring that people with HIV receive ongoing care and treatment to improve their health and reduce transmission to others
- Ensuring those at highest risk for HIV have the knowledge and tools needed to protect themselves
See the CDC Announcement
See the CDC Report on Prevalence of Diagnosed and Undiagnosed HIV Infection
See the CDC Report on Identifying New Positives and Linkage to HIV Medical Care