COMMENTARY

HIV Rates Drop Across US, but Especially in These States

Heather Boerner

Disclosures

August 08, 2017

The rate of new HIV infections either stayed stable or dropped in every state with enough HIV infections to measure, according to recent data from the Centers for Disease Control and Prevention (CDC). In some areas, like Washington, DC; Georgia; Pennsylvania; and Maryland, new infections dropped by as much as 10% per year.

Anna Satcher Johnson, MPH, of the CDC, called the drops both "statistically significant" and "impressive," especially in DC, which had the highest estimated annual drop in HIV incidence, at 10%.

"Whatever they're doing there for testing and linking people to care are probably efforts that can be modeled by other states to make the same advancement in incidence that they have," she said, referring to the DC results in particular. "This is great in terms of state-by-state advancement in preventing HIV."

The test, treat and prevent programs laid out in the National HIV/AIDS Strategy are working.

Getting Granular With Data

The data[1] were released in a late-breaking poster session at the Conference on Retroviruses and Opportunistic Infections (CROI) in February and were companion data to an abstract presented by Sonia Singh, PhD, of CDC, on national trends. Those data showed that HIV rates had dropped by 18% in 6 years.

The state-level data estimated incidence, prevalence, and percentage of the population undiagnosed in 33 states and DC. Year over year, HIV incidence remained essentially unchanged in 28 states, including in states with some of the highest HIV prevalence, such as Florida. In another 15 states, there weren't enough new HIV cases to power the analysis.

But in eight states/districts, the changes were notable and statistically significant: DC, Georgia, Illinois, Maryland, New York, North Carolina, Pennsylvania, and Texas. The model considers the change significant if P<.05.

Table 1. Greatest Estimated Annual Percentage Changes (EAPC) in HIV Incidence, 2014

Jurisdiction EAPC P Value
United States -3.6% <.01
Washington, DC -10% <.01
Maryland -7.5% <.01
Pennsylvania -7.3% <.01
Georgia -6.1% <.01
New York -5.1% <.01
North Carolina -4.9% .01
Illinois -4.3% .03
Texas -2.4% .03

Prevalence of HIV increased in 23 states and nationally, which sounds bad but is actually good news, said Johnson.

"It means that treatment is improving and people are living longer," she said.

Another table in the dataset was also significant: the percentage of people estimated to be living with HIV without knowing it. There again, EAPC dropped by 2.6% nationally and in every state for which there were enough HIV cases to estimate.

And again, some states stood out against others for significant drops in undiagnosed HIV.

Table 2. Greatest EAPC in Undiagnosed HIV, 2014

Jurisdiction EAPC P Value
United States -3.4 <.01
Ohio -0.8 .01
Pennsylvania -7.9% <.01
Georgia -6.1% <.01
Louisiana -5.3% .02
Illinois -5.0% .02
Maryland 04.3% .05
Texas -3.8% <.01
California -2.6% .03

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