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The number of new yearly HIV infections in the U.S. has decreased by 73% since the peak of the HIV/AIDS epidemic during the mid-1980s, the Centers for Disease Control and Prevention estimated in a new report

“Despite the lack of a cure or a vaccine, today’s HIV prevention tools, including HIV testing, prompt and sustained treatment, preexposure prophylaxis, and comprehensive syringe service programs, provide an opportunity to substantially decrease new HIV infections,” the CDC stated. It recommended “intensifying efforts to implement these strategies equitably” to continue reducing transmission, illnesses and deaths.

The estimates were calculated by analyzing data from the National HIV Surveillance System. The CDC study estimated 2.2 million total new HIV infections between 1981 to 2019. Using those numbers, researchers compared trends by sex at birth, race and ethnicity, and transmission category. 

Their analysis showed that male-to-male sexual contact accounted for more than half of infections each year, except for 1988 to 2002 when heterosexual sex was a greater factor. Those who inject drugs saw the largest relative reduction in HIV incidence during the past four decades. And females made up a larger proportion of infections in 2019 than during the epidemic’s peak. 

But despite the substantial decrease in new yearly infections overall, the CDC noted that “disparities continue, and some have worsened over time.”

The study found that different minority groups actually saw increases of new yearly HIV cases during the study period. Despite Black people making up 12% of the U.S. population, they accounted for 41% of new HIV infections in 2019, up from 29% of infections in 1981. Hispanic people also make up an increasing proportion of HIV infections, from the 16% reported in 1981 to 29% in 2019, while they representing 17% of the country’s population. 

Another recent report from the CDC found that about 4 in 10 transgender women surveyed in seven major U.S. cities have HIV. 

Barriers such as poverty, systemic racism and discrimination may be driving such health disparities by affecting access to treatment, testing and prevention services, the study stated. 

“Ending the HIV epidemic requires addressing health disparities,” the CDC said. “Underlying causes for many disparities highlight the importance of social and economic determinants of health.”  

The report also points out how FDA-approved antiviral medication known as preexposure prophylaxis, or PReP, could help prevent even more cases if it were taken more widely by people at risk; PReP is more than 99% effective at preventing acquiring HIV when taken as prescribed.

But the report estimated that in 2019, just 23% of Americans who could benefit from PReP were taking it, and once again there were big racial disparities. Only 8% of Black people and 14% of Hispanic people who could have benefitted from the medication were receiving it, compared to 63% of White people at similar risk.

“Prevention tools are increasingly effective, but they need to reach the populations most affected,” the CDC said.