World AIDS Day 2018: Progress and Challenges

WASHINGTON, DC – World AIDS Day, observed annually on December 1, celebrates accomplishments in combating the disease, remembers those who have lost their lives to HIV and AIDS, and refocuses efforts on what is still needed to end the epidemic. Advances in testing technologies and biomedical interventions have expanded and transformed the way we approach HIV prevention and care, but disparities remain. This year’s World AIDS Day theme, “Know Your Status,” aims to address this by encouraging people to get tested and, in the event of a positive diagnosis, engage in care. Local health departments are on the forefront of these efforts, working on initiatives to address the prevention and treatment of HIV and AIDS. This update is provided by the National Association of County and City Health Officials (NACCHO), representing the nation’s nearly 3,000 local health departments.

Status of the Epidemic
The annual number of new HIV infections has declined over the last decade. Still, more than 1.1 million people are estimated to be living with HIV in the U.S., and one in seven are unaware of their status.

Progress in the HIV epidemic is uneven across populations and regions.

* Black populations account for nearly half – 44% – of HIV diagnoses, despite representing just 12% of the U.S. population.

* Men who have sex with men (MSM) remain most affected, representing 67% of new diagnoses in 2016. However, white MSM are seeing decreases of 10% in HIV diagnoses, while black and Latino MSM have experienced increases of 4% and 14%, respectively. The Centers for Disease Control and Prevention analysis suggests that if current HIV diagnosis rates persist, one in two black MSM and one in four Latino MSM will be diagnosed with HIV in their lifetime.

* Youth ages 13-24 make up 20% of all new HIV diagnoses and are the least likely of any age group to be linked to care in a timely manner.

* Nearly one in ten new HIV diagnoses are among people who inject drugs, reflecting the severity of the opioid epidemic.

* Southern states account for more than half of new HIV diagnoses and 44% of all people living with HIV, while making up 38% of the national population.

Medical and community-based interventions are making a difference.

* Antiretroviral therapy (ART) significantly extends and improves the quality of life for people living with HIV, and there is now conclusive scientific evidence that people living with HIV who are on ART and virologically suppressed do not sexually transmit HIV.

* Pre-exposure prophylaxis (PrEP), as well as post-exposure prophylaxis (PEP), uptake is a critical intervention for decreasing the risk of HIV transmission.

The Role of Local Health Departments and NACCHO

Local health departments are key leaders in providing and assuring access to HIV prevention, care, and treatment for the communities they serve. As community health strategists, local health departments facilitate collaboration among public health, healthcare, and social services organizations, among others, to achieve more integrated, evidence-based, culturally competent systems for HIV prevention and care. They are uniquely positioned to provide data and are leaders in broader efforts to fight stigma and address the root causes of health inequities and structural barriers to effective HIV prevention and care. These local efforts are critical to address disparities in the impact and reach of the epidemic. Local health departments are also addressing the intersecting threats of sexually transmitted infections, viral hepatitis, tuberculosis, and the opioid crisis.

NACCHO works closely with its members to help advance the National HIV/AIDS Strategy goals:

NACCHO’s Southern Initiative seeks to improve HIV outcomes among minority populations in the south through the use of Community Health Workers.

Projects in rural areas of Kentucky, Virginia, and West Virginia are increasing local capacity to respond to the infectious disease consequences of the opioid epidemic and offer comprehensive harm reduction programs to address the needs of people who inject drugs.
NACCHO recently completed an action planning project focused on building local health department capacity to collaborate with schools and other key stakeholders to implement school-based prevention programs that reduce HIV/STIs among adolescents.

This year, NACCHO also signed the U=U Consensus Statement, published the findings of a survey about PrEP implementation among LHDs, presented findings from an evaluation of local implementation of Health is Power, a campaign to promote sexual health among heterosexual black men ages 18-30, and updated its HIV Prevention, Care, and Treatment policy statement.

To learn more about NACCHO’s work to reduce HIV in the U.S., visit its HIV, STI, and Viral Hepatitis webpage.