New HIV infections dropped 12 percent in 2021 compared to 2017, according to new Centers for Disease Control and Prevention estimates released Tuesday, with the biggest drops among young gay and bisexual men.

But the agency warned that HIV prevention efforts need to be accelerated to reach the national goals.

The data Tuesday credited the overall decrease to a 34 percent drop in infections among 13-24 year olds, with the largest declines among young gay and bisexual men. Annual HIV infections among young people decreased from 9,300 to 6,100, but among young LGBTQ men new infections dropped from 7,400 to 4,900.

“Our nation’s HIV prevention efforts continue to move in the right direction,” said CDC Director Rochelle Walensky, who called for accelerating efforts to reach groups at risk more quickly and more equitably. “Longstanding factors, such as systemic inequities, social and economic marginalization and residential segregation, however, stand between highly effective HIV treatment and prevention and people who could benefit from them.”

Reductions in new infections were not uniform against racial and ethnic groups. CDC estimated a 45 percent drop in new infections among young LGBTQ white males, compared to a 36 percent drop in young Hispanic/Latino LGBTQ males and only a 27 percent drop among young LGBTQ Black males.

CDC credited factors like more widespread access to HIV testing, treatment and pre-exposure prophylaxis, or PrEP, to reductions in new infections, but acknowledged other factors may limit availability to these tools among Black and Hispanic/Latino individuals.

The use of PrEP, a medication taken to reduce the risk of contracting HIV, grew, with 30 percent of the recommended population getting a prescription for the drug, up from 13 percent in 2017.

In 2021, an estimated 1.2 million people would have benefited from the drug. PrEP uptake was highest among white individuals 16 and up at about 78 percent compared to about 11 percent among Black and 21 percent in Hispanic/Latino individuals 16 and up.  

“In prevention, patience is not a virtue.” said Jonathan Mermin, director of CDC’s National Center for HIV, Viral Hepatitis, STD, and TB Prevention. “Decreasing HIV incidence among youth, including young gay and bisexual males, shows us what is possible. But ending the HIV epidemic and achieving equity requires we expand this progress to all.”  

The agency acknowledged that the COVID-19 pandemic may have contributed to lags in access to treatment and testing as well as in surveillance efforts for 2020 data.

Next steps

The United States announced its “Ending the HIV Epidemic” plan in 2019, and currently aims to reduce new infections by 75 percent by 2025 and by at least 90 percent by 2030, compared to 2017 levels.

CDC, in releasing the new data, called for increasing investments in the “Ending the HIV Epidemic” plan, expanding how and where individuals could access HIV testing and ensuring HIV prevention efforts are more equitable.

The White House budget request released in March seeks $850 million for the plan, or 48 percent over enacted levels.  It also proposes reducing barriers to access PrEP through Medicaid and to make PrEP free for uninsured and underinsured individuals. The proposed national PrEP program would cost $237 million for fiscal 2024.

Carl Schmid, executive director of the HIV+Hepatitis Policy Institute, praised the positive progress from the new data but said the documented discrepancies underscore the need for increased funding for HIV/AIDs and a national PrEP program.

“Both Presidents Trump and Biden have put forth initiatives to end HIV with calls for increased funding for testing, treatment, and prevention, including for PrEP. However, it is necessary for Congress to commit to the investments as well,” said Schmid. “While there have been some increases, they have not been at the level needed to put the U.S. on a path to end HIV. This will result in new infections, more people living with HIV, and the need to provide lifetime care and treatment.”

He also called on CDC to increase accountability for state grantees so that existing HIV prevention resources are better targeted at communities facing disparities. 

The White House budget also calls for funding bumps to domestic HIV prevention efforts at CDC and for the Ryan White Program, under the Health Resources and Services Administration, which administers domestic HIV safety net programming and grants.

Neither chamber has released its draft fiscal 2024 Labor-HHS-Education spending text yet.