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HIV: global numbers on the rise, yet the Big Apple and London report drops and better prevention

The Human Immunodeficiency Virus (HIV) is a highly contagious infection usually transmitted through body fluids during sexual contact, blood transfusion, during pregnancy, delivery, and breastfeeding through breast milk.  Worldwide, there were about 37.9 million people across the globe with HIV in 2018, and approximately 1.7 million people became newly infected across the globe in 2018 alone. Reporting of new cases of HIV started in 2001 and since then there has been a steady rise and stability of numbers. In 2018 for the first time in nearly two decades, researchers have reported number of new cases to be below 2,000 over the year. This is a record 67% decline in the numbers since 2001. Further the decline in the numbers has been seen in nearly all age groups between 2017 and 2018. These results were released in the 2018 HIV Surveillance Annual Report that shows that in 2018 there were 1,917 new cases of HIV in New York City in 2018. In 2017 there had been 2,157 new cases (11%) and the decline from 2001 since the survey began was 67%.

Dr. Oni Blackstock, Assistant Commissioner for the Health Department’s Bureau of HIV also said, “I am thrilled to see declines in annual new HIV diagnoses among nearly all groups, and ever-increasing numbers of New Yorkers with HIV being linked to care and achieving viral suppression. These data show the power of our dynamic, forward-thinking approach to ending the epidemic, and what we can achieve when community and government come together to prioritize science over stigma and sex-positivity over shame. But there is still work to do. Until we see equitable progress among New Yorkers from all walks of life, we must double down on our efforts to fight the institutional racism, sexism, homophobia, transphobia, and other forms of stigma that put people at greater risk of HIV infection and, for people with HIV, put care and treatment further out of reach. We cannot end the epidemic among New Yorkers without ending the epidemic among all New Yorkers”.

The report reveals that there has been a reduction in the number of new cases among specific populations including Black, Latino and also among White, Asian/Pacific Islander, and Native Americans. In both age groups – 0 to 49 years and 60 years and above, similar decline has been knotted. The decline in the numbers was similar among people residing in all the five boroughs of NYC. The report also reveals that there has been a total decline in the number of HIV positive persons over the years in NYC. The decline is 16% since 2017 and 41% since 2014 says the 2018 report. The aim of therapy is to suppress the viral load in the blood. Persons on antiretroviral therapy are in a viral suppression mode. This report shows that in 2014, 81% of the HIV positive individuals were virally suppressed. In 2018 the viral suppressed individuals were 87%. Persons who are virally suppressed are also incapable of transmitting the infection to others via unprotected sex. These high numbers of virally suppressed individuals is thus an encouraging finding, says the report.

NYC has been on the path to ending the HIV epidemic since Mayor Bill de Blasio in 2015 announced the “NYC Ending the Epidemic Plan” and sanctioned an annual investment of $23 million so that more and more of the population has access to HIV prevention services and also persons with HIV get access to adequate treatment for HIV, methods for looking at the modes of transmission of the infection. To implement the plan, NYC reworked eight of its Sexual Health Clinics to provide low to no-cost detection of sexually transmitted infections (STIs) and HIC and also provision of emergency medications for Post-exposure prophylaxis, Pre-exposure prophylaxis, JumpstART (immediate initiation of HIV treatment with navigation to longer-term care), counselling for patients etc. For all individuals aged 12 years and above irrespective of their insurance coverage, financial condition, immigration status, the services are made accessible at the Sexual Health Clinics.

Despite the new numbers of newly infected people across thje globe, a positive 2020 report shows that HIV new infections among gay and bisexual men dropped by 71% in England, from about 2,800 infections in 2012 to 800 in 2018. In 2014, there are an estimated 7,000 gay, bisexual, and men who have sex with men living with undiagnosed HIV infection and it plummeted to 3,600 in 2018. The largest decline of new infections in gay and bisexual men was among those who were born and residing in the UK, white, and between 25 and 49 years old. According to the report by Public Health England, after a sharp rise of new HIV infections in the UK in 2014, it has seen a rapid decline between 2014 and 2018, from a staggering 6,278 to 4,453. While the largest decline was among gay and bisexual men, people who got infected heterosexually also fell as much as 43 percent, from 3,400 in 2009 down to 1,940 in 2018. The steepest declines were in London residents, in those aged 25 to 34 years, in persons of black African ethnicity and those born abroad.

Nearly half of all adults diagnosed in 2018 who acquired HIV heterosexually were born in a country of high HIV prevalence. The report is a strong indicator that the country is nearing its goal to eliminate HIV transmission by 2030. The sharp decline in new diagnoses of HIV in the UK can be attributed to the country’s efforts to reach its goal. In 2018, the UK continued to exceed UNAIDS targets. Out of the 103,800 people living with HIV, about 93 percent were diagnosed, 97% of those diagnosed are under treatment, and 97 percent of those under treatment are now virally suppressed. Also, thanks to HIV testing as fewer people remain unaware they’re infected. The country aims to conduct widespread HIV testing to detect undiagnosed infection. More than 1.1 million attendees in all specialist sexual health services (SHS) were tested for HIV, which increased by 6% since 2017.

Among gay, bisexual, and men who have sex with men, a total of 127,633 were tested for HIV, which increased by 9% from the previous year. Aside from the increased rate of HIV testing, the decline has been credited to the introduction of the pre-exposure prophylaxis (PrEP) pill, which is widely and freely available in Wales and Scotland to people at a high risk of HIV exposure. By the last quarter of 2018, approximately 13,000 to 19,500 persons, across the UK, were under PrEP, a majority of whom receive the drug through a publicly funded trial or clinic, while others by self-purchase. Dr. Michael Brady, National Adviser for LGBT Health to the NHS, concluded: “Thanks to excellent NHS care, people living with HIV now get immediate access to highly effective treatments, meaning that they can expect to live long and healthy lives and be confident they won’t pass the virus to their partners. The NHS is determined to carry on the significant progress towards eliminating HIV and achieving zero new transmissions by 2030, as part of our Long-Term Plan to improve the prevention of avoidable illnesses and tackle health inequalities”.

  • Edited by Dr. Gianfrancesco Cormaci, PhD, specialista in Clinical Biochemistry.

Scientific references

Hanum N et al. Lancet Public Health. 2020 Sep; 5(9):e501-11. 

John SA et al. Arch Sex Behav. 2020 Aug; 49(6):2081-2089.

Edelstein ZR et al. JAMA Intern Med. 2020 Apr; 180(4):616.

Witzel TC et al. Int J Envir Res Pub Health 2020;17(2):466.

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Dott. Gianfrancesco Cormaci

Medico Chirurgo, Specialista; PhD. a CoFood s.r.l.
- Laurea in Medicina e Chirurgia nel 1998 (MD Degree in 1998) - Specialista in Biochimica Clinica nel 2002 (Clinical Biochemistry residency in 2002) - Dottorato in Neurobiologia nel 2006 (Neurobiology PhD in 2006) - Ha soggiornato negli Stati Uniti, Baltimora (MD) come ricercatore alle dipendenze del National Institute on Drug Abuse (NIDA/NIH) e poi alla Johns Hopkins University, dal 2004 al 2008. - Dal 2009 si occupa di Medicina personalizzata. - Guardia medica presso strutture private dal 2010 - Detentore di due brevetti sulla preparazione di prodotti gluten-free a partire da regolare farina di frumento enzimaticamente neutralizzata (owner of patents concerning the production of bakery gluten-free products, starting from regular wheat flour). - Responsabile del reparto Ricerca e Sviluppo per la società CoFood s.r.l. (Leader of the R&D for the partnership CoFood s.r.l.) - Autore di articoli su informazione medica e salute sul sito www.medicomunicare.it (Medical/health information on website) - Autore di corsi ECM FAD pubblicizzati sul sito www.salutesicilia.it
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