The annual HIV diagnosis rate in the U.S. decreased more than 30 percent from 2002-2011, with declines observed in several key populations, although increases were found among certain age groups of men who have sex with men, especially young men, according to a study in the July 23/30 issue of JAMA, a theme issue on HIV/AIDS. The issue is being released early to coincide with the International AIDS Conference.

“There has been increasing emphasis on care and treatment for persons with human immunodeficiency virus (HIV) in the United States during the past decade, including the use of antiretroviral therapy for increasing survival and decreasing transmission. Accurate HIV diagnosis data recently became available for all states, allowing for the first time an examination of long-term national trends. These data can be used to monitor awareness of serostatus among persons living with HIV, primary prevention efforts, and testing initiatives,” according to background information in the article.

Anna Satcher Johnson, M.P.H., of the Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, and colleagues examined trends in HIV diagnoses from 2002-2011 among persons ages 13 years or older in the United States, using data from the National HIV Surveillance System of the CDC. All data were collected through routine HIV surveillance mandated by laws or regulations in the 50 states and the District of Columbia.

During 2002-2011, 493,372 persons were diagnosed with HIV in the United States.

The annual diagnosis rate decreased by 33.2 percent, from 24.1 per 100,000 population in 2002 to 16.1 in 2011. Statistically significant decreases in diagnosis rates over time were found in nearly every demographic population with the largest changes observed in women, persons 35-44 years of age, and persons of multiple races. Changes were not evident for Asians or Native Hawaiians/other Pacific Islanders. The annual number of HIV diagnoses decreased in persons with infection attributed to injection drug use or to heterosexual contact.

From 2002-2011, diagnoses attributed to male-to-male sexual contact remained stable overall, increasing among males 13-24, 45-54, and 55 years or older, and decreasing among males 35-44 years of age. The largest change (132.5 percent increase) was observed among males 13-24 years of age.

The authors note that because of delays in diagnosis, trends in diagnoses and variations among groups may reflect earlier changes in HIV infection rates. They add that this study is limited in that trends in diagnoses can be influenced by changes in testing patterns. “The HIV testing services were expanded during the analysis period and early outcomes of testing initiatives often indicate increases in diagnoses until some level of testing saturation occurs. Our study found overall decreases in annual diagnosis rates despite the implementation of testing initiatives during the period of analysis.”

“Among men who have sex with men, unprotected risk behaviors in the presence of high prevalence and unsuppressed viral load may continue to drive HIV transmission. Disparities in rates of HIV among young men who have sex with men present prevention challenges and warrant expanded efforts.”

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(doi:10.1001/jama.2014.8534; Available pre-embargo to the media at http://media.jamanetwork.com)

Editor’s Note: The CDC provides funds to all states and the District of Columbia to conduct the HIV surveillance data used in this study. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, etc.

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Anna Satcher Johnson
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