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May 24, 2023

Fewer gay and bisexual men are getting HIV, but prevention barriers still persist

New cases have dropped by 34% among young men, the CDC found. But Black and Hispanic males remain disproportionately impacted by the virus

The rate of new HIV infections in the United States is slowing, with young gay and bisexual men driving the downward trend, according to the latest estimates from the U.S. Centers for Disease Control and Prevention. 

There were an estimated 32,100 new HIV infections nationwide in 2021, a 12% decline from 2017, the CDC noted in an annual report released Tuesday. That drop-off was fueled by a 34% decline in new infections among young gay and bisexual men. Still, men accounted for nearly 80% of new infections, with those who have sex with men being the most affected. 

An estimated 6,100 people ages 13 to 24 – the report's youngest age group – contracted HIV in 2021, down from 9,300 in 2017. People ages 25 to 34 accounted for the largest percentage of infections, at 37%. The bulk of new infections, at 52%, were among people from the South. The Northeast, which includes Pennsylvania and New Jersey, accounted for 14%. 

Philadelphia also has seen a drop in HIV diagnoses, but health officials are working to determine whether the trend represents a decrease in testing or an actual decrease in infections, according to a Department of Public Health spokesperson. In 2021, Philly recorded 365 new diagnoses, up 9% from 2020 but down 18% from 2019, according to city health data. The city and federal government each seek to reduce the number of new HIV infections by at least 90% by 2030

"Our nation's HIV prevention efforts continue to move in the right direction," CDC Director Dr. Rochelle Walensky said. "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. Efforts must be accelerated and strengthened for progress to reach all groups faster and equitably." 

Black Americans saw a modest decline in new infections but remain disproportionately impacted by HIV, accounting for 40% of infections in 2021. Hispanic and Latino residents make up 29% of infections, while white people accounted for 26% of new infections. 

Though the rates of new HIV infection fell among young gay and bisexual men, that downward trend was not felt among all racial groups. The CDC noted in its report that racism, stigma, discrimination and economic barriers to HIV testing and treatment drive disparities in new HIV infections. 

One of the biggest drivers in the downward trend of HIV cases is the increased use of pre-exposure prophylaxis, or PrEP, among gay and bisexual men. Still, CDC data indicates that relatively few Black or Hispanic people received prescriptions for PrEP in 2021, despite being the most at-risk for contracting the disease. 

PrEP, administered via pill or injection, reduces the likelihood of contracting HIV from sex by 99% when taken as prescribed. It drops the risk of infection via drug injection by 74%. Efforts have been made to make PrEP more accessible to those most at risk for contracting HIV, but health officials say there are gains to be made. 

Less than half of Philadelphians most at risk for HIV take the medication, according to city health data. A telehealth program established in partnership with Einstein Medical Center and the Department of Public Health connects patients with health care providers who can prescribe PrEP free of charge. 

Earlier this month, regulators with the Food and Drug Administration finalized a plan to allow more gay and bisexual men to donate blood, expanding the number of eligible donors amid a nationwide blood shortage. Blood banks have spent decades restricting men who have sex with men from donating, citing concerns that making people in that category eligible would lead to the spread of HIV. 

The FDA has ended the requirement that all gay and bisexual men must abstain from sex for three months prior to donating, with those in monogamous relationships no longer required to abstain. The plan, which was first announced in January, "ends a decades-old ban rooted in discrimination and bias," said Kelley Robinson, president of the Human Rights Campaign. 

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