World AIDS Day 2024: Take the rights path

World AIDS Day, observed annually on December 1st, unites people to share their experiences with HIV and to raise awareness of the HIV epidemic and the advancements in combatting it. This year, we are supporting the World Health Organization’s (WHO) World AIDS Day theme, “Take the rights path: My health, my right,” and its call to support the right to health by bringing awareness both to health disparities that persist in the epidemic and to national strategic efforts in place to alleviate these inequalities.

Read about the basics of HIV, including how it affects the body and health; its symptoms; how it can spread; and options for prevention, testing, treatment, and care:

• About HIV–Centers for Disease Control and Prevention (CDC)
• HIV and AIDS–WHO

HIV in the United States: Looking Into Health Disparities

Since the 1980s, HIV incidence and mortality rates have steadily decreased, thanks to advances in science and medicine that led to effective, evidence-based testing, prevention, treatment, and care options for people with HIV.¹ However, HIV continues to affect some groups more than others. Based on 2022 data from CDC, significant disparities exist in HIV based on certain factors (e.g., gender, race and ethnicity, sexuality, regionality):²

• HIV incidence was significantly higher among men (81%) than women (19%) (p. 59).
• 67% of new HIV infections were among gay, bisexual, and other men who reported male-to-male sexual contact. (p. 59).
• Nearly half (49%) of new HIV infections were in the South (p.59).
• Black and Latino people accounted for 70% of new HIV infections (p. 59).

In addition, HIV diagnoses increased among transgender men (23% increase) and women (25% increase) but remained stable among cisgender men and women.³

People who inject drugs (PWID) also face HIV-related disparities, specifically in its prevention. For example, pre-exposure prophylaxis (PrEP) is a medicine that is highly effective in preventing HIV from sexual transmission, though less so in reducing the risk of HIV from injection drug use (IDU). Another approach to HIV prevention among PWID are syringe services programs (SSPs), which provide access to sterile syringes and to other preventive and treatment services. Despite the growing research indicating the effectiveness of SSPs in reducing the risk of HIV transmission,⁴ many PWID do not have access to these programs in their communities or even in their states.⁵ Though IDU accounted for approximately 7.5% of new HIV infections in 2022,⁶ we must consider that PWID may have less effective prevention strategies available to them compared to other populations.

Social and structural issues that influence health outcomes (e.g., stigma, homophobia, discrimination, poverty, limited access to health care) continue to drive these disparities and must be addressed to ensure all people have equal opportunity for HIV testing, prevention, and treatment.

Closing the Health Disparities Gap in HIV

Ending the HIV epidemic is on the forefront of public health efforts across the United States. In 2021, the U.S. Department of Health and Human Services published its third iteration of the HIV National Strategic Plan, outlining goals and objectives to end the epidemic, which focus on populations disproportionately affected and on key areas to strengthen the national response. The plan also details actionable steps and strategies to achieve the goals and objectives, including, but not limited to:⁷

• Developing new and scaling up existing interventions to improve health outcomes among priority populations and other populations or geographic areas experiencing disparities
• Expanding workforce capacity to provide culturally competent and linguistically appropriate HIV services in areas with healthcare shortages
• Strengthening enforcement of civil rights laws, including language access services and disability rights; reforming state HIV criminalization laws; and assisting states in protecting people with HIV from violence, retaliation, and discrimination associated with HIV status, homophobia, transphobia, xenophobia, racism, and sexism
• Implementing a no-wrong-door approach to screening and linkage to services for HIV, sexually transmitted infections, viral hepatitis, and substance use and mental health disorders across programs

While we have achieved tremendous progress in combatting HIV since it first emerged in 1981, we must build on lessons learned over the past 40 years to engage everyoneliving with, at risk for, or affected by HIV to end the epidemic. Every person should have access to the health services they need—including HIV prevention, treatment, and care services—without discrimination, regardless of HIV status, background, gender, or where they live.

References

¹ Centers for Disease Control and Prevention (CDC). (2024, May-a). Estimated HIV incidence and prevalence in the United States, 2018–2022. HIV Surveillance Report. Supplemental Report, 29(1), p. 8.

² CDC. (2024, May-a).

³ CDC (2024, May-b). Diagnoses, deaths, and prevalence of HIV in the United States and 6 territories and freely associated states, 2022. HIV Surveillance Report, 2022, 35. pp. 11–12.

⁴ Palmateer, N., Hamill, V., Bergenstrom, A., Bloomfield, H., Gordon, L., Stone, J., Fraser, H., Seyler, T., Duan, Y., Tran, R., Trayner, K., Biggam, C., Smith, S., Vickerman, P., Hickman, M., & Hutchinson, S. (2022). Interventions to prevent HIV and Hepatitis C among people who inject drugs: Latest evidence of effectiveness from a systematic review (2011 to 2020). The International Journal on Drug Policy, 109, 103872.

⁵ North American Syringe Exchange Network, & Dave Purchase Project. (2024). Harm reduction locations. Temple University, Center for Public Health Law and Research. (n.d). Syringe service program laws. LawAtlas.

⁶ CDC. (2024, May-a), p. 57.

⁷ U.S. Department of Health and Human Services. (2021). HIV National strategic plan for the United States: A roadmap to end the epidemic 2021–2025.