Gaps in the HIV care continuum account for more than 90 percent of disease transmission
A new article, published in the Journal of the American Medical Association, paints a grim picture of how gaps in care for the HIV-positive population in this country are the driving force behind new infections with the virus that causes AIDS. The article also points out just how valuable diagnosis and treatment is to fighting the spread of those new infections.
According to the research, from the Centers for Disease Control and Prevention, people infected but undiagnosed and people diagnosed but not yet in medical care accounted for more than 90 percent of HIV transmission in 2009.
The study’s authors estimated the rate of infection based on which of the five stages of the continuum of care the 1.1 million HIV-positive people were in: 1) infected but undiagnosed, 2) diagnosed but not yet in care, 3) retained in medical care but not prescribed anti-retroviral therapy (ART), 4) prescribed ART but not virally suppressed, 5) and achieved viral suppression.
They found 18 percent were infected but didn’t know their status. An alarming 45 percent were diagnosed but not yet in medical care. Another 4 percent were receiving medical care but not prescribed ART, and 7 percent were prescribed ART but not virally suppressed. Only 25 percent had achieved viral suppression.
The numbers spotlight the role gaps in the care continuum play in helping to spread HIV. About 70 percent of the positive population was going without testing or treatment. Those who where undiagnosed or diagnosed but not in treatment accounted for 30 percent and 61 percent, respectively, of the estimated 45,000 transmission in 2009. But those who were in medical care and virally suppressed were 94 percent less likely to infect undiagnosed people.
“In the United States, persons living with HIV who are retained in medical care and have achieved viral suppression are 94 percent less likely to transmit HIV than HIV-infected undiagnosed persons. Unfortunately, too few persons living with HIV have achieved viral suppression,” the authors wrote. “These estimates of the relative number of transmissions from persons along the HIV care continuum highlight the community-wide prevention benefits of expanding HIV diagnosis and treatment in the United States. Improvements are needed at each step of the continuum to reduce HIV transmission. Through stronger coordination of efforts among individuals, HIV care providers, health departments and government agencies, the United States can realize meaningful gains in the number of persons living with HIV who are aware of their status, linked to and retained in care, receiving ART and adherent to treatment.”
This news is particularly troubling for the black community. Two recent studies found African Americans have the highest rates of new HIV diagnoses and death rates from the disease.