Book ReviewVOLUME 17 ISSUE # 27

With COVID, 2020 was ‘lost year’ in fight against HIV

Due to the COVID-19 pandemic, 2020 was likely a “lost year” in the public health battle against the long-lasting HIV epidemic in the U.S., a public health official says.

The launch of a federal initiative, called Ending the HIV Epidemic in the U.S., was overshadowed by delayed diagnoses and treatment due to stay-at-home orders and other coronavirus-related safety restrictions. “We definitely had a hit from COVID-19,” Demetre Daskalakis, MD, director of the CDC’s Division of HIV/AIDS Prevention, told NBC News.

“We don’t really know where HIV transmission is going to land, but it’s something that we obviously are concerned about,” he said. Public health officials are talking about the 4-decade HIV epidemic after the release of the CDC’s annual HIV Surveillance Report. The report includes 2020 data, which shows that HIV testing fell sharply due to interruptions in clinical care services, hesitance to get health care services, and shortages in materials for HIV tests during the first year of the pandemic.

The pandemic-related disruptions to HIV services could take years to undo, NBC News reported. The national HIV transmission rate could potentially also increase again after years of declines. From 2019 to 2020, HIV diagnoses dropped by 17%, according to the CDC report. Nearly 37,000 cases were diagnosed in 2019, as compared to about 30,600 in 2020. Since 2016, the numbers hadn’t declined by more than 3% annually. “There are likely many more individuals who are undiagnosed than we have had in recent years,” Hansel Tookes, MD, an infectious diseases specialist who cares for HIV patients at the University of Miami, told the news outlet.

Delays in HIV diagnoses can cause the disease to be transmitted more, he explained. HIV is more easily passed when people have recently contracted the virus and have high viral loads. When people are diagnosed and begin antiretroviral therapies, transmission drops.

The HIV Surveillance Report found that nearly 1.1 million people were living with diagnosed HIV in the U.S. in 2020. Based on 2019 data, the CDC previously estimated that 1.2 million Americans likely have HIV, including those who are undiagnosed. The report also shows how the pandemic worsened inequities in HIV transmission. Overall, the diagnosis rate in the South was twice that of the Midwest in 2020. Georgia had the highest HIV diagnosis rate of the year, with 22 diagnoses per 100,000 people, as compared with 12 per 100,000 in California and New York.

The epidemic also disproportionately affects Black Americans, who make up 13% of the U.S. population but accounted for 42% of HIV diagnoses in 2020. Hispanic and Latino Americans accounted for 27% of diagnoses, and white Americans accounted for 26% of diagnoses.