The Centers for Disease Control and Prevention (CDC) just released a report about HIV trends for people under 30 in the U.S., and the numbers show an increase in one particular group: 25- to 29-year-olds.
After collecting data from all over the country on HIV and AIDS diagnoses between 2010 and 2014, the CDC found that overall rates of infection for 13- to 29-year-olds has remained stable overall. And for some of the younger groups, like those aged 15 to 19, rates have actually gone down.
But “We can’t pat ourselves on the back just yet,” said Craig Wilson, a professor of epidemiology and public health at the University of Alabama at Birmingham, in an interview.
Wilson notes that although we’re seeing an overall “flattening” in the number of HIV infections in younger demographics — which is certainly better than an increase — the results shouldn’t be taken as too encouraging.
“There are good things if you look at it historically, but the bad part is, why aren’t we doing better?” asked Wilson, who was not involved in the CDC report.
Although these are estimations and not exact numbers, rates increased from around 32 to 35 cases per 100,000 people in the 24- to 25-year range and from around 30 to 34 cases in the 26- to 27-year range between 2010 and 2014. (Collectively, these fall under the CDC data collection system for the 25-29 year range.)
HIV — a virus that attacks and destroys cells in the body’s immune system to the point that it causes acquired immune deficiency syndrome, or AIDS — has existed in the U.S. since the 1970s and was first recognized by medical experts in the early 1980s. Nearly four decades later, tens of thousands of new infections are diagnosed in the U.S. each year. Risk of infection from sex, however, can be reduced by over 90 percent if modern PrEP medications are taken as directed, says the CDC. These drugs are designed to stop HIV from establishing itself or spreading throughout the body. And, of course, a person has to know they’re infected to start taking medication.
What’s worrisome is that the younger demographic of 13- to 29-year-olds makes up a disproportionate number of new HIV infections. The CDC says this group made up 23 percent of the U.S. population in 2014, but accounted for 40 percent of diagnoses that year.
Why aren’t the infection numbers going down?
The flattening trend in HIV diagnosis among younger teens and millennials isn’t bad, in the sense that matters could be worse — and still could get much worse. Wilson cites CDC stats from 2016 that he called “scary”; this government report projected that half of black gay men and a quarter of Latino gay men would be diagnosed with HIV in their lifetimes.
Although there’s potential for HIV diagnoses to dramatically increase in some populations, experts still find the recent flattening trend unacceptable.
“The status quo isn’t so good — we need to do a better job,” said Sharon Nachman, division chief of pediatric infectious diseases and professor of pediatrics at Stony Brook Medicine, who also took no part in the CDC report.
A primary reason why overall rates aren’t dropping, and are actually increasing in 25- to 29-year-olds, is that millennials are failing to take the first preventative steps, like getting tested. “Even though the rates may be stable, millennials are less likely to have had an HIV test, even compared to older groups,” said Brandon Brown, an HIV expert at the University of California Riverside School of Medicine who played no part in the report, over email.
There could be many reasons for this, he noted, like millennials believing they’re not at risk, or possibly thinking HIV is now a manageable illness.
But getting tested is critical to getting the currently “flattening” trend to begin tracking down.
Wilson said the greater goal is for 90 percent of people infected with HIV to know their diagnosis, and then for 90 percent of those who know to receive therapy for HIV — therapy that decreases transmission.
“If we hit those numbers, we’ll start seeing downtrends, because HIV transmission is taking place from those not on therapy,” said Wilson.
Inadequate testing, however, is not just the fault of millennials. Getting people to know their status requires doctors doing a better job about talking to their patients about testing.
Nachman says doctors should ask about about HIV the same way they ask about smoking. And all doctors these days, from cardiologists to dentists, seem to ask whether you smoke.
“Until we normalize HIV testing and remove testing stigma, this will continue to be a problem where many don’t know their status,” said Brown.