national hiv/aids strategy

Scientists and mathematicians evaluated the feasibility of the National HIV/AIDS Strategy to end AIDS by 2025, and report that the plan is on track.

In 2010 President Obama released a comprehensive national HIV/AIDS Strategy (NHAS) to end AIDS by 2025 and address some disturbing trends.  Despite initial intensified efforts to end AIDS in the 1980’s and 90’s, the U.S. failed to significantly reduce the number of new HIV infections throughout the 2000’s and the number stabilized at approximately 50,000 new cases a year.  In addition, the public’s sense of urgency had waned, and HIV infections were affecting certain vulnerable populations disproportionately, particularly in the Southern U.S.

With the NHAS, President Obama aimed to reduce new HIV infections, improve access to health care and health outcomes for people living with HIV and reduce HIV related disparities by the year 2015, ultimately aiming to “end AIDS” by 2025.  At the launch of the NHAS the president declared; “The question is not whether we know what to do, but whether we will do it… whether we will marshal our resources and the political will to confront a tragedy that is preventable.”

The National HIV/AIDS Strategy sets key HIV prevention and care targets for the year 2020 with the goal of “ending AIDS” by 2025.  The authors set out to test the feasibility of that goal.  Authors modeled HIV incidence, prevalence, and mortality for the U.S. over 10 years to determine whether this goal is achievable.

The researchers used data gathered from the Center for Disease Control and Prevention surveillance data from 2010 to 2013 and analyzed it in 2016.  The authors applied a “90/90/90 framework” (90% of people who are HIV positive will be aware of their status, 90% of diagnosed individuals are receiving medical care, and 90% of individuals on retroviral therapy are virally suppressed) to 2020 with the goal of achieving a “95/95/95 framework” in 2025, to assess the feasibility of meeting these targets.

Scientists used the transmission rate as an epidemiological marker. The transmission rate is defined as the number of individuals newly infected with HIV for every 100 HIV-positive individuals per year.  The target goal was set at reducing new infections to 21,000 in 2020, (the transmission rate would be 1.74, with 1,205,515 people living with HIV) a significant decline since 2013 which saw a transmission rate of 3.53.  By 2025, the target is merely 12,571 new cases which would represent a 69% decrease in HIV incidence – a transmission rate of 0.98 and 1,220,615 people living with HIV.

These key milestones are an ambitious but realistic goal, and an important pathway to reduce U.S. HIV incidence below 12,000 new infections in 2025.  With a sustained and intensified national commitment, the NHAS is on track to effectively end AIDS by 2025.

Written By: Lisa Borsellino, B.Sc.

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