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The Centers for Disease Control and Prevention reported deaths related to HIV in the United States fell significantly from 2010 through 2018, regardless of sex, age, race or region.

Experts said the death rate declined overall by about half, a welcome sign in the fight against the virus. The data also highlighted some troubling trends with smaller improvements in death rates among women, Black people and those of multiple races. Additionally, the rate of death was about twice as high in Southern states as in the Northeast.

It is possible the pandemic has dampened these improvements. The CDC did not offer numbers on testing for HIV or access to preventative pre-exposure prophylaxis (PrEP) therapy over the past few months, but many facilities have shuttered their HIV clinics or reported decreases in the number of people using their services, the researchers said.

Still, experts said the news was a testament to the enormous strides made in efforts to end the HIV epidemic.

[Note: Many agencies, including Samaritan Ministry, have reduced or suspended HIV testing during the pandemic. We are sending at-home HIV testing kits to those who need to be tested, but that process has been slow.]

“The reduction in death is something that we couldn’t have imagined even as recently as 2010,” roughly a decade after the introduction of powerful antiretroviral drugs, said Dr. Jeanne Marrazzo, the director of infectious diseases at the University of Alabama in Birmingham. “The fact that these therapies have become so standard and turned things around for so many people is just incredibly gratifying and astonishing.”

Dr. Marrazzo credited the success to investments in HIV care for services of nutritional support, social work, psychiatry and other assistance that is provided through programs such as the federal Ryan White HIV/AIDS Program. “This is not just about the drugs. It’s the entire structure that supports people,” she said. “Sometimes that’s lost in the dialogue.”

From 1990 through 2011, deaths among people with AIDS decreased significantly. They dropped even more after 2012, when treatment guidelines began recommending antiretroviral therapy for anyone with HIV.

CDC researchers, led by epidemiologist Dr. Karin Bosh, conducted a study that analyzed National HIV Surveillance System data for the years of 2010 to 2018. The data analysis revealed that the overall death rate among people with HIV dropped by about one-third, but the rate of deaths directly related to HIV decreased by 48%. More than 16,000 people with HIV died in 2017 and about 5500 of those deaths were from HIV-related causes. This positioned the virus among the ten leading causes of death in certain population groups. “There’s still work to be done (and) this is concerning because HIV deaths are preventable,” said Dr. Bosh.

Women with HIV, unlike gay men, come from many different walks of life and are often disconnected from networks of support, said Dr. Eileen Scully, an infectious diseases physician at Johns Hopkins University. “We still have a lot of work to do, both to build trust and to bring, in particular, minority women into the health care system in ways that they feel safe and supported.”

Race also played an outsized role in HIV deaths, with the highest rates among Black people or those of multiple races. Dr. Marrazzo compared the high numbers in the American South to the “Global South” — resource-poor countries in sub-Saharan Africa and elsewhere that also cope with issues of stigma and opaque sexual networks, particularly among gay Black men.

“The fact is that a Black person living with HIV in Mississippi is more than six times more likely to die of HIV than a white person in New York — and that’s pretty astonishing if you think about it,” said James Krellenstein, executive director of the advocacy group PreP4All Collaboration. Although “the top line numbers are impressive,” he said, “this does point to a real crisis in the American health care system’s ability to deliver HIV treatment equitably.”

“The next step really is going to be continuing to ratchet up (services for) those people who are diagnosed, and diagnosed early,” stated Dr. Marrazzo. Early treatment has been shown to be key to getting the virus under control. “The earlier you can do it, the better.”

Taken from the New York Times – November 19, 2020.