HIV Prevention

Excerpt

HIV can infect individuals of any age, gender, race, or social class. Due to the effectiveness of antiretroviral therapy (ART), HIV infection is now seen as a manageable chronic disease. However, despite significant advancements in controlling the virus, the disease remains a significant global health concern fed by and contributing to inequities.

The World Health Organization (WHO) estimates more than 630,000 people died from HIV-related causes in 2022.[WHO. HIV Data and Statistics. 2023] Thirty-nine million people are living with HIV, of whom two-thirds are living in Africa, and 1.5 million are children aged 0 to 14. In addition, 1.3 million people acquire HIV each year, most commonly from heterosexual contact.

The Centers for Disease Control and Prevention (CDC) estimates that 1.2 million people in the United States (US) had HIV at the end of 2021, of which 87% were aware.[CDC. Basic Statistics. 2023] Male-to-male sexual (MSM) contact accounts for 67% of all new HIV diagnoses in the United States, with heterosexual contact accounting for 22% and intravenous drug use 7%.[CDC. Basic Statistics. 2023] High-risk groups included MSM, transgender individuals, people with multiple partners or who do not use condoms, individuals who trade sex for money, goods, or services, people living in locations where the incidence is 3% or greater, and individuals who have had sexually transmitted infections (STIs) or who share injection drug needles, syringes or other equipment, amongst others. The number of new diagnoses in the United States each year decreased by approximately 7% from 2017 to 2021.[CDC. Basic Statistics. 2023]

Targets and initiatives set by the United Nations (UN), the WHO, and individual countries' centers for disease control have fostered immense progress in scaling up testing and implementing antiretroviral therapy (ART. However, knowledge of HIV status, use of preventive services, and access to and retention in care remain suboptimal in the United States and worldwide, with large inequities between populations. The Joint UN Programme for HIV/AIDS (UNAIDS) has set "95-95-95" goals for 2025.

1. 95% of all individuals with HIV will know their status

2. 95% of all those who have HIV will receive antiretroviral therapy

3. 95% of all people on ART will achieve viral suppression

The projected impact of this will be fewer than 370,000 people acquiring HIV and fewer than 250,000 people dying from HIV in 2025 (see Image. Global Trends in people acquiring or dying from HIV).

This article focuses on biomedical HIV prevention approaches for clinicians as part of an overall public health approach to achieving global and national targets and decreasing the global burden of this disease. It reviews the modes of transmission of HIV, pharmaceutical strategies for at-risk populations, implementation considerations for select populations, and select public health measures of relevance across the interdisciplinary team.

See "Monitoring, Surveillance, and Reporting" under "Enhancing Healthcare Team Outcomes" in this article for further information on the 95-95-95 goals. See StatPearls' companion topics, "HIV and AIDS" and "HIV Antiretroviral Therapy," for further information on these topics.