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Managing the Urban HIV Epidemic in the United States: More Than the Status Quo Needed

Graber CJ. Managing the Urban HIV Epidemic in the United States: More Than the Status Quo Needed. IDSA Newsletter Journal Club [Internet]. 2019 Dec 11. Available from:


The scientific and medical communities have made tremendous strides in the past quarter century in developing effective treatments for HIV infection. However, fully implementing these treatments and other preventive strategies to the point where an end to the epidemic in the United States is in sight has so far been elusive. A modeling study recently published in Clinical Infectious Diseases poses a provocative question: What will the HIV epidemic look like in 2030 if the current status quo is maintained in terms of access to HIV treatment care and prevention services? The authors created a dynamic, compartmental HIV transmission model for six U.S. cities: Atlanta, Baltimore, Los Angeles, Miami (Dade County), New York City, and Seattle (King County). The model captured heterogeneity in risk of HIV transmission, age, and disparities in access to care and preventive services, examining 1,667 parameters for each city derived from 11 primary database analyses, 59 peer-reviewed publications, and 24 public health and surveillance reports. Across all six cities, overall population-weighted HIV incidence, as compared to 2020, was estimated to decrease by 3.1 percent by 2025 and 4.3 percent by 2030, but variation was high in both 2025 (range from 0.6 percent increase in Los Angeles to 12.2 percent decrease in New York City) and 2030 (5.2 percent increase in Atlanta to 19.7 percent decrease in New York City). Particular factors that affected incidence included strong political support and treatment scale-up in New York City; enhanced prevention efforts among young men who have sex with men (MSM) in Seattle; a decline in HIV incidence in black MSM in Los Angeles (due in part to epidemic saturation) that is offset by increases in HIV incidence among white and Hispanic MSM; increasing incidence among Hispanic MSM in Miami and Atlanta; and a shift in Baltimore's HIV epidemic to younger black and Hispanic MSM. This study depicts the HIV epidemic in the United States as a complex aggregation of micro-epidemics, at least in the urban setting. It serves as a powerful wake-up call that more needs to be done if an end to the HIV epidemic is going to occur in our lifetime

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