Today, more Americans are aware of their HIV status than ever before, however one in six Americans with HIV do not know that they are HIV-positive. HIV testing saves lives. It allows those living with the virus to access lifesaving treatments that can drastically reduce the risk of HIV transmission to others. But, despite recommendations from the Center for Disease Control and Prevention that everyone age 13-64 be tested for HIV routinely, only half of Americans have been tested at least once in their lifetime. Undiagnosed HIV infections contribute to the approximately 50,000 Americans who continue to become infected with HIV each year and the 130 Americans who become newly infected with HIV each day.
Despite decades of prevention efforts and reductions in HIV incidence in the 1980s and 1990s, today we have a stubbornly stable HIV epidemic in the United States. There is little question that, without the past three decades of investments in research and HIV prevention programs, our U.S. HIV epidemic would be much worse than the one we live with today. But new strategies are needed to push us to further reduce new HIV transmissions.
It is also important to recognize that not all Americans are at equal risk for HIV. Gay and bisexual men comprise two thirds of new HIV infections annually nationwide and are the only U.S. risk population for whom the number of new HIV infections continues to grow each year. Black Americans are also disproportionately impacted by HIV, and disparities in HIV infection between black and white Americans show no signs of narrowing. And risk is also not evenly distributed across the United States -- 92 percent of new HIV diagnoses occur in just 25 percent of counties, mostly representing urban areas.
In 2010, President Barack Obama released the first comprehensive National HIV/AIDS Strategy to reduce new HIV infections, improve access to care for people living with HIV, and reduce HIV-related health disparities. A major priority of the Strategy is to focus the most effective tools to combat HIV within those communities where HIV remains concentrated.
In the era of geolocation and Google maps, technology is an emerging tool in combatting HIV. By mapping the disease, we can understand what areas are most impacted by HIV. One innovative tool, AIDSVu, uses data collected by state and local health departments to visualize where HIV is concentrated. Launched by Emory University in 2011 in partnership with Gilead Sciences, Inc, AIDSVu is a public resource that graphically illustrates the HIV epidemic across the United States, showing prevalence rates by state, city, ZIP code and census tract. The resulting interactive maps are being used by health departments, academic institutions, and community-based organizations to pinpoint where HIV testing, prevention and care efforts are needed most.
This is just one example of how we can leverage technology to reduce the spread of HIV in our communities. Throughout the country, health providers and public health practitioners are finding other ways to use technology in the fight against HIV. For example, HIV mapping has been used to determine where to place telemedicine centers; video conferencing technology helps to connect people living with HIV in rural areas with urban HIV specialists. New research studies are using Skype-based video counseling to support couples learning their HIV status together with at-home test kits. Mobile apps are being tested to provide tailored information and prevention recommendations and direct people seeking HIV testing to nearest convenient testing locations.
Helping people move from being unaware of their HIV infection to being treated for HIV is impactful. Fifty percent of new HIV infections arise from people who don't know they are infected. Conversely, once effectively treated, people living with HIV are over 90 percent less likely to transmit HIV to their partners. Through evolving technologies and innovation we can reduce new infections by targeting testing, prevention and treatment efforts to those areas and populations most impacted by HIV. The more we all know about where to find HIV in our communities, the more we can do to stop its transmission.
Patrick Sullivan, PhD is a professor of Epidemiology at the Rollins School of Public Health at Emory University, and the lead researcher for AIDSVu.
Gregorio Millett is Vice President and Director of Public Policy for amfAR, The Foundation for AIDS Research, and a former senior policy advisor at the White House Office of National AIDS Policy