Rates of new HIV infections are falling in Massachusetts and across the United States, but the progress has not been evenly spread across ethnic and racial groups.
New data published Tuesday by the Centers for Disease Control and Prevention show a 12 percent drop in estimated new HIV infections nationally between 2017 and 2021 and a 34 percent decrease in new infections among people between the ages of 13 and 24, who make up the bulk of new cases.
However, the declines were greatest among white gay and bisexual men, whose annual rates of new infections decreased 45 percent, compared to 36 percent among Hispanic/Latino men and 27 percent among Black/African American men.
“It’s a good news, bad news situation,” said Dr. Kenneth Mayer, medical research director and cochair of the Fenway Institute, which provides health services for the LGBTQ+ community and those affected by HIV.
In Massachusetts, HIV diagnoses have been on the decline over the past decade. In 2019, the number of new HIV infections diagnosed declined to a 10-year low of 539, a 15.7 percent reduction from an average of 640 diagnoses per year from 2014 to 2018, according to a 2022 report from the Massachusetts Department of Public Health.
The Commonwealth has enacted numerous HIV prevention and care policies over the past two decades, which have helped it see progress faster than other states, said state Senator Julian Cyr. Since 2006, the state government has expanded access to Medicaid for low-income residents with HIV infection, authorized verbal consent to HIV testing to improve access, and required insurers to cover prescribed HIV-related treatments.
“The promising indicators we’ve been seeing nationally have been playing out sooner in Massachusetts due to the robust levels of funding we have for HIV prevention and treatment work that has been showing success for some time,” said Cyr.
But there is still more to be done as the state continues to see outbreaks of new infections among people who use drugs, particularly among those experiencing homelessness, who continue to account for nearly a third of deaths among people with HIV, according to the state Department of Public Health. After decreasing by 50 percent between 2017 and 2019, the number of reported HIV cases associated with injection drug use as the main mode of exposure increased by 29 percent in 2020.
“What’s worrisome is that there are periodic clusters in cases that crop up, which shows how fragile prevention efforts are in the population of people who use drugs,” said Dr. Paul Sax, the clinical director of the Division of Infectious Diseases at Brigham and Women’s Hospital and professor of medicine at Harvard Medical School. “You get very few cases and all of a sudden there are dozens of cases in a community.
The state is also not immune to the stark racial disparities playing out at a national level. Between 2018 and 2020, Black non-Hispanic and Hispanic individuals in the Commonwealth were diagnosed with HIV at rates eight and four times higher than those of white non-Hispanic individuals respectively, according to DPH data.
Rates remain particularly high for young men of color who have sex with men, in part because they are more likely to feel social stigma about their sexuality, less likely to regularly see primary care physicians, and historically have distrusted medical systems, said Gary Daffin, executive director of the Multicultural AIDS Coalition in Roxbury. Daffin said his organization is seeing a sharp rise in sexually transmitted diseases.
Because PrEP is only available through a prescription, part of closing the racial and socioeconomic gaps is making sure that the most at-risk communities are regularly going in to see providers, said Sax. “People who are at the highest risk are often getting no regular health care or going to an emergency room for treatment of sexually transmitted infections, but that’s not the setting where they can be prescribed.”
CDC data shows that men of color, who need access to PrEP the most, are much less likely to be prescribed it than white men. In 2021, researchers estimate that less than a quarter of the Black and Hispanic men who could benefit from it were prescribed PrEP, compared to over three-quarters of White people.
These disparities are not specific to the HIV epidemic but reflect larger barriers to health care that diverse communities face, according to Mayer. Adapting policies and programs to meet people where they are and supporting the community organizations that are on the front lines of providing care are crucial parts of breaking through these trends and creating more equitable systems.
“We just have to keep getting the message out, particularly when we’re talking about an epidemic that more and more affects younger individuals,” he said.