Most Americans think of HIV/AIDS as a challenge for other nations around the world, not the United States.   The alarming fact is that 3.2% of all adults ages 15 to 49 in Washington, DC are HIV positive.

 If the US capital were a nation in Africa it would rank 23^rd out of 54 countries in percentage of people with HIV.

Here are a few comparisons:

While great strides are being made in reducing the number of people with HIV/AIDS globally, the US must also focus on our own HIV/AIDS epidemic which includes more than 1.1 million people living with HIV, and 50,000 new infections each year.

An estimated 1 in 6 people living with HIV in the US do not know they are infected, and about 1 in 4 new HIV infections are among youth ages 13-24.   Expanded “Know Your Status” campaigns are critical to getting people into life-saving care and treatment, and helping to reduce the US epidemic.

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Data from:   UNAIDS, US Centers for Disease Control, PBS News hour

A new report by UNAIDS shows that 19 of the 35 million people living with HIV globally do not know their HIV positive status.    While the report highlights how the efforts to increase access to life-saving antiretroviral treatment (ART) are making a difference, there is much more to be done in order to end the epidemic. According to UNAIDS Executive Director Michele Sidebe,

“Smarter scale-up is needed to close the gap between people who know their HIV status and people who don’t, people who can get services and people who can’t and people who are protected and people who are punished.”

By the end of 2013, the estimated number of people accessing ART globally was nearly 13 million, and AIDS-related deaths were at their lowest since the peak in 2005, having declined by 35%.  “If we accelerate all HIV scale-up by 2020, we will be on track to end the epidemic by 2030,” Sidebe said.   “If not, we risk significantly increasing the time it would take—adding a decade if not more.”

Ending the epidemic by 2030 would avert 18 million new HIV infections and 11.2 million AIDS-related deaths between 2013 and 2030 around the world.

If we accelerate all HIV scale-up by 2020, we will be on track to end the epidemic by 2030

The first of its kind, the UNAIDS Gap Report highlights which countries  account for the highest number of new infections; countries that are being left behind and are facing the triple threat of high HIV burden, low treatment coverage and little or no reductions in new HIV infections; and emphasizes the importance of location and population through in-depth regional analysis of HIV epidemics.  It also identifies 12 populations at higher risk of HIV.   It analyzes reasons for the growing gap between people with access to HIV prevention, treatment, care and support and people who are being left behind; showing how focusing on the underserved and higher risk populations will be the key to ending the epidemic.

Groups at High Risk: HIV prevalence is estimated to be 28 times higher among injecting drug users, 12 times higher among sex workers, 19 times higher among me who have sex with men, and 49 times higher among transgender women than among the rest of the adult population.   In sub-Saharan Africa adolescent girls and young women account for one in four new HIV infections.

“There will be no ending AIDS without putting people first,” Mr. Sidebe said.  “Without a people-centered approach we will not go far in the post-2015 era.”

While much of the media attention and funding focuses in the global pandemic—particularly on hardest hit sub-Saharan Africa–reality is that the US HIV epidemic is an ongoing reality.

According to the US Centers for Disease Control and Prevention (CDC), more than 1.1 million people in the US age 13 and older are living with HIV infection and almost 1 in 6 (15.8%) don’t know they are infected.  The US has about 50,000 new HIV infections per year.   Over the past decade the number of people living with HIV has increased while the annual number of new HIV infections has remained relatively stable at around 50,000.

Every 9.5 minutes someone in the US is diagnosed with HIV

HIV/AIDS is not evenly distributed across the US.   Generally HIV and AIDS are concentrated in urban areas.    In 2009, the number of adults and adolescents living with an HIV diagnosis was highest in the South.   In 2010, blacks accounted for the largest proportion of AIDS diagnoses in the South, Northeast and Midwest.

Men who have sex with men, particularly young African American men, are most seriously affected by HIV, accounting for 78% of new infections in 2010.

Hispanics/Latinos represent 16% of the population but accounted for 21% of new HIV infections in 2010.   In 2010 the rate of new HIV infections for Latino males was 2.9 times that for white males and the rate of infections for Latinas was 4.2 times that for white females.

African Americans continue to experience the most severe burden of HIV compared with other races and ethnicities, representing about 12% of the US population but accounting for 44% of new HIV infections in 2010.   Unless the course of the epidemic changes, at some point in their lifetime an estimated 1 in 16 black men and 1 in 32 black women will be diagnosed with HIV infection.

Note:   Statistics taken from www.aids.gov.

When the global response to HIV/AIDS began there were 10,000 new infections daily; 50,000 people on treatment in Sub-Saharan Africa; health systems totally overwhelmed; and life expectancy declined more than 20 years in some countries. Comparing the quest to end the HIV/AIDS pandemic to President Kennedy’s challenge to put a man on the moon, new Global AIDS Coordinator Ambassador Deboroah Birx described her vision for the third phase of the President’s Emergency Plan for AIDS Relief (PEPFAR) to a Town Hall audience. She set the tone for her vision by describing the situation today in which 6.7 million people are on life-saving treatment; over 1 million babies have been born HIV-free; 4.7 million men have received voluntary male circumcision services; 17 million people received care and support; 21 million people in priority populations have been reached with prevention interventions. In recognition of economic realities, Ambassador Birx said that PEPFAR will need to do more with less and work to expand services by shifting resources toward proven interventions,  concentrating on where they are most needed to have the highest impact.

“We have begun to change the course of the pandemic but we are not done.   This week alone over 4,000 babies were infected, over 7,000 young women were infected and over 24,000 people living with HIV died in Africa.”

Resting on pillars of accountability, transparency and impact Dr. Birx’s strategy focuses on expanding impact, efficiency, sustainability, partnerships and human rights as the blueprint for an AIDS-Free Generation. “We are going to deliver the right thing (core interventions) in the right place (geographically focused; reaching the most vulnerable effectively) at the right time and show how we will achieve success,” Ambassador Birx concluded. “I’m passionate about the possibility of achieving this goal and am reminded that Nelson Mandela said, ‘It seems impossible until it’s done.’   Every single target we have will seem impossible until it’s done.  Controlling the pandemic may seem impossible but I think it can be done.    That’s where each of you every day. . .need to be focused and committed to this goal because we can do it and we can do it together.”