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The new program aims to reduce HIV infection in the US by at least 90% in ten years



President Donald Trump called for the abolition of HIV transmission in the United States by 2030 on the occasion of the Union's speech in February. On Monday, Surgeon General Dr. Jerome M. Adams highlights four key elements of the HIV program – diagnosis, treatment, protection and response in more detail than previously described. The program will focus on the 48 highest-HIV districts and seven high-HIV coun- tries in rural areas, as well as Washington, DC and San Juan (Puerto Rico). The states are Alabama, Arkansas, Kentucky, Mississippi, Missouri, Oklahoma and South Carolina.

"HIV has cost America too much for too long," Adams said at a press conference on Monday. He described two successful medical tools that will be critical to the program: antiretroviral therapy (ART), which can prevent the transmission of HIV, and pre-exposure prophylaxis (PrEP), which can prevent the transmission of HIV to people at risk of infection ,

"If we can identify all infected and vulnerable people with these medical devices, we could theoretically end the epidemic today," Adams said.

Both treatments are already used in the United States. How does HIV spread?

Most new infections are transmitted by only 40% of those infected with HIV ̵
1; people who have either been undiagnosed or diagnosed but have not received treatment, according to the US Department of Health's new Center for Disease Control and Prevention and Vital Signs released on Monday.
However, the majority of people taking antiretroviral therapy can achieve viral suppression within six months of initiating therapy. If HIV-positive people maintain repression through persistence of ART, they can live a long, healthy life effectively without risking the infection of sexual partners, according to the authors of the report.

"Today's treatment regimens are simpler than those prescribed in the past and sometimes only require single-tablet formulations with fewer side effects," the authors wrote. "Despite the availability of effective treatment, many of the 1.1 million people with HIV infection in the United States are not treated effectively."

Only 40% of people with HIV transmit most new infections

In 2016, an estimated 38,700 people have received a new HIV infection.

CDC scientists constructed a model to estimate the relationship between transmission and treatment rates in 2016. In modeling data that includes sexual behavior and the behavior of needles, researchers analyzed the contribution of new transfers to specific groups.

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People who have just been infected and are unaware of their status led to 4% of new infections. Those who were long-term infected and unaware of their status accounted for 33.6% of new infections. Those who were aware of their status but did not receive care accounted for 42.6%. Patients in need of care who were not completely suppressed accounted for 19.8% of new infections.

People living with HIV on viral infection with ART did not contribute to any new infections.

Overall, about 15% of those infected with HIV have an undiagnosed infection. According to the researchers, nearly a quarter (around 23%) is diagnosed but not treated. Just over 1 in 10 people living with HIV (11%) are cared for but not completely suppressed.

"In the future, the percentage of people with HIV infection who have achieved viral suppression and are unable to transmit HIV will become more critical in ending the HIV epidemic in the United States," the authors wrote.

Proper care can suppress viral load and prevent new infections

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