A decade ago, we called for applying public health principles to the human immunodeficiency virus (HIV) epidemic in the United States. Over the past decade, U.S. health departments, community organizations, and health care providers have expanded HIV screening and targeted testing, and as a result a greater proportion of HIV-infected people are now aware of their infection; the number of reported new diagnoses of HIV infection has decreased; and people with HIV infection are living longer. We have more sensitive diagnostic tests; more effective medications and medications with better side-effect profiles; rigorous confirmation that treatment prevents the spread of HIV and improves the health of infected people; and documentation of the potential benefit of preexposure prophylaxis for some high-risk people.
Despite this progress, most people living with HIV infection in the United States are not receiving antiretroviral treatment (ART); notification of partners of infected people remains the exception rather than the norm; and several high-risk behaviors have become more common. Anal sex without a condom has become more common among gay and bisexual men and there appears to be an increased number of people sharing needles and other injection paraphernalia. The number of new infections has increased among younger gay and bisexual men, particularly black men. Although surveillance has improved, data-driven targeted interventions are not being rapidly and effectively implemented in most geographic areas. Much more progress is possible through further application of public health principles by public health departments and the health care system and, most important, through closer integration of health care and public health action.
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