Nearly 80 percent currently have some form of health care coverage. The percent of those without coverage dropped from 25.4 percent in 2011 to 20.7 percent in 2015. According to the second annual Ryan White HIV/AIDS Program Annual Client-Level Data Report, although the percentage of clients retained in care remains stagnant, the percent of those with suppressed viral loads has jumped from 72.6 percent to 83.4 percent, rising nearly 11 percent between 2011 and 2015.
These are two critical indicators in the fight against HIV and these numbers indicate that there are more people who are virally suppressed in the U.S. than ever before. This is particularly good news because we now know that those who are undetectable have virtually no chance of passing HIV to their sexual partners and Treatment as Prevention (TasP) is truly working.
However, the study also reveals that the percentages of Americans with HIV who are retained in care has remained relatively consistent (around 80 percent) since 2011. And both of these finding suggest that reaching the 90-90-90 goals in the next three years may be difficult to achieve. By 2020, the United Nations and numerous jurisdictions around the world have committed to seeing 90 percent of all people living with HIV knowing their status, 90 percent of all people diagnosed with HIV retained in care and receiving antiretroviral therapy, and 90 percent of those receiving antiretroviral therapy having reached viral suppression. This latest study shows that getting that last 10 percent may take even more resources — just as it seems likely the Trump Administration will cut those that already exist.
The study, published this week by the Health Resources and Services Administration’s HIV/AIDS Bureau reviews data collected on the more than 325,000 people who are receiving services through the Ryan White HIV/AIDS Program.
Some of the other key findings:
The RWHAP client population is aging. The number of people aged 50 years and over served by the Ryan White HIV/AIDS Program rose 9 percent, from 33.6 percent in 2011 to 42.5 percent in 2015. To put that into perspective, this change reflects “an increase of over 40,000 clients aged 50 years and older.”
Nearly 75 percent of RWHAP clients are from racial/ethnic minority populations. In 2015, 47 percent identified Black/African American, 23 percent Hispanic/Latino, versus 27 percent of Whites. This distribution has remained consistent since 2011.
Nearly two-thirds of RWHAP clients are living at or below the federal poverty level. Almost 66 percent live at or below the poverty level and women and transgender people are more likely to be living below poverty than men at 75 percent and 80 percent respectively.
Approximately 15 percent of clients lack stable housing, with 10 percent living in temporary housing, and 5 percent having unstable housing situations. Rates were worse among trans people and were particularly bad for trans sex workers who use injection drugs, of whom 19 percent live in temporary housing and 27 percent are in unstable housing situations.
Fewer youths and Native Americans are retained in care. The average for retention in care was around 80 percent but only 73 percent of those who were 20–29 years old, and 75 percent of American Indian/Alaska Natives remained in care and on antiretroviral medication. Also with lower retention percentages were those with unstable housing (70 percent) and — surprisingly — those with private individual or employer insurance (70 and 72 percent respectively).
Young people have the lowest percentages of viral suppression across age groups. In 2015, only 68 percent of those aged 15 to 24 years old had viral suppression; but these numbers do "reflect a 17 percentage point increase for clients aged 15–19 and a 19 percentage point increase for those aged 20–24 from 2011 through 2015." So while work still needs to be done, great strides have been made. Young MSM who also inject drugs (69 percent) and male youth reporting heterosexual contact (68 percent) and youth with unstable housing (67 percent) had lower supression rates, but it was lowest among transgender youth (61 percent), young males who inject drugs (59 percent) and youth with unstable housing (58 percent).
HIV-positive people with unstable housing have lower percentages of viral suppression than clients with stable or temporary housing. In 2015, 69 percent of those with ounstable housing achieved viral suppression, versus 78 percent of those with temporary housing and 85 percent with stable housing.
Transgender women have the lowest percentages of viral suppression across gender subpopulations. Actually the report reveals that the lowest viral suppression rates were for the grouping for the gender subpopulation "Transgender unknown" with 75 percent having viral suppression. (Although the report doesn't detail who is included in the "unkown" category, these may be those who identify as genderqueer or nonbinary, a group who may be at even higher risks for the kind of discrimination that many trans people face). The rates of viral suppression for the report's categories were: Males 84 percent, Females 82 percent, Transgender (male-to-female) 77 percent, and Transgender (female-to-male) 83 percent.