The magnitude of key HIV prevention challenges in the United States: implications for a new national HIV prevention plan

Abstract

The Centers for Disease Control and Prevention has undertaken an advisory process to update its national HIV prevention plan. We offer observations on the magnitude of HIV prevention challenges in the United States and reflect on how these challenges might influence the structure of a new HIV prevention plan. We recommend a plan structure that (1) is based on fundamental principles of prevention, (2) enables accountability and mid-course correction, and (3) if achieved, would result in historic changes in the US HIV epidemic. The recommended plan structure would differentially prioritize serostatus determination and prevention and care interventions for people living with HIV while retaining goals directed at high-risk HIV-negative and general population members.

FIGURE 1—

Key populations for HIV prevention in the United States.

FIGURE 2—

Desirable movement among subpopulations and directions for HIV prevention services in the United States. Note. The arrows show desired directions of population change, and the cross-shaped symbol indicates that all persons living with HIV need to learn of their HIV serostatus and have access to high-quality HIV-related care. The twisted arrow indicates that very low risk levels and non-stigmatizing attitudes should be maintained.