Human Immunodeficiency Virus in the State of Texas of the United States: Past Reflections, Present Shortcomings, and Future Needs of the Public Health Response

Abstract

A strategy titled "Ending the HIV Epidemic: A Plan for America" aims to reduce human immunodeficiency virus (HIV) incidence in the United States by at least 90% by 2030, using diagnosis, treatment, and prevention strategies. Texas is a Southern state that has one of the highest numbers of new HIV diagnoses and people with HIV in the country, and where HIV disproportionately impacts minorities. We retrace the historical epidemic in its largest city, Houston, to illustrate the lessons learned and milestones accomplished, which could serve as guideposts for the future. We examine the current epidemic in Texas, including the achieved levels of HIV testing, treatment continua, and pre-exposure prophylaxis prescription, and compare and contrast these with the national estimates and Plan targets. Our findings call for urgent and accelerated expansion of efforts to end HIV in Texas.

Keywords: EHE; HIV; Houston; Texas; epidemic.

Figure 1.

Forty-eight highest burden counties, Washington DC, and San Juan, Puerto Rico, that accounted for more than 50% of new human immunodeficiency virus (HIV) diagnoses during 2016 and 2017 are shown in purple. Seven states with substantial rural burdens of HIV are shown in blue. Adapted from Centers for Disease Control and Prevention. Ending the HIV epidemic. Available at: https://www.cdc.gov/endhiv/index.html. Accessed 17 July 2020.

Figure 2.

(Top) Mary’s bar located on Westheimer Avenue in Houston was a prominent place of support and family for the community. Credit: JD Doyle, HoustonLGBTHistory.org. (Center) George Foreman, right, with Director of Houston AIDS Foundation and Adan Rios, donates a check for the Food Pantry. Credit: Dr. Adan Rios. (Bottom) John Lawrence (left) and Tyron Garner recite the Pledge of Allegiance at a Houston rally after the Supreme Court’s 2003 decision in Lawrence v. Texas. Credit (original photograph owner): © 2018 The Dallas Morning News, Inc.

Figure 3.

New human immunodeficiency virus (HIV) diagnoses, persons with HIV (PWH), and deaths among PWH in Texas (1980–2019). Adapted from Texas Health and Human Services. Patterns in new HIV diagnoses and HIV prevalence, Texas 2018. Available at: https://dshs.texas.gov/hivstd/reports/. Accessed 17 July 2020.

Figure 4.

Texas and Harris County diagnosis-based human immunodeficiency virus (HIV) care continuum, 2018. Data source [5]; HIV diagnosed = persons with HIV alive at year-end 2018; Met need = ≥1 CD4 or viral load (VL) test during 2018; Retained in care = ≥2 CD4 or VL tests performed at least 3 months apart during 2018. Virally suppressed = VL test <200 copies/mL in 2018.