HIV Deaths Have Dropped by Half in the Past 10 Years: Not all the news is good

The CDC recently reported on the reduction in deaths among people with HIV (see: https://www.cdc.gov/mmwr/volumes/69/wr/mm6946a1.htm). This is an excellent indication of the progress being made in management of HIV care. While encouraging, this news should not leave us feeling complacent or satisfied. A more careful look at the data illuminates serious problems in our healthcare system because at this point, almost no one should be dying from HIV/AIDS-which has become largely a medically manageable condition- and any death should be regarded as a failure.

As noted in this report in the NY Times (https://www.nytimes.com/2020/11/19/health/hiv-aids-death-rates-cdc.html), we have made substantial progress in managing HIV as a result of earlier initiation of antiretroviral treatment and improvements in the social safety net supports for people with HIV through efforts like the federal Ryan White HIV/AIDS program which provides nutritional support, social work, psychiatry and other assistance to those with HIV. The complete array of services is improving outcomes.

Nevertheless, when we examine the rates of death in people with HIV disease in the US, there are startling and disturbing inconsistencies. Among those with HIV infection, deaths are higher among young people, women, people of color and those living in southern states (as opposed to the northeast). As noted by activist James Krellenstein, “a Black person with HIV living in Mississippi is more than 6 times more likely to die of HIV than a white person in NYC”. What all the higher risk groups have in common in lower access to healthcare and other relevant supports. This lower access might come from: lack of available services, lack of health insurance, not knowing how to access services because they are not connected to a system that can help direct them to care and services, or avoidance of obtaining services because of personal of cultural stigma/embarrassment about either HIV or other circumstances (sexual identity, drug use).

What can we learn from this?

These finding provide a powerful reminder that medical science and technology alone are not enough to tackle healthcare challenges. Whether we are considering preventing HIV deaths, managing the COVID19 pandemic or preventing suicides, it is not enough to have the basic medical science tools to address the problems. Unless there is education of healthcare providers and the lay public (to inform about identifying risk and disease and to counteract stigma), ability to identify people who need care and make sure they know how to and feel comfortable getting care, and equitable access to affordable care when needed, we will not be able to make further progress.

Medical knowledge is essential but without public health efforts to bring the knowledge, care and support to individuals, families, and communities we will not save the lives we could be.