 Division of HIV Health (DHH) just released the 2023 HIV Surveillance Report){kind=link}
Philadelphia announced in 2020 that the city would be participating in an initiative to “end” the HIV epidemic by reducing new diagnoses by 90% in ten years — a goal outlined by a federal plan (known as Ending the HIV Epidemic, or EHE) that guides the city.
That plan includes a milestone of reducing new cases by 75% by 2025 — the initiative’s halfway mark. Although it’s officially 2025, it won’t be clear if Philly has hit that target until data about transmissions through 2025 is collected and analyzed, within the next two years. But the Philadelphia Department of Public Health’s (PDPH) Division of HIV Health (DHH) just released the 2023 HIV Surveillance Report — which includes data about diagnoses through December 31, 2023 and cases reported for a six-month time period that followed.
The report includes the most up-to-date data the city has collected about HIV rates, at-risk populations, and the care and needs that emerge with diagnosis. It provides an idea about how far the city has come and where there’s room for improvement — including comparison points as Philadelphia pursues EHE goals.
New diagnoses
One of the most important metrics the surveillance report has captured since its inception is a record of newly diagnosed HIV cases. This new report shows that 378 new diagnoses were confirmed through June 2024. This number is down slightly from the 2022 report — which noted 391 new diagnoses.
That number is still up from the initiative’s low of 341 new diagnoses in 2020 — but it’s possible that 2020’s report is skewed based on disruptions in HIV testing during the pandemic.
“Covid-19 had a substantial impact on the HIV prevention and care infrastructure in Philadelphia during 2020, especially during the local stay-at-home order that went into effect on March 23, 2020,” the report explains.
New cases in 2023 decreased by approximately 25% since the 2017 baseline of 509 new diagnoses and by approximately 15% since 2019’s pre-pandemic numbers. However, it’s far from the goal of a 75% reduction which the city hopes to achieve in the next year or two.
That goal is to reduce the number of newly confirmed cases to 127 by the time 2025 numbers are reported — which would be a dramatic drop given recent trends that show numbers as closer to stable rather than improving since 2020.
Issues in access to care
New AIDS diagnoses remained stable from 2022, “but remain higher than prior years,” the report notes, underlining that these new and concurrent diagnoses “represent missed opportunities for early testing and care.”
People assigned male at birth, men who have sex with men and non-Hispanic Black men make up those new AIDS diagnoses. Although HIV rates are highest among various minority groups and marginalized people, non-Hispanic Black men who have sex with men continue to have the highest rates of HIV in Philadelphia — underlining a significant problem in supporting this population which is at-risk for transmission and keeping them in care if diagnosed.
This isn’t the only population lacking access to care. After attempts to re-link 864 people back to care in 2023 — resulting in an approximately 62% success rate — the lowest rates of re-linkage among adults were in 25-29 years olds. The top barrier to care by far — affecting 70% of those who faced barriers — was issues with health care providers. The report addresses issues in a lack of culturally-competent care and room for improvement in addressing barriers to access.
An estimated 1586 Philadelphians living with HIV are unaware of their status, accounting for an estimated 8.6% of the city’s population of people living with HIV. The city’s goal is to improve knowledge of status to 95% awareness by 2025 — but current awareness has been lingering around what the report calls a “stable” 90% with very little improvement since 2017.
Improvements in access to care
Efforts to promote viral load suppression — or levels of HIV so low they’re undetectable in the blood — is just above the baseline with approximately 74% of people living with HIV in viral suppression, an improvement from pandemic lows of 67.3%.
Both rates of viral suppression and retention to care are lower than the national average, but linkages to care in Philadelphia are back near baseline after the pandemic — which helps people pursue viral suppression through medical interventions.
“Efforts to restore HIV services and improve access to care [following the pandemic] were the focus of 2021 and continued into 2022,” the report explains.
“During 2023, PHPD increased testing and care engagement opportunities through low threshold sexual health sites, the PEP Center of Excellence, the HIV self-test kit program, and through outreach via the Field Services Program,” the report continues — highlighting many of the ways the city improved access to care that year.
When HIV is undetectable in the blood, it is no longer transmittable. The goal is to get 95% of those living with HIV into suppression by 2025. This is a crucial aspect of reducing transmissions.
PrEP coverage
A surveillance report including transmission rates from 2013 estimated that 700 new cases would be diagnosed per year by 2017 — a figure the city has inched near but never met or surpassed since 2012.
PrEP — which reduces the risk of HIV acquisition by up to 99% when used consistently and as directed — first became available in July 2012. 674 new HIV cases were diagnosed in 2013. With 378 new cases in 2023, Philadelphia saw an approximately 44% improvement in new diagnoses over this past decade. And based on findings from a recent study that highlighted PrEP as key for ending HIV, it’s likely that PrEP usage contributed to that continued decrease.
The city has hit their 2025 goal of improving access to PrEP to 50% of those who are most at-risk. The 2023 report shows that the goal was initially met in 2022 and is slowly continuing to increase.
Programs like Keep on Lovin’ — a telePrEP program that allows users to receive medications through the mail — have supported that goal.
But that doesn’t mean that everyone is using it. Just 3.4% of people who inject drugs have used PrEP despite an ongoing outbreak among this population. Discussions about PrEP with medical providers are especially low in that population and even lower for heterosexual people who are at-risk for transmission. No data was reported about PrEP use for at-risk heterosexual people — but only 1.6% of that population discussed PrEP with medical providers.
Some LGBTQ+ populations are aware of PrEP but don’t necessarily use it, according to data reflected in the 2023 report.
Supporting marginalized populations
“The quality of data on transgender people has not improved at the same pace as surveillance data on the overall population,” the report notes, explaining that this creates hurdles in collecting information about this population and their needs — including misclassifying trans women as men who have sex with men.
In Philadelphia, women of trans experiences and trans-feminine populations are most at-risk for HIV if they experience unstable housing, live below the federal poverty line, or encounter discrimination and abuse.
Homelessness among people living with HIV hit an all-time low during 2020 then skyrocketed but appears to be slowly improving again in overall populations. However, rates significantly increased among Hispanic and Latinx people living with diagnosed HIV, and although rates decreased for non-Hispanic Black people, it remained higher than the overall rate.
Non-Hispanic Black men who have sex with men have the highest rates for PrEP indication.For multiple years in a row, Black men who have sex with men continue to account for the highest rate of new diagnoses and of late diagnoses — posing a serious risk for long-term outcomes.
An emerging campaign — Philly S.A.F.E. — centers the Black, queer community and aims to break stigmas.
“Identifying and removing barriers to PrEP for underserved populations is necessary to improve the PrEP continuum among all groups,” the report noted — underlining that increasing access and removing stigma for some benefits the entire community.