Monitoring Selected National HIV Prevention and Care Objectives By Using HIV Surveillance Data United States and 6 Dependent Areas, 2020: Commentary

The Centers for Disease Control and Prevention (CDC) collects data to monitor progress toward achieving national goals and the objectives set forth in federal directives [1–4]. This surveillance supplemental report complements the 2020 HIV Surveillance Report [5] and presents the results of focused analyses of National HIV Surveillance System (NHSS) [6] data to measure progress toward achieving HIV prevention and care goals [1–3]. Data in this report are also used to monitor progress toward the HIV-related national objectives in Healthy People 2030, the National HIV/AIDS Strategy (2022–2025), and the Ending the HIV Epidemic in the U.S. (EHE) initiative [1–4].

Impact of COVID-19 Pandemic

For this report, due to the impact of the COVID-19 pandemic on HIV testing in the United States during 2020, HIV diagnosis, death, and prevalence trends through 2020 are not discussed in the Commentary [7–10]. The overall number of HIV diagnoses in the United States in 2020 (30,403) was 17% lower than in 2019 (36,585) [5]. The steep reduction in diagnoses in 2020 is likely due to disruptions in clinical care services, patient hesitancy in accessing clinical services, and shortages in HIV testing reagents/materials, which causes concern regarding underdiagnosis [7–10]. Although state/local health departments developed innovative strategies for HIV-related testing (self-tests) and care services (telehealth) during the COVID-19 pandemic, these strategies did not make up for declines in laboratory reporting because self-test results are not routinely reported to health departments or CDC [11, 12]. In addition, telehealth visits might not have included orders for laboratory testing during periods of strict social distancing or patients may have been reluctant to complete testing.

As the COVID-19 pandemic is still ongoing, more time and data are needed to accurately assess COVID-19’s impact on HIV in the United States. Data for the year 2020 should be interpreted with caution due to the impact of the COVID-19 pandemic on access to HIV testing, care-related services, and case surveillance activities in state/local jurisdictions. To emphasize the need for caution, tables presenting data for the year 2020 include “COVID-19 pandemic” in the title, and the 2020 column is highlighted in tables that provide multiple years of data. Assessment of trends in HIV diagnoses, deaths, and prevalence that include the year 2020 is discouraged.

Report Changes

• Terminology for gender and transmission category labels were updated.
• Risk factor data for transgender and additional gender identity persons have been added. Data are presented using the exposure category classification, which is meant to convey all the known ways a person could have been exposed to HIV (see Technical Notes for more information on exposure category).
• The Prevalence-based HIV Care Continuum table and associated data are not included in this issue of the report due to the lack of prevalence and knowledge of status estimates for the year 2020.