Sec. 7202. Findings
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/bill/117/s/4486/is/section-7202·A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
The Congress finds the following: Over 1,100,000 people are estimated to be living with HIV in the United States according to the Centers for Disease Control and Prevention, 14 percent of whom are unaware they are living with HIV. The Centers for Disease Control and Prevention estimates that, in 2019, there were approximately 34,800 people newly diagnosed with HIV. New HIV infections declined 8 percent from 37,800 in 2015, after a period of general stability. From 2015 to 2019, new infections among young gay and bisexual men (ages 13 to 24) dropped 33 percent overall, with declines in young men of all races, but African Americans, Hispanics, and Latinos continue to be severely and disproportionately affected.
HIV disproportionately affects certain populations in the United States. Though Blacks/African Americans represent approximately 13 percent of the population, they account for almost half (44 percent) of all people living with HIV in the United States. Black/African-American men who have sex with men account for 26 percent of all new HIV infections and have remained stable from 2010 to 2019. Disparities continue to exist among Latinos and Hispanics; in 2019, Latinos and Hispanics made up 18 percent of the United States population and 30 percent of new infections.
Though the rate of new infections among American Indians and Alaska Natives (referred to in this section as AI/AN ) is proportional to their population size, from 2015 to 2019, the annual number of HIV diagnoses increased among American Indians and Alaska Natives. Asian Americans account for about 2 percent of new HIV infections, but in 2013, 22 percent were undiagnosed, the highest rate of undiagnosed HIV among any race or ethnicity. Between 2010 and 2016, the number of Asian Americans receiving an HIV diagnosis increased by 42 percent.
The latest data from the Centers for Disease Control and Prevention indicates that new infections among women remained stable in 2019. The history of HIV shows that culturally relevant and gender-responsive supportive services, including psychosocial support, treatment literacy, case management, and transportation are necessary strategies to reach and engage women and girls in medical care. From 2015 through 2019 in the United States and 6 dependent areas, the number of diagnoses of HIV infection for transgender adults and adolescents increased.
In 2019, among transgender adults and adolescents, the largest percentage (93 percent) of diagnoses of HIV infections was for transgender male-to-female
(MTF)people. By age, in 2019, the largest percentage (24 percent) of diagnoses of HIV infection among transgender persons was for transgender MTF adults and adolescents aged 20 to 24 years, followed by transgender MTF adults and adolescents aged 25 to 29 years (23 percent). Stigma and discrimination contribute to such disparities. The Centers for Disease Control and Prevention has determined that increasing the proportion of people who know their HIV status is an essential component of comprehensive HIV treatment and prevention efforts and that early diagnosis is critical in order for people with HIV to receive life-extending therapy. Additionally, the Centers for Disease Control and Prevention recommends routine HIV screening in health care settings for all patients aged 13 to 64, regardless of risk. In 1998, Congress created the National Minority AIDS Initiative to provide technical assistance, build capacity, and strengthen outreach efforts among local institutions and community-based organizations that serve racial and ethnic minorities living with or vulnerable to HIV. To combat the HIV epidemic in the United States, the National HIV/AIDS Strategy (referred to in this section as NHAS ) provides a framework of increasing access to care, reducing new infections, and eliminating HIV-related health disparities. The vision of NHAS is The United States will be a place where new HIV infections are prevented, every person knows their status, and every person with HIV has high-quality care and treatment, lives free from stigma and discrimination, and can achieve their full potential for health and well-being across their lifespan. This vision includes all people, regardless of age, sex, gender identity, sexual orientation, race, ethnicity, religion, disability, geographic location, or socioeconomic circumstance. . In January 2019, the Department of Health and Human Services began implementing the initiative Ending the HIV Epidemic: A Plan for America . The initiative seeks to reduce the number of new HIV infections in the United States by 75 percent by 2025, and then by at least 90 percent by 2030, for an estimated 250,000 total HIV infection averted. At present, many States and United States territories have criminal statutes based on exposure to HIV. Most of these laws were adopted before the availability of effective antiretroviral treatment for HIV/AIDS. Research shows that stable housing leads to better health outcomes for those living with HIV. Inadequate or unstable housing is not only a barrier to effective treatment, but also increases the likelihood of engaging in risky behaviors leading to HIV infection. Insecure housing puts people with HIV/AIDS at risk of premature death from exposure to other diseases, poor nutrition, and lack of medical care. Due to advances in treatment, many people living with HIV today are living healthy lives and have the ability and desire to fully participate in all aspects of community life, including employment. Research associates being employed with tremendous economic, social, and health benefits for many people living with HIV. Despite the tremendous progress made in the treatment and prevention of HIV/AIDS, discriminatory policies stemming from continued stigmatization of HIV/AIDS and the LGBTQ+ community continue to plague the scientific community. This includes blood donation guidance updated by Food and Drug Administration in 2020 that recommends a 3-month deferral policy for gay and bisexual men before they are eligible to donate blood. Health agencies in the United States must implement blood donation policies that are grounded in science and that do not unfairly single out any group of individuals. The common benefits associated with employment include income, autonomy, productivity, status within society, daily structure, making a contribution to one’s community, and increased skills and self-esteem. Research also indicates that many people with disabilities, including people living with HIV, report perceiving themselves as being less disabled or not disabled at all, when working. Furthermore, some studies link working with better physical and mental health outcomes for people living with HIV when compared to those who are not working. Preliminary data also suggest that transitioning to employment is associated with reduced HIV-related health risk behavior for many people. In July 2012, the Food and Drug Administration approved the first drug to be used as pre-exposure prophylaxis (PrEP). PrEP reduces the risk of HIV infection in HIV-negative individuals. Studies have shown that PrEP reduces HIV transmission from sex by about 99 percent when taken consistently. Despite increases in PrEP uptake, PrEP use remains low among gay and bisexual men of color. The Centers for Disease Control and Prevention found that uptake was lower among African-American (26 percent) and Latino (30 percent) men compared with White men (42 percent). Similarly, PrEP awareness was lower among African-American (86 percent) and Latino (87 percent) men compared with White men (95 percent). While clinical research on transgender populations and PrEP is currently limited, the Centers for Disease Control and Prevention recommends PrEP use in transgender populations. In September 2019, the Food and Drug Administration approved the second drug to be used as PrEP. Syringe service programs have been associated with lowered HIV infections, lower hepatitis C infections, and increased linkage to substance use treatment. There is now conclusive scientific evidence that a person living with HIV who is on antiretroviral therapy and is durably virally suppressed (defined as having a consistent viral load of less than 200 copies/ml) does not sexually transmit HIV. The conclusive evidence about the highly effective preventative benefits of antiretroviral therapy provides an unprecedented opportunity to improve the lives of people living with HIV, improve treatment uptake and adherence, and advocate for expanded access to treatment and care.