Mixed Progress in Combating Infectious Diseases

While some progress has been made in the fight against HIV, tuberculosis (TB), viral hepatitis, and sexually transmitted infections (STIs), significant challenges remain in the United states, mirroring trends observed in Europe. A recent report highlighted that “the estimated number of new HIV infections has declined by 35% as the 2010 baseline in the EU/EEA,” but the report also cautioned that “progress is slower than needed to reach the 2025 interim target.” this mirrors the situation in the U.S., where HIV infection rates have decreased, but disparities persist, and the goal of ending the HIV epidemic remains elusive.

The Centers for Disease Control and Prevention (CDC) estimates that in 2021, over 32,000 new HIV infections occurred in the United States. While this represents a significant decrease from the peak of the epidemic, the rate of decline has slowed in recent years. Furthermore, certain populations, including men who have sex with men (MSM), racial and ethnic minorities, and people living in the Southern U.S., continue to be disproportionately affected.

HIV: Prevention and Treatment Gaps

The report indicates that “HIV testing and treatment progress is encouraging, but reaching the undiagnosed and ensuring linkage to care remains a challenge across the EU/EEA.” This is also true in the U.S. An estimated 13% of people living with HIV in the United States are unaware of thier status, according to the CDC. Reaching these individuals with testing and linking them to prompt treatment is crucial to preventing further transmission and improving their health outcomes. “The use of prevention tools, such as pre-exposure prophylaxis (PrEP) for HIV, is increasing but needs further scaling-up,” the report states. While PrEP has been a game-changer in HIV prevention, its uptake remains uneven across the U.S., particularly among communities most at risk.

For example, a recent study published in *JAMA Network Open* found that PrEP coverage was considerably lower among Black and Hispanic/Latino MSM compared to White MSM, despite the higher HIV incidence rates in these populations. Factors contributing to this disparity include lack of awareness, stigma, cost, and limited access to healthcare.

Tuberculosis: A Persistent Threat

Regarding tuberculosis,the report notes that “the estimated incidence has decreased by 35% since 2015,but success rates for TB treatment remain below the 90% target,particularly for drug-resistant TB.” While TB rates in the U.S. are relatively low compared to other parts of the world, cases have plateaued in recent years, and drug-resistant TB remains a serious concern. The CDC reported 8,300 cases of TB in the U.S. in 2022. Multidrug-resistant TB (MDR-TB) poses a significant challenge, requiring longer and more complex treatment regimens with perhaps severe side effects.

Addressing TB requires a multifaceted approach, including improved screening and diagnosis, effective treatment regimens, and strategies to address social determinants of health that increase TB risk, such as homelessness and poverty.

Viral Hepatitis: A Silent Epidemic

Viral hepatitis B and C are major public health concerns, and according to the report, “viral hepatitis B and C cause the majority of the nearly 57 000 annual deaths attributed to AIDS, TB and viral hepatitis in the EU/EEA.” In the U.S., the CDC estimates that millions of people are living with chronic hepatitis B or C, many of whom are unaware of their infection. “For hepatitis B and C, the available facts suggests significant shortfalls in reaching testing and treatment coverage targets, and mortality rates show no signs of decline,” the report highlights, a trend mirrored in the U.S. These infections can lead to liver damage,cirrhosis,liver cancer,and death.

Effective treatments are available for hepatitis C, and vaccination can prevent hepatitis B. Though, challenges remain in scaling up testing and treatment, particularly among marginalized populations. High drug costs and limited access to specialized care are significant barriers to hepatitis C treatment in many parts of the U.S.

Rising STI Rates: A Cause for Concern

The report also notes alarming trends regarding STIs: “Reported cases of STIs such as syphilis and gonorrhoea are increasing across the EU/EEA, reaching the highest numbers since surveillance by ECDC began in 2009.” This mirrors the situation in the U.S., where STI rates have been steadily rising for years, according to the CDC. Syphilis,gonorrhea,and chlamydia are all on the rise,posing a significant threat to public health. “Data on testing and treatment coverage for STIs are largely unavailable,complicating the overall picture,” the report adds,something that also hinders effective interventions in the U.S.

Increased awareness, regular testing, and prompt treatment are essential to controlling the spread of STIs. Public health campaigns that promote safe sex practices and encourage regular STI screening are needed to reverse this alarming trend.

Call to Action: Scaling Up Prevention and Treatment

To achieve the goals of reducing the burden of infectious diseases, a complete and coordinated effort is needed, both in the U.S. and globally. The report emphasizes that “in order to reach the 2030 targets, efforts must be made to scale up prevention interventions like PrEP for HIV, hepatitis B vaccination, and harm reduction services for people who inject drugs, alongside promoting condom use.” This includes increasing access to PrEP for those at risk of HIV, expanding hepatitis B vaccination programs, and providing comprehensive harm reduction services, such as syringe exchange programs, for people who inject drugs. “It is also crucial to expand integrated testing services for multiple infections in various settings, including community-based testing, to reach those at risk at an earlier stage,” the report asserts.

Moreover, “improving linkage to care and supporting treatment adherence is vital for improving individual outcomes and preventing onward transmission, especially for TB and viral hepatitis.” This requires addressing barriers to care, such as stigma, discrimination, and lack of access to affordable healthcare. Patient navigation programs and other support services can help individuals stay engaged in treatment and achieve optimal health outcomes.

the Importance of Data and Surveillance

Accurate and timely surveillance data are essential for tracking progress and identifying emerging threats. “Strengthening the quality and completeness of surveillance and monitoring data is essential, as is collecting data specific to the key populations most affected by these infections,” the report emphasizes. This includes improving data collection on HIV,TB,viral hepatitis,and STIs,as well as gathering data on risk factors,demographics,and access to care. “To reduce mortality from preventable diseases, sustained efforts are needed, and improving the availability and quality of surveillance data is fundamental to track progress accurately.”

Counterargument: Are Resources Better Spent Elsewhere?

Some might argue that with limited public health resources,focusing on other pressing health issues,such as cancer or heart disease,would yield a greater return on investment. While these diseases are undoubtedly critically important, neglecting infectious diseases would be a grave mistake. Infectious diseases can spread rapidly, disproportionately affect vulnerable populations, and have significant economic consequences. Furthermore, investments in infectious disease prevention and control can have broader benefits for the healthcare system, such as strengthening public health infrastructure and improving access to care for all.

FAQ: Understanding Infectious Diseases

What are the primary ways HIV is transmitted?

HIV is primarily transmitted thru unprotected sex, sharing needles, syringes, or other drug injection equipment, and from mother to child during pregnancy, childbirth, or breastfeeding.

How can I lower my risk of contracting an STI?

Consistent and correct use of condoms,limiting the number of sexual partners,getting vaccinated (for HPV and hepatitis B),and regular STI testing can significantly lower your risk.

Is there a cure for hepatitis C?

Yes,highly effective antiviral treatments can cure hepatitis C in most people. Early diagnosis and treatment are crucial to prevent liver damage.

What are the symptoms of tuberculosis (TB)?

Common symptoms of TB include persistent cough, fever, night sweats, weight loss, and fatigue. However, many people with TB infection have no symptoms (latent TB).

Where can I get tested for HIV and other STIs?

You can get tested at your doctor’s office, local health departments, community health centers, and free clinics. Many at-home testing options are also available.