The widespread use of antiretroviral treatment made HIV prevalence no longer a good measure of population-level transmission risk. The objective of this analysis was to use the prevalence of unsuppressed HIV to describe population-level HIV transmission risk.Methods:
Using New York City (NYC) HIV surveillance data, we reported HIV prevalence and the prevalence of unsuppressed HIV, defined as the number of persons living with HIV with an unsuppressed viral load divided by population size.Results:
The estimated number of persons living with HIV in NYC increased from 79,100 [95% confidence interval (CI): 78,200 to 80,000] in 2010 to 81,700 (95% CI: 80,500 to 82,900) in 2014. HIV prevalence (≥18 years old) remained unchanged at 1.22% (95% CI: 1.21% to 1.24%) in 2010 and 1.22% (95% CI: 1.20% to 1.24%) in 2014. The prevalence of unsuppressed HIV (≥18 years old) steadily decreased from 0.49% (95% CI: 0.48% to 0.51%) in 2010 to 0.34% (95% CI: 0.32% to 0.36%) in 2014. Men had both higher HIV prevalence (1.86% vs. 0.65% in 2014) and higher prevalence of unsuppressed HIV (0.51% vs. 0.18% in 2014) than women. In 2014, the black–white ratio of prevalence of unsuppressed HIV was 5.8 among men and 26.3 among women, and the Hispanic–white ratio was 2.7 among men and 10.0 among women.Conclusions:
The prevalence of unsuppressed HIV has been steadily decreasing in NYC. As antiretroviral treatment continues to expand, programs should consider using the prevalence of unsuppressed HIV to measure population-level transmission risk.