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State of the HIV Epidemic

SUBSTANTIAL PROGRESS
AND
THE CHALLENGES THAT REMAIN

The United States has made enormous strides in HIV treatment, care, and prevention since the epidemic began 40 years ago.1 HIV was once the leading cause of death for young people, but because of scientific advances, fewer people are becoming infected with HIV, and those who do are living longer and healthier lives.2-5 The rate of new HIV infections declined 73% between 1984 and 2019, and the age-adjusted death rate has dropped more than 80% since its peak in 1995.4,6

In some ways, however, progress has stalled; too many people remain unaware of their HIV status, and the uptake of pre-exposure prophylaxis (PrEP) medicine has been slow.7,8

  • In 2019, there were approximately 1.2 million people living with HIV in the US9
  • In 2019, there were 34,800 new infections in the US, which represented an 8% decrease since 20159
  • In 2019, an estimated 1 in 8 people living with HIV in the US did not know they had it7
  • In 2019, about 66% of people living with HIV received some HIV care, 50% were retained in care, and 56% were virally suppressed10 *
  • In 2016, an estimated 1.1 million people in the US were eligible for PrEP medicine based on their risk factors, but only 78,360 people filled prescriptions8

Annual HIV
Infections in the
US, 2015-2019

Graph Showing Annual HIV Infections in the US, 2015-2019Graph Showing Annual HIV Infections in the US, 2015-2019
Source: CDC. Annual HIV
infections in the US, 2015-2019.
 2019 National HIV Surveillance
System Reports
, 2021.

Despite the advancements in HIV prevention and care,4 the state of the epidemic today reminds us of the role stigma and discrimination play in increasing risk. There are many social, economic, and structural barriers that continue to prevent some people from accessing the care they need.11

As a result, progress has been unevenly distributed, with already marginalized groups continuing to bear the brunt of the HIV epidemic.6 These widening disparities can be seen when looking at the data below, which show rates of new infections, treatment, and death among those groups most impacted by HIV.

*Viral suppression means the amount of virus in the blood is so low it cannot be measured by a test (<200 copies/mL). This is sometimes referred to as undetectable. Viral suppression is the ultimate goal of HIV care and treatment.12

Men who have sex with men (MSM) have been the population most impacted by the epidemic since the beginning.13 MSM of color are even more disproportionately impacted by HIV, as issues of stigma and discrimination on the basis of sexual orientation intersect with racism and other social determinants of health. If current rates continue, it is estimated that 1 in 6 MSM will be diagnosed with HIV at some point in their lives.14

  • MSM make up an estimated 2% of the US population, but accounted for 66% of new annual HIV infections in 201715
  • As of 2019, 56% of people living with HIV in the US contracted it through male-to-male sexual transmission16
  • As of 2018, 1 in 6 MSM living with HIV was unaware of their status13
  • Analysis of HIV diagnoses between 2010 and 2016 found that new infections among all MSM in the US remained stable, but they increased 65% among young Black American MSM aged 25 to 34 and 68% among Hispanic/Latino American MSM in that same age group15

New HIV
Diagnoses Among
MSM in the US by Race/Ethnicity, 2019

Graph Showing New HIV Diagnoses Among MSM in the US by Race/Ethnicity, 2019Graph Showing New HIV Diagnoses Among MSM in the US by Race/Ethnicity, 2019
Source: CDC. Diagnoses of HIV infection, by race/ethnicity and selected characteristics, 2019. 
HIV Surveillance Supplemental
Report
. 2019;32.

Black Americans in this country deal with structural racism and inequality that impacts every aspect of their lives from economic stability to education, housing, food security, and healthcare.11 Together, this impact may leave individuals at increased risk for HIV and make them less likely to receive the care they need.4,17 It is not surprising, therefore, that survival after an AIDS diagnosis is lower for Black Americans than for most other racial/ethnic groups or that Black Americans have had the highest age-adjusted death rate due to HIV disease throughout most of the epidemic.4

  • In 2018, Black people made up 13% of the population but accounted for 42% of new HIV diagnoses17
  • As of 2018, an estimated 40% of people living with HIV in the US were Black American17
  • In 2019, Black Americans had the highest rate of new HIV diagnoses at 45 diagnoses per 100,000 people, which was more than 8.5 times the rate for White Americans16
  • Among PrEP medicine users in 2016 for whom race/ethnicity data were available, only about 11% were Black American compared to about 69% who were White American8
  • In 2018, for every 100 Black Americans living with HIV, 63 received some care, 48 were retained in care, and 51 were virally suppressed.* In comparison, for every 100 people of all races living with HIV, 65 received some care, 50 were retained in care, and 56 were virally suppressed17

New HIV
Diagnoses in the US, 2018

Pie Chart Showing New HIV Diagnoses in the US For Black Americans, 2018Pie Chart Showing New HIV Diagnoses in the US For Black Americans, 2018

Black Americans Accounted For
nearly HALF of new
HIV diagnoses in 2018.

Source: CDC. Diagnoses of HIV infection, by race/ethnicity and selected characteristics, 2018. 
HIV Surveillance Supplemental
Report
. 2020;31.

*Viral suppression means the amount of virus in the blood is so low it cannot be measured by a test (<200 copies/mL). This is sometimes referred to as undetectable. Viral suppression is the ultimate goal of HIV care and treatment.12

Hispanic/Latino American communities deal with disproportionate poverty, lower educational levels, and language barriers that can make it harder for people to access the care and services they need. Hispanic Americans are also more likely to be uninsured than any other community. Moreover, some Hispanic/Latino Americans may not utilize the HIV prevention and care services in their area out of fear of disclosing their immigration status.18,19

  • Hispanic/Latino Americans made up approximately 18% of the US population in 2017 but accounted for 27% of new HIV diagnoses in 201818,20
  • In 2019, Latino/x Americans in the US had a diagnosis rate of about 22 diagnoses per 100,000 people, which was 4 times the rate for White Americans4
  • In 2018, most new HIV diagnoses in Hispanic/Latino Americans in the US (85%) were among MSM18
  • As of 2018, 1 in 6 Hispanic/Latino Americans living with HIV in the US was unaware of their status18
  • In 2018, for every 100 Hispanic/Latino Americans living with HIV in the US, 61 received some care, 49 were retained in care, and 53 were virally suppressed.* In comparison, for every 100 people of all races living with HIV, 65 received some care, 50 were retained in care, and 56 were virally suppressed18
  • In one Centers for Disease Control and Prevention (CDC) report from 2017, only 21% of Hispanic/Latino American MSM used PrEP medicine, compared with 31% of White American MSM21

New hiv Diagnoses Among Hispanic/Latino American Men
by Transmission Category, 2018

Pie Chart Showing New HIV Diagnoses in the US For Hispanic/Latino Americans, 2018Pie Chart Showing New HIV Diagnoses in the US For Hispanic/Latino Americans, 2018

The Majority of new
hiv diagnoses
among Hispanic/Latino AMERICAN men in 2018 WERE through male-to-male sexual contact.

Source: CDC. Diagnoses of HIV infection, by race/ethnicity and selected characteristics, 2018. 
HIV Surveillance Supplemental
Report
. 2020;31.

*Viral suppression means the amount of virus in the blood is so low it cannot be measured by a test (<200 copies/mL). This is sometimes referred to as undetectable. Viral suppression is the ultimate goal of HIV care and treatment.12

Data have not historically captured transgender people, so there is still not a complete understanding of HIV among this group.22,23 Data across many fields show that transphobia impacts all aspects of life for transmen and transwomen, from housing and employment to health and safety and puts them at increased risk for HIV.22 Transgender people also face high rates of violence including sexual assault, which can further increase the HIV risk, and are less likely to receive hospital care, including postexposure prophylaxis, after an assault.24

  • In 2018, transgender people accounted for 2% of new HIV diagnoses in the US25
  • A study of transwomen in 7 major US cities from 2019 to 2020 found that 42% of those interviewed were living with HIV26
  • According to an analysis of international studies between 2000 and 2011, transwomen were 49 times more at risk of living with HIV compared to the general population27
  • In 2018, most new HIV diagnoses among transgender people in the US were among Black Americans. Specifically, 40% of new HIV diagnoses in transgender men and 49% of new HIV diagnoses in transgender women were among Black Americans25

In the US, women accounted for approximately 1 in 5 people living with HIV in 2018, yet the narrative of the HIV epidemic often excludes their stories.28 Biological factors (heterosexual sex is more likely to transmit HIV to a woman from her male partner than vice versa) and social factors (including gender discrimination and barriers to accessing reproductive care) put women at increased risk of HIV.29,30 In addition, women are more likely to experience intimate partner violence, which also increases their HIV risk. Women of color are further disproportionately impacted by HIV as they experience stigma and discrimination based on both gender and race.28

  • In 2018, 19% of new HIV diagnoses were among women31
  • The majority of new HIV diagnoses among women (85%) in 2018 were attributed to heterosexual sex, while another 15% were attributed to injection drug use31
  • In 2018, for every 100 women diagnosed with HIV in the US, 76 received some care, 58 were retained in care, and 63 were virally suppressed.* In comparison, for every 100 people diagnosed with HIV, 76 received some care, 58 were retained in care, and 65 were virally suppressed. (Note: These rates are among women diagnosed with HIV and do not account for any women living with HIV who may not be aware they have it)31
  • In 2018, Black American women made up only 13% of the US female population and accounted for over half (58%) of new HIV diagnoses among women. In comparison, White American women accounted for 21% and Latinas for 17% of new HIV diagnoses among women28
  • According to data from 2010 to 2014, the likelihood of a woman in the US being diagnosed with HIV over the course of her lifetime is significantly higher for Black women (1 in 54) and Hispanic/Latina American women (1 in 256) than for White American women (1 in 941)14
  • There has been some progress in recent years, however, with new HIV diagnoses dropping 10% among Black American women and 9% among Hispanic/Latina American women between 2014 and 201831
  • According to the CDC, only 7% of women in the US who would benefit from PrEP medicine were prescribed the prevention regimen in 201832

New HIV
Diagnoses Among Women by Race/Ethnicity in the US, 2018

Bar Graph Showing New HIV Diagnoses in the US For Women By Race/Ethnicity, 2018Bar Graph Showing New HIV Diagnoses in the US For Women By Race/Ethnicity, 2018
Source: CDC. Diagnoses of HIV infection, by race/ethnicity and selected characteristics, 2018. 
HIV Surveillance Supplemental
Report
. 2020;31.

Young people ages 13 to 24 are among those most at risk for HIV as a result of numerous social, biological, and behavioral factors.33,34 In 2008, prevalence data suggested that half of new sexually transmitted infections (STIs) occur in young people (aged 15 to 24), and having certain kinds of STIs can increase the risk of acquiring HIV.35,36 Young people may also have difficulty gaining access to HIV testing, treatment, and prevention for HIV and other STIs because of lack of transportation, inability to pay, or privacy concerns.33,37 Young people who are members of other marginalized communities—including young Black American men and young MSM—face increased stigma and higher risk.4,17

  • 21% of new HIV diagnoses in 2018 were among young people ages 13 to 2433
  • Most new HIV diagnoses among youth (92%) were among young MSM33
  • Young people are less likely to know their HIV status. As of 2018, for every 100 young people living with HIV in the US, only 55 knew their status. In comparison, for every 100 people of all ages living with HIV, 86 knew their status33
  • In 2018, for every 100 young people diagnosed with HIV, 79 received some care, 58 were retained in care, and 60 were virally suppressed.* In comparison, for every 100 people of all ages diagnosed with HIV, 76 received some care, 58 were retained in care, and 65 were virally suppressed. (Note: These rates are among young people diagnosed with HIV and do not account for any young people living with HIV who may not be aware they have it)33
  • According to the CDC, only 11% of young people aged 16 to 24 in the US who could benefit from PrEP medicine were prescribed the prevention regimen in 201838

New HIV
Diagnoses Among Young People in
the US, 2018

Pie Chart Showing New HIV Diagnoses in the US Among Young People, 2018Pie Chart Showing New HIV Diagnoses in the US Among Young People, 2018

Young people ages 13 to 24 accounted for 21% of new HIV diagnoses in 2018.

Source: CDC. Diagnoses of HIV infection, by race/ethnicity and selected characteristics, 2018. 
HIV Surveillance Supplemental
Report
. 2020;31.

*Viral suppression means the amount of virus in the blood is so low it cannot be measured by a test (<200 copies/mL). This is sometimes referred to as undetectable. Viral suppression is the ultimate goal of HIV care and treatment.12

HIV is more prevalent in the South where the epidemic is largely driven by poverty, racism, and lack of access to healthcare. The South has the highest poverty rate, lowest median household income, and greatest percentage of uninsured people (ie, nearly half of Americans without insurance live in the South) in the country.39,40 Yet, fewer people in the South are aware they have HIV which means they do not access care or reach viral suppression.* In addition, non-urban areas in the South are bearing the brunt of the nation’s opioid crisis which put residents at additional risk of HIV. The HIV epidemic in the South illustrates the increased risk among those who identify with more than one marginalized group as HIV is more likely among Black Americans in the South and particularly among Black American MSM.39

  • Data from 2019 showed more than half (51%) of HIV diagnoses occurred in people living in the South even though only 38% of the US population lives in this region39
  • In 2019, 8 of the 10 states and 9 out of 10 metropolitan areas with the highest rates of new HIV diagnoses were in the South39
  • In fact, in 2017, the South had a greater proportion of new HIV diagnoses than all other regions combined39
  • In 2017, the South accounted for 47% of deaths among people with HIV39
  • In 2016, Southerners accounted for only 27% of PrEP medicine users39
  • Black Americans accounted for 53% of new HIV diagnoses in the region in 201739
  • Among Blacks/African Americans in the South, 6 out of 10 new diagnoses in 2017 were in MSM39
  • New HIV diagnoses among Hispanic/Latino American MSM in the South increased 37% between 2012 and 2019 while they decreased by 23% for White MSM in the region during that same time period16,41
  • In 2019, among people living with HIV, the highest percentage of people living with undiagnosed HIV infection was in the Midwest (14.9%) and the South (14.8%), followed by the West (13.9%) and Northeast (8.6%)9
  • In 2018, 81% of new HIV diagnoses among men in the South were transmitted through male-to-male sexual contact, 12% through heterosexual contact, 4% through injection drug use, and 3% through injection drug use and male-to-male sexual contact42
  • In 2018, 77% of new HIV diagnoses among women in the South were transmitted through heterosexual contact and 23% through injection drug use42

Rates of People Living with HIV,
2018

Map of the US Showing Rates of People Living With HIV, 2018Map of the US Showing Rates of People Living With HIV, 2018
Source: AIDSVu. Rates of persons living with HIV, 2018. Local Data: United States. Map data available through J Med Internet Res, 2020.
https://aidsvu.org/local-data/united-states/

Rates of People
Newly Diagnosed
with HIV, 2018

Map of the US Showing Rates of People Newly Diagnosed With HIV, 2018Map of the US Showing Rates of People Newly Diagnosed With HIV, 2018
Source: AIDSVu. Rates of persons newly diagnosed with HIV, 2018. View the Map. Interactive map data available through J Med Internet Res, 2020.
https://map.aidsvu.org/map

*Viral suppression means the amount of virus in the blood is so low it cannot be measured by a test (<200 copies/mL). This is sometimes referred to as undetectable. Viral suppression is the ultimate goal of HIV care and treatment.12

Moving Forward

HIV has gone from a death sentence to a manageable chronic condition with treatment options.5,43 But, as the data show, access to these prevention and treatment options is not always evenly distributed.10 Moving forward, we must focus on ways to lessen the burden of HIV on marginalized communities and recognize that doing so will take collective efforts to overcome the societal barriers that prevent too many members of these communities from accessing the care they need.

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