HIV and Native Hawaiians and Other Pacific Islanders

Although Native Hawaiians and Other Pacific Islanders (NHOPI)a account for a very small percentage of new HIV diagnosesb in the United States (US) and dependent areas,c HIV affects NHOPI in ways that are not always apparent because of their small population size. In 2018, NHOPI made up 0.2% of the US population.d

The Numbers

HIV Diagnoses

Of the 37,968 new HIV diagnoses in the US and dependent areas in 2018, less than 1 percent (68) were among Native Hawaiians and Other Pacific Islanders (NHOPI).
New HIV Diagnoses Among NHOPI in the US and Dependent Areas by Sex* and Transmission Category, 2018
Among NHOPI women, 100 percent of diagnoses were attributed to heterosexual contact.
Among NHOPI men, 84 percent of diagnoses were attributed to male-to-male sexual contact, 6 percent were attributed to heterosexual contact, 6 percent were attributed to male-to-male sexual contact and injection drug use, 3 percent were attributed to injection drug use.

* Based on sex at birth and includes transgender people. Total for men may not equal 100% due to rounding.
Source: CDC. Diagnoses of HIV infection in the United States and dependent areas, 2018 (updated)HIV Surveillance Report 2020;31.

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HIV diagnoses increased 51% (from 45 to 68) among NHOPI overall from 2014 to 2018.

HIV Diagnoses Among NHOPI in the US and Dependent Areas, 2014-2018*†
NHOPI men increased 80 percent and NHOPI women decreased 44 percent.

* Changes in subpopulations with fewer HIV diagnoses can lead to a large percentage increase or decrease.
Based on sex at birth and includes transgender people.
Source: CDC. Diagnoses of HIV infection in the United States and dependent areas, 2018 (updated)HIV Surveillance Report 2020;31.

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Living With HIV

Adult and Adolescent NHOPI With HIV in the 50 States and District of Columbia
At the end of 2018, an estimated 1.2 million people had HIV. Of those, 1,100 were NHOPI.
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It is important for NHOPI to know their HIV status so they can take medicine to treat HIV if they have the virus. Taking HIV medicine every day can make the viral load undetectable. People who get and keep an undetectable viral load (or stay virally suppressed) have effectively no risk of transmitting HIV to HIV-negative sex partners.

Compared to all people with HIV, NHOPI have about the same viral suppression rates. For every 100 NHOPI with HIV in 2016, 60 received some HIV care, 43 were retained in care, and 54 were virally suppressed. For comparison, for every 100 people overall with HIV, 64 received some HIV care, 49 were retained in care, and 53 were virally suppressed.
Compared to all people with HIV, NHOPI have about the same viral suppression rates. For every 100 NHOPI with HIV in 2016, 60 received some HIV care, 43 were retained in care, and 54 were virally suppressed. For comparison, for every 100 people overall with HIV, 64 received some HIV care, 49 were retained in care, and 53 were virally suppressed.

* Had 2 viral load or CD4 tests at least 3 months apart in a year.
† Based on most recent viral load test.
Source: Estimated HIV incidence and prevalence in the United States 2014–2018 pdf icon[PDF – 3 MB]. HIV Surveillance Supplemental Report 2020;25(1).
Source: CDC. Selected national HIV prevention and care outcomes  pdf icon[PDF – 2 MB](slides).

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Deaths

In 2018, there were 15 deaths among NHOPI with diagnosed HIV in the US and dependent areas. These deaths may be due to any cause.

Prevention Challenges

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Socioeconomic issues. Poverty, inadequate or no health care coverage, language barriers, and lower educational attainment may make it harder for some NHOPI to get HIV testing and care.

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Cultural factors. NHOPI cultural customs, such as not talking about sex across generations, may stigmatize sexuality in general and homosexuality specifically. This could result in lower use of HIV prevention methods like condoms.

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Limited research. With limited research about NHOPI health and HIV, creating targeted HIV prevention programs and behavioral interventions for this population can be challenging.

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Data limitations. The reported number of HIV cases among NHOPI may not reflect the true HIV diagnoses in this population because of race/ethnicity misidentification. This could lead to an underestimation of HIV infection in this population.

What CDC Is Doing

CDC is pursuing a high-impact HIV prevention approach to maximize the effectiveness of HIV prevention interventions and strategies. Funding state, territorial, and local health departments and community-based organizations (CBOs) to develop and implement tailored programs is CDC’s largest investment in HIV prevention. This includes longstanding successful programs and new efforts funded through the Ending the HIV Epidemic initiative. In addition to funding health departments and CBOs, CDC is also strengthening the HIV prevention workforce and developing HIV communication resources for consumers and health care providers.

  • Under the integrated HIV surveillance and prevention cooperative agreement, CDC awards around $400 million per year to health departments for HIV data collection and prevention efforts. This award directs resources to the populations and geographic areas of greatest need, while supporting core HIV surveillance and prevention efforts across the US.
  • In 2019, CDC awarded $12 million to support the development of state and local Ending the HIV Epidemic plans in 57 of the nation’s priority areas. To further enhance capacity building efforts, CDC uses HIV prevention resources to fund the National Alliance of State and Territorial AIDS Directors (NASTAD) $1.5 million per year to support strategic partnerships, community engagement, peer-to-peer technical assistance, and planning efforts.
  • In 2020, CDC will award around $109 million per year to support the implementation of state and local Ending the HIV Epidemic plans with a five-year funding program.
  • Under the flagship community-based organization cooperative agreement, CDC awards about $42 million per year to community organizations. This award directs resources to support the delivery of effective HIV prevention strategies to key populations.
  • In 2019, CDC awarded a cooperative agreement to strengthen the capacity and improve the performance of the nation’s HIV prevention workforce. New elements include dedicated providers for web-based and classroom-based national training, and technical assistance tailored within four geographic regions.
  • Through its Let’s Stop HIV Together campaign, CDC offers resources about HIV stigma, testing, prevention, and treatment and care. This campaign is part of the Ending the HIV Epidemic.


a Adult and adolescent Native Hawaiians and Other Pacific Islanders aged 13 and older.
b HIV diagnoses refers to the number of people who received an HIV diagnosis during a given time period, not when the people got HIV infection.
c Unless otherwise noted, the term United States (US) includes the 50 states, the District of Columbia, and the 6 dependent areas of American  Samoa, Guam, the Northern Mariana Islands, Puerto Rico, the Republic of Palau, and the US Virgin Islands.
d The US Census Bureau’s population estimates include the 50 states, the District of Columbia, and Puerto Rico.

  1. CDC. Diagnoses of HIV infection in the United States and dependent areas, 2018HIV Surveillance Report 2020;31.
  2. CDC. Estimated HIV incidence and prevalence in the United States, 2014-2018 pdf icon[PDF – 3 MB]HIV Surveillance Supplemental Report 2020;25(1).
  3. CDC. Monitoring selected national HIV prevention and care objectives by using HIV surveillance data—United States and 6 dependent areas, 2017 pdf icon[PDF – 3 MB]HIV Surveillance Supplemental Report 2019;24(3).
  4. CDC. Selected national HIV prevention and care outcomes pdf icon[PDF – 3 MB] (slides).
  5. Adih WK, Campsmith M, Williams CL, Hardnett FP, Hughes D. Epidemiology of HIV among Asians and Pacific Islanders in the United States, 2001-2008. J Int Assoc Physicians AIDS Care (Chic) 2011;10(3):150-9. PubMed abstractexternal icon.
  6. DiStefano AS, Hui B, Barrera-Ng A, et al. Contextualization of HIV and HPV risk and prevention among Pacific Islander young adults in Southern California. Soc Sci Med 2012;75(4):699-708. PubMed abstractexternal icon.
  7. Takahashi LM, Kim AJ, Sablan-Santos L, et al. HIV testing behavior among Pacific Islanders in Southern California: Exploring the importance of race/ethnicity, knowledge, and domestic violence. AIDS Educ Prev 2011;23(1):54-64. PubMed abstractexternal icon.