Diagnoses of HIV Infection in the United States and Dependent Areas, 2018: Commentary

The Centers for Disease Control and Prevention (CDC) collects, analyzes, and disseminates surveillance data on HIV infection; these data are one of the nation’s primary sources of information on HIV in the United States. The annual surveillance report, published by CDC, summarizes information about diagnosed HIV infection in the United States and dependent areas. HIV surveillance data are used by CDC’s public health partners in other federal agencies, health departments, nonprofit organizations, academic institutions, and the general public to help focus prevention efforts; plan services; allocate resources; develop policy; detect, monitor, and intervene in HIV clusters; and monitor trends in HIV infection.

Numbers and rates of diagnoses of HIV infection during 2014–2018 are based on data from all 50 states, the District of Columbia, and 6 U.S. dependent areas (American Samoa, Guam, the Northern Mariana Islands, Puerto Rico, the Republic of Palau, and the U.S. Virgin Islands). When presenting rates by race/ethnicity, data are only provided for the United States (50 states and the District of Columbia) because denominator data are not available by race/ethnicity for all U.S. dependencies.

During 2014–2018, the annual number and rate of diagnoses of HIV infection decreased in both the United States and 6 dependent areas. Although numbers and rates decreased overall, diagnoses of HIV infection increased in some subgroups and decreased in others. Variations in trends among groups are expected and may be due to differences in testing behaviors, targeted HIV testing initiatives, or changes in the numbers of new HIV infections (incidence) in some subgroups. For information and data on trends among selected populations, see the national and special focus profile sections.

Recognizing the changing needs for data, CDC has transitioned to publishing the annual report earlier in the calendar year. The updated 2018 report is presented in a new format that includes figures and tables that provide additional stratifications by birth sex and gender for multiple years (2014–2018), and includes data reported to CDC’s National HIV Surveillance System (NHSS) through December 31 of the prior year (instead of June 30). The use of data reported to CDC through December will allow for a 12-month reporting delay and assessment of trends through the most recent diagnosis, death, and prevalence year.

• This report is presented in a new, digital format that includes figures based on charts and maps from the HIV surveillance slide sets.
• Data on prevalence and deaths are based on a 12-month reporting delay instead of the previous 18-month reporting delay. Therefore, data are presented for the most recent year (2018). Death and prevalence data for the year 2018 are preliminary and based on death data received by CDC through December 2019. Therefore, death and prevalence trends through 2018 should be interpreted with caution.
• Tables were added and display data for transgender persons (Tables 4a/b, 13a/b, and 17a/b) and data for sex at birth (Tables 12a/b and 16a/b) by age, race/ethnicity, and region of residence for multiple years (2014–2018).
• Tables 1a/b, 2a/b, and 9 display data for diagnoses of HIV infection attributed to perinatal exposure as a separate transmission category among adults and adolescents.
• A special focus profiles section was added to highlight 5 key populations: (1) transgender persons, (2) gay, bisexual, and other men who have sex with men (MSM), (3) persons who inject drugs (PWID), (4) women, and (5) children aged less than 13 years.
• Data for stage 3 (AIDS) are no longer presented in tables. The data formerly displayed in the stage 3 (AIDS) tables are available via Atlas Plus (for 2000 through the most recent year) and in the AIDS trends slide set (for cumulative data from 1985 through the most recent year).