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

HIV Surveillance Report: Diagnoses of HIV Infection in the United States and Dependent Areas, 2018 (Updated)

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Figure 1. Rates of Diagnoses of HIV Infection among Adults and Adolescents, 2018—United States and 6 Dependent Areas

In the United States and 6 dependent areas, the overall rate in 2018 was 11.5 per 100,000 population; among adults and adolescents, the rate was 13.6 per 100,000 population. The District of Columbia (i.e., Washington, DC) is a city; use caution when comparing the HIV diagnosis rate in DC with the rates in states.

Figure 2. Diagnoses of HIV Infection among Adults and Adolescents, by Gender, 2014–2018—United States and 6 Dependent Areas

From 2014 through 2018 in the United States and 6 dependent areas, the number of diagnoses of HIV infection for transgender male-to-female (MTF) and transgender female-to-male (FTM) adults and adolescents increased. The number of diagnoses among male and female adults and adolescents decreased.

Note: See Data Tables, Definitions, and Acronyms for more information on gender.

Figure 3. Rates of Diagnoses of HIV Infection among Adults and Adolescents, by Age at Diagnosis, 2014–2018—United States

From 2014 through 2018 in the United States, the rates for persons aged 13–24, 35–44, 45–54, and 55 years and older decreased. The rate for persons aged 25–34 years remained stable.

Figure 4. Rates of Diagnoses of HIV Infection among Adults and Adolescents, by Race/Ethnicity, 2014–2018—United States

From 2014 through 2018 in the United States, the rate for Native Hawaiians/other Pacific Islanders increased. The rates for Asians, blacks/African Americans, Hispanics/Latinos, whites, and persons of multiple races decreased. The rate for American Indians/Alaska Natives remained stable. Hispanics/Latinos can be of any race.

Note: See Data Tables, Definitions, and Acronyms for more information on race/ethnicity.
^aHispanics/Latinos can be of any race.

Figure 5. Percentages of Diagnoses of HIV Infection among Adults and Adolescents, by Transmission Category, 2014–2018—United States and 6 Dependent Areas

Note: Data have been statistically adjusted to account for missing transmission category. See Data Tables, Definitions, and Acronyms for more information on transmission categories.

Figure 6. Percentages of Diagnoses of HIV Infection among Adults and Adolescents, by Transmission Category, 2018—United States and 6 Dependent Areas

In 2018, among all adults and adolescents, the diagnoses of HIV infections attributed to male-to-male sexual contact (approximately 70%, including 4% male-to-male sexual contact and IDU) and those attributed to heterosexual contact (24%) accounted for approximately 94% of diagnoses in the United States. Data have been statistically adjusted to account for missing transmission category. Heterosexual contact is with a person known to have, or to be at high risk for, HIV infection.

Note: Data have been statistically adjusted to account for missing transmission category. Total N includes perinatal and other transmissions among adults and adolescents. See Data Tables, Definitions, and Acronyms for more information on transmission categories.

Figure 7. Rates of Deaths of Adults and Adolescents with Diagnosed HIV Infection, 2018—United States and 6 Dependent Areas

In 2018, in the United States and 6 dependent areas, the rate of deaths of adults and adolescents with diagnosed HIV infection was 5.7 per 100,000 population. The District of Columbia (i.e., Washington, DC) is a city; use caution when comparing the rate of persons living with diagnosed HIV infection in DC with the rates in states. Data are based on address of residence as of December 31, 2018 (i.e., most recent known address). Persons living with a diagnosis of HIV infection are classified as adult or adolescent based on age at year-end 2018.

Note: Data for the year 2018 are preliminary and based on deaths reported to CDC as of December 2019. Data are based on address of residence at death. Asterisk (*) indicates incomplete reporting. See Data Tables, Definitions, and Acronyms for more information on deaths.

Figure 8. Rates of Deaths for Persons with Diagnosed HIV Infection, by Race/Ethnicity, 2014–2018—United States

From 2014 through 2018 in the United States, the rate of deaths for American Indians/Alaska Natives, blacks/African Americans, Hispanics/Latinos and persons of multiple races decreased. The rates for Asians and whites remained stable. Deaths of persons with diagnosed HIV may be due to any cause. Unknown race/ethnicity is not displayed because it comprises less than 1% of cases. The Asian category includes Asian/Pacific Islander legacy cases (cases that were diagnosed and reported under the pre-1997 Office of Management and Budget race/ethnicity classification system). Hispanics/Latinos can be of any race.

Note: Data for the year 2018 are preliminary and based on deaths reported to CDC as of December 2019. See Data Tables, Definitions, and Acronyms for more information on deaths and race/ethnicity.
^aHispanics/Latinos can be of any race.
^b Includes Asian/Pacific Islander legacy cases.

Figure 9. Rates of Adults and Adolescents Living with Diagnosed HIV Infection, Year-end 2018—United States and 6 Dependent Areas

At year-end 2018 in the United States and 6 dependent areas, 1,040,352 adults and adolescents were living with diagnosed HIV infection. The prevalence of diagnosed HIV infection was 374.6 per 100,000 population. Data are based on address of residence as of December 31, 2018 (i.e., most recent known address). Persons living with a diagnosis of HIV infection are classified as adult or adolescent based on age at year-end 2018.

Note: Data for the year 2018 are preliminary and based on deaths reported to CDC as of December 2019. Data are based on address of residence as of December 31, 2018 (i.e., most recent known address). Asterisk (*) indicates incomplete reporting. See Data Tables, Definitions, and Acronyms for more information on prevalence.

Figure 10. Adults and Adolescents Living with Diagnosed HIV Infection, by Sex at Birth and Race/Ethnicity, Year-end 2018—United States and 6 Dependent Areas

At the end of 2018, 1,040,352 adults and adolescents were living with diagnosed HIV infection in the United States and 6 dependent areas. Among 795,198 males living with diagnosed HIV infection, 35% were black/African American, 33% were white, 25% were Hispanic/Latino, 5% were males of multiple races, and 2% were Asian. Less than 1% each were American Indian/Alaska Native and Native Hawaiian/other Pacific Islander. Among 245,154 females living with diagnosed HIV infection, 58% were black/African American, 20% were Hispanic/Latino, 16% were white, 5% were females of multiple races, and 1% were Asian. Less than 1% each were American Indian/Alaska Native and Native Hawaiian/other Pacific Islander. The Asian category includes Asian/Pacific Islander legacy cases (cases that were diagnosed and reported under the pre-1997 Office of Management and Budget race/ethnicity classification system). Hispanics/Latinos can be of any race. Unknown race/ethnicity is not displayed because it comprises less than 1% of cases. Persons living with diagnosed HIV infection are classified as adult or adolescent based on age at year-end 2018.

Note: Data for the year 2018 are preliminary and based on deaths reported to CDC as of December 2019. See Data Tables, Definitions, and Acronyms for more information on prevalence and race/ethnicity.
^a Includes Asian/Pacific Islander legacy cases.
^b Hispanics/Latinos can be of any race.

Figure 11. Diagnoses of HIV Infection among Transgender Adults and Adolescents, by Age at Diagnosis, 2014–2018—United States and 6 Dependent Areas

From 2014 through 2018 in the United States and 6 dependent areas, the number of diagnoses of HIV infection for transgender adults and adolescents aged 25–34, 35–44, and 45–54 years increased. The number for transgender adults and adolescents aged 13–24 years decreased.

Note: See Data Tables, Definitions, and Acronyms for more information on gender.

Figure 12. Diagnoses of HIV Infection among Transgender Adults and Adolescents, by Race/Ethnicity, 2014–2018—United States and 6 Dependent Areas

From 2014 through 2018 in the United States and 6 dependent areas, the number of diagnoses of HIV infection for Hispanic/Latino transgender adults and adolescents increased. The number for black/African American, white, and persons of multiple race transgender adults and adolescents remained stable. Hispanics/Latinos can be of any race.

Note: See Data Tables, Definitions, and Acronyms for more information on race/ethnicity.
^aHispanics/Latinos can be of any race.

Figure 13. Percentages of Diagnoses of HIV Infection among Transgender Adults and Adolescents, by Gender and Race/Ethnicity, 2018—United States and 6 Dependent Areas

In 2018 in the United States and 6 dependent areas, among transgender adults and adolescents, the percentage of diagnoses of HIV infection among transgender MTF, vs. transgender FTM, was largest among persons of multiple races (96%), Hispanics/Latinos (94%), and blacks/African Americans (93%). Hispanics/Latinos can be of any race.

Note: See Data Tables, Definitions, and Acronyms for more information on gender and race/ethnicity.
^a Hispanics/Latinos can be of any race.

Figure 14. Diagnoses of HIV Infection among Men Who Have Sex with Men, by Age at Diagnosis, 2014–2018—United States and 6 Dependent Areas

From 2014 through 2018 in the United States and 6 dependent areas, the largest number of diagnoses of HIV infection attributed to male-to-male sexual contact were among MSM aged 25–34 years. The number of diagnoses among MSM aged 25–34 years increased 6% (from 9,242 in 2014 to 9,760 in 2018). The number of diagnoses among MSM aged 45–54 years decreased 22%, MSM aged 13–24 years decreased 15%, and MSM aged 35–44 years decreased 12% from 2014 through 2018. The number of diagnoses among MSM aged 55 years and older remained stable. Data have been statistically adjusted to account for missing transmission category. Data on men who have sex with men do not include men with HIV infection attributed to male-to-male sexual contact and injection drug use.

Note: Data have been statistically adjusted to account for missing transmission category. See Data Tables, Definitions, and Acronyms for more information on transmission categories.

Figure 15. Percentages of Diagnoses of HIV Infection among Men Who Have Sex with Men, by Race/Ethnicity, 2014–2018—United States and 6 Dependent Areas

From 2014 through 2018 in the United States and 6 dependent areas, HIV infection diagnoses among Native Hawaiian/other Pacific Islander MSM increased 71% (from 31 in 2014 to 53 in 2018). MSM of multiple races decreased 44% (from 1,096 in 2014 to 610 in 2018) and white MSM decreased 16% (from 7,630 in 2014 to 6,372 in 2018). Data have been statistically adjusted to account for missing transmission category. Data on men who have sex with men do not include men with HIV infection attributed to male-to-male sexual contact and injection drug use. Hispanics/Latinos can be of any race.

Note: Data have been statistically adjusted to account for missing transmission category. See Data Tables, Definitions, and Acronyms for more information on race/ethnicity and transmission categories.
^a Hispanics/Latinos can be of any race.

Figure 16. Diagnoses of HIV Infection among Men Who Have Sex with Men, by Age Group and Race/Ethnicity, 2018—United States and 6 Dependent Areas

In 2018 in the United States and 6 dependent areas, black/African American men who have sex with men (MSM) accounted for 25% (9,444) of the 37,968 diagnosed HIV infections and 38% of diagnosed HIV infections (52% of MSM aged 13–24 years and 33% of MSM aged greater than 24 years) among all MSM. Data have been statistically adjusted to account for missing transmission category. Data on men who have sex with men do not include men with HIV infection attributed to male-to-male sexual contact and injection drug use. Hispanics/Latinos can be of any race.

Figure 17. Diagnoses of HIV Infection among Men Who Have Sex with Men, by Region of Residence and Race/Ethnicity, 2018—United States and 6 Dependent Areas

In 2018 in the United States and 6 dependent areas, the South had more diagnoses of HIV infection (12,540) among MSM than any other region and accounted for 50% of all diagnoses of HIV infection among MSM. The largest percentage of HIV diagnoses among MSM in the South was in blacks/African Americans (48%), followed by Hispanics/Latinos (26%), and whites (23%). The largest percentage of MSM with HIV infection diagnoses in the West was among Hispanics/Latinos (46%), followed by whites (29%), and blacks/African Americans (16%). The largest percentage of MSM with HIV infection diagnoses in the Northeast was among Hispanics/Latinos (35%), followed by blacks/African Americans (34%) and whites (24%). The largest percentage of MSM with HIV infection diagnoses in the Midwest was among blacks/African Americans (45%), followed by whites (34%), and Hispanics/Latinos (16%). MSM of multiple races, and American Indian/Alaska Native, Asian, and Native Hawaiian/other Pacific Islander MSM combined accounted for less than 10 percent of all diagnoses of HIV infection among MSM in any region. Data have been statistically adjusted to account for missing transmission category. Data on men who have sex with men do not include men with HIV infection attributed to male-to-male sexual contact and injection drug use. Hispanics/Latinos can be of any race.

Note: Data have been statistically adjusted to account for missing transmission category. See Data Tables, Definitions, and Acronyms for more information on interpreting numbers, race/ethnicity, transmission categories, and U.S. Census Regions.
^a Hispanics/Latinos can be of any race.

Figure 18. Diagnoses of HIV Infection among Persons Who Inject Drugs, by Sex at Birth and Race/Ethnicity, 2018—United States and 6 Dependent Areas

In 2018 in the United States and 6 dependent areas, among 1,434 male adult and adolescent persons who inject drugs (PWID) with diagnosed HIV infection, approximately 41% were among whites, 30% among blacks/African Americans, and 24% among Hispanics/Latinos. Among 1,058 female adult and adolescent PWID with diagnosed HIV infection, 50% were among whites, 30% among blacks/African Americans, and 15% among Hispanics/Latinos. Please use caution when interpreting data for American Indian/Alaska Native, Asian, persons of multiple races, Native Hawaiian/other Pacific Islander PWID: the numbers are small. Data have been statistically adjusted to account for missing transmission category. Data on injection drug use among males do not include men with HIV infection attributed to male-to-male sexual contact and injection drug use. Hispanics/Latinos can be of any race.

Figure 19. Diagnoses of HIV Infection among Persons Who Inject Drugs, by Region and Race/Ethnicity, 2018—United States and 6 Dependent Areas

Note: Data have been statistically adjusted to account for missing transmission category. See Data Tables, Definitions, and Acronyms for more information on race/ethnicity, transmission categories, and U.S. Census Regions.
^a Hispanics/Latinos can be of any race.

Figure 20. Rates of Diagnoses of HIV Infection among Female Adults and Adolescents, 2018—United States and 6 Dependent Areas

In 2018 in the United States and 6 dependent areas, the rate of diagnoses of HIV infection among female adults and adolescents was 5.1 per 100,000 population. The rate of diagnoses for female adults and adolescents ranged from zero per 100,000 in American Samoa, Guam, Northern Mariana Islands, and the Republic of Palau to 19.4 per 100,000 in the District of Columbia, 12.6 in Louisiana, 11.9 in Georgia, 10.3 in Maryland, and 10.0 in Florida. The District of Columbia (i.e., Washington, DC) is a city; use caution when comparing the HIV diagnosis rate in DC with the rates in states.

Figure 21. Percentages of Diagnoses of HIV Infection and Population among Female Adults and Adolescents, by Race/Ethnicity, 2018—United States

In 2018 in the United States, blacks/African Americans made up 13% of the female population but accounted for 58% of diagnoses of HIV infection among females. Whites made up 62% of the female population and accounted for 21% of diagnoses of HIV infection among females. Hispanics/Latinos made up 16% of the female population and accounted for 17% of diagnoses of HIV infection among females. Asians made up 6% of the female population but accounted for 1% of HIV diagnoses among females. Females of multiple races made up 2% of the female population and accounted for 3% of HIV diagnoses among females. Native Hawaiians/other Pacific Islanders and American Indians/Alaska Natives each made up 1% or less of the female population and each accounted for less than 1% of HIV diagnoses among females. Please use caution when interpreting data for American Indian/Alaska Native, Asian, females of multiple races, Native Hawaiian/other Pacific Islander females: the numbers are small. Hispanics/Latinos can be of any race.

Note: See Data Tables, Definitions, and Acronyms for more information on race/ethnicity.
^aHispanics/Latinos can be of any race.

Figure 22. Diagnoses of HIV Infection among Female Adults and Adolescents, by Race/Ethnicity, 2014–2018—United States and 6 Dependent Areas

From 2014 through 2018 in the United States and 6 dependent areas, black/African American female adults and adolescents accounted for the largest numbers of diagnoses of HIV infection each year although the number decreased from 4,573 in 2014 to 4,097 in 2018. White and Hispanic/Latino female adults and adolescents had similar numbers of diagnoses of HIV infection each year. Hispanics/Latinos can be of any race.

Note: See Data Tables, Definitions, and Acronyms for more information on race/ethnicity.
^aHispanics/Latinos can be of any race.

Figure 23. Percentages of Diagnoses of HIV Infection among Female Adults and Adolescents, by Race/Ethnicity and Transmission Category, 2018—United States and 6 Dependent Areas

In 2018 in the United States and 6 dependent areas, black/African American female adults and adolescents had the largest percentage (92%) of diagnoses of HIV infection attributed to heterosexual contact among females, followed by Hispanic/Latino (87%) and white (64%) females. The percentage (43%) of diagnoses of HIV infection attributed to injection drug use was largest among American Indian/Alaska Native female adults and adolescents, followed by white (35%), Hispanic/Latino (12%) and black/African American (8%) females. The perinatal and “Other” transmission categories accounted for 1% or less of cases among each racial/ethnic group. Data have been statistically adjusted to account for missing transmission category. Hispanics/Latinos can be of any race. Heterosexual contact is with a person known to have, or to be at high risk for, HIV infection.

Note. Data have been statistically adjusted to account for missing transmission category. See Data Tables, Definitions, and Acronyms for more information on race/ethnicity and transmission categories.
^a Hispanics/Latinos can be of any race.

Figure 24. Rates of Diagnoses of HIV Infection among Female Adults and Adolescents, by Region and Race/Ethnicity, 2018—United States

In 2018 in the United States, the South had more diagnoses (3,988) of HIV infection among female adults and adolescents than any other region. The highest rates of diagnoses of HIV infection were among black/African American females in the South (24.6) and in the Northeast (23.5). The highest rate of diagnoses of HIV infection among Hispanic/Latino female adults and adolescents was in the Northeast (8.9). The highest rate of diagnoses of HIV infection among white female adults and adolescents was in the South (2.4). Hispanics/Latinos can be of any race.

Note: See Data Tables, Definitions, and Acronyms for more information on race/ethnicity and U.S. Census Regions.
^a Hispanics/Latinos can be of any race.

Figure 25. Diagnoses of Perinatally Acquired HIV Infection among Children Born During 2017, by Area of Residence—United States and Puerto Rico

In the United States and Puerto Rico, a total of 39 children born during 2017 had HIV infection attributed to perinatal transmission. Florida and Illinois reported the largest numbers of HIV infections attributed to perinatal transmission in infants born in 2017. Thirty-two areas reported no perinatally acquired infections among infants born in 2017. Because of delays in the reporting of births and diagnoses of HIV infection attributed to perinatal exposure, the exclusion of data for the most recent 2 years allowed at least 24 months for data to be reported to CDC. Data reflect all infants with diagnosed perinatally acquired HIV infection who were born in the United States and 6 dependent areas during 2017, regardless of year of diagnosis.

Figure 26. Diagnoses of HIV Infection among Children Aged <13 Years, by Age at Diagnosis, 2014–2018—United States and 6 Dependent Areas

From 2014 through 2018 in the United States and 6 dependent areas, there were a total of 645 children (aged less than 13 years) who received a diagnosis of HIV infection. Approximately 31% of children (aged less than 13 years) had their HIV infection diagnosed within the first 6 months of life (i.e., 0–5 months), and an additional 4% during months 6–11. Please use caution when interpreting trend data for children aged less than 13 years with diagnosed HIV infection: the numbers are small.

Figure 27. Time of Maternal HIV Testing among Children with Diagnosed Perinatally Acquired HIV Infection and Children Exposed to HIV, Birth Years 2014–2017—United States and Puerto Rico

From 2014 through 2017 in the United States and Puerto Rico, among the 244 children born with diagnosed perinatally acquired HIV, 44% were born to mothers who were tested before pregnancy, 18% were born to mothers who were tested during pregnancy, and 5% to mothers tested at the time of birth. An additional 21% of children with diagnosed perinatally acquired HIV infection were born to mothers who were tested after the child’s birth, and 9% were born to mothers whose time of maternal HIV testing was unknown. The number of areas contributing exposure data varied by year. Because not all jurisdictions have exposure reporting in place, the number presented likely underestimates the number of exposed infants in the United States and Puerto Rico. Because of delays in the reporting of births and diagnoses of HIV infection attributed to perinatal exposure, the exclusion of data for the most recent 2 years allowed at least 24 months for data to be reported to CDC.

Figure 28. Percentages of Diagnoses of HIV Infection among Children Aged <13 Years, by Race/Ethnicity, 2014—2018—United States and 6 Dependent Areas

From 2014 through 2018 in the United States and 6 dependent areas, among children aged less than 13 years, the percentage of diagnosed HIV infection in black/African American children ranged from 55% to 63%. From 2014 through 2018, percentages of HIV diagnoses among children remained stable among whites. Please use caution when interpreting trend data for American Indian/Alaska Native, Asian, Hispanic/Latino, Native Hawaiian/ other Pacific Islander, and children of multiple races aged less than 13 years with diagnosed HIV infection: the numbers are small. Hispanics/Latinos can be of any race.

Note: See Data Tables, Definitions, and Acronyms for more information on race/ethnicity.
^aHispanics/Latinos can be of any race.

Figure 29. Percentages of Diagnoses of HIV Infection and Population in Children Aged <13 Years, by Race/Ethnicity, 2018—United States

In 2018 in the United States, blacks/African Americans made up approximately 14% of the population of children aged less than 13 years but accounted for 61% of diagnoses of HIV infection among children aged less than 13 years. Hispanics/Latinos made up 26% of the population of children aged less than 13 years in the United States but accounted for 10% of diagnoses of HIV infection. Whites made up 50% of the population of children aged less than 13 years but accounted for 17% of diagnoses of HIV infection in children aged less than 13 years. Data by race/ethnicity are not provided for the 6 U.S. dependent areas because the U.S. Census Bureau does not collect information from all United States dependent areas. Hispanics/Latinos can be of any race.

Note: See Data Tables, Definitions, and Acronyms for more information on race/ethnicity.
^aHispanics/Latinos can be of any race.

Figure 30. Rates of Children Aged <13 Years Living with Diagnosed HIV Infection, Year-end 2018—United States and 6 Dependent Areas

At the end of 2018 in the United States and 6 dependent areas, approximately 1,918 children aged less than 13 years were living with diagnosed HIV infection. Areas with the highest rates of children aged less than 13 years living with diagnosed HIV infection at the end of 2018 were the District of Columbia (13.8), the U.S. Virgin Islands (10.5), Maine (8.0), Vermont (7.4), Maryland (6.3), Rhode Island (6.2). Data for the year 2018 are preliminary and based on deaths reported to CDC as of December 2019. Persons living with a diagnosis of HIV infection are classified as children based on age at year-end 2018.

Note: Data for the year 2018 are preliminary and based on deaths reported to CDC as of December 2019. Data are based on address of residence as of December 31, 2018 (i.e., most recent known address). Asterisk (*) indicates incomplete reporting. See Data Tables, Definitions, and Acronyms for more information on prevalence.

Figure 31. Persons Living with Diagnosed Perinatally Acquired HIV Infection, Year-end 2018—United States and 6 Dependent Areas

At the end of 2018 in the United States and 6 dependent areas, there were 12,310 persons living with diagnosed perinatally acquired HIV infection. The numbers of persons living with diagnosed perinatally acquired HIV infections ranged from zero in American Samoa, the Northern Mariana Islands, and the Republic of Palau to 2,440 in New York. Data reflect all persons (i.e., children, adolescents, and adults) with diagnosed perinatally acquired HIV infection who were alive at year-end 2018, regardless of their age at year-end 2018. Data for the year 2018 are preliminary and based on deaths reported to CDC as of December 2019. The District of Columbia (i.e., Washington, DC) is a city; use caution when comparing persons living with diagnosed HIV infection in DC with the numbers in states. Data are based on address of residence as of December 31, 2018 (i.e., most recent known address).

Data Tables, Definitions, and Acronyms Used on this Page

The data in this report include information received by CDC through December 31, 2019. The data are organized into 2 sections: National Profile and Special Focus Profiles. For both the National and Special Focus Profiles, figures are presented. For the National Profile, tables are presented in the Tables section in 2 formats. Tables in the first format—labeled “a”—exclude data from the dependent areas (American Samoa, Guam, the Northern Mariana Islands, Puerto Rico, the Republic of Palau, and the U.S. Virgin Islands). Tables in the second format—labeled “b”—include data from the dependent areas.

Please use caution when interpreting numbers less than 12, and rates and trends based on these numbers.

Persons reported to the National HIV Surveillance System are assumed alive unless their deaths have been reported to CDC. Death data include deaths of persons with diagnosed HIV infection (Figures 7 and 8; Tables 10a/b–13a/b) regardless of the cause of death. Death data are based on a 12-month reporting delay to allow data to be reported to CDC. For the death tables, region or area of residence is based on residence at death. When information on residence at death is not available, the state where a person’s death occurred is used. Data for the year 2018 are preliminary and based on death data received by CDC through December 2019. Trends through 2018 should be interpreted with caution. Due to incomplete reporting of deaths for the year 2018, death data for Alabama, Oklahoma, South Carolina, and the U.S. Virgin Islands should be interpreted with caution.

Prevalence trends and data reflect persons living with diagnosed HIV infection, regardless of stage of disease, (Figures 9, 10, 30, and 31; Tables 14a/b–17a/b, 19, 20, and A2) at the end of a given year during 2014–2018. Because of delays in the reporting of deaths, prevalence data are based on a 12-month reporting delay to allow data to be reported to CDC. For tables presenting prevalence data, region or area of residence is based on most recent known address as of the end of the specified year. Data for the year 2018 are preliminary and based on death data received by CDC through December 2019. Trends through 2018 should be interpreted with caution. Due to incomplete reporting of deaths for the year 2018, prevalence data for Alabama, Oklahoma, South Carolina, and the U.S. Virgin Islands should be interpreted with caution.

Gender identity refers to a person’s internal understanding of their own gender, or gender with which a person identifies. HIV surveillance personnel collect data on gender identity, when available, from sources such as case report forms submitted by health care or HIV testing providers and medical records, or by matching with other health department databases (e.g., Ryan White program data). In May 2013, CDC issued guidance to state and local programs on methods for collecting data on transgender persons and working with transgender-specific data. However, characterization of HIV infection among transgender persons may require supplemental data from special studies. A person’s transgender status in NHSS is determined based on two variables – sex assigned at birth and current gender identity. Both variables are examined, using a two-step approach, to assess transgender status. Although not used in this report, cisgender is a term used to indicate that a person’s sex assigned at birth and current gender identity are the same (i.e., a person assigned male at birth and who currently identifies as a man, is a cisgender male).

Categories

Male: persons assigned “male” sex at birth and current gender identity is not “transgender male-to-female” or “additional gender identity” (current gender identity can be listed as “male,” “female,” “transgender female-to-male,” “unspecified,” or left blank).
Female: persons assigned “female” sex at birth and current gender identity is not “transgender female-to-male” or “additional gender identity” (current gender identity can be listed as “male,” “female,” “transgender male-to-female,” “unspecified,” or left blank).
Transgender male-to-female (transgender MTF): persons assigned “male” sex at birth and current gender identity is “transgender male-to-female.”
Transgender female-to-male (transgender FTM): persons assigned “female” sex at birth and current gender identity is “transgender female-to-male.”
Additional gender identity (AGI): persons assigned “male” or “female” sex at birth and current gender identity is “additional gender identity.” AGI includes “bigender,” “gender queer,” and “two-spirit.”

In the Federal Register [6] for October 30, 1997, the Office of Management and Budget (OMB) announced the Revisions to the Standards for the Classification of Federal Data on Race and Ethnicity. Implementation by January 1, 2003 was mandated. At a minimum, data on the following race categories should be collected:

American Indian or Alaska Native
Asian
black or African American
Native Hawaiian or other Pacific Islander
white

Additionally, systems must be able to retain information when multiple race categories are reported. In addition to data on race, data on 2 categories of ethnicity should be collected:

Hispanic or Latino
not Hispanic or Latino

The Asian or Pacific Islander category displayed in annual surveillance reports published prior to the 2007 surveillance report was split into 2 categories: (1) Asian and (2) Native Hawaiian or other Pacific Islander. The Asian category (in tables where footnoted) includes the cases in Asians/Pacific Islanders (referred to as legacy cases) that were reported before the implementation of the new race categories in 2003 (e.g., cases of HIV infection that were diagnosed and reported to CDC before 2003 but that were classified as stage 3 [AIDS] after 2003) and a small percentage of cases that were reported after 2003 but that were reported according to the old race category (Asian/ Pacific Islander). In tables of diagnoses of HIV infection during 2014–2018, the Asian category does not include Asian/Pacific Islander cases because these cases were diagnosed after 2003 and were reported to CDC in accordance with OMB’s Revisions to the Standards for the Classification of Federal Data on Race and Ethnicity [6].

This report also presents data for persons for whom multiple race categories are reported. In this report, persons categorized by race were not Hispanic or Latino. The number of persons reported in each race category may, however, include persons whose ethnicity was not reported.

Transmission category is the term for the classification of cases that summarizes an adult’s or adolescent’s possible HIV risk factors; the summary classification results from selecting, from the presumed hierarchical order of probability, the 1 (single) risk factor most likely to have been responsible for transmission. For surveillance purposes, a diagnosis of HIV infection is counted only once in the hierarchy of transmission categories [7]. Adults or adolescents with more than 1 reported risk factor for HIV infection are classified in the transmission category listed first in the hierarchy. The exception is men who had sexual contact with other men and injected drugs; this group makes up a separate transmission category.

Hierarchical Categories:

Male-to-male sexual contact: men who have had sexual contact with men (i.e., homosexual contact) and men who have had sexual contact with both men and women (i.e., bisexual contact)
Injection drug use (IDU): persons who have injected non-prescription drugs
Male-to-male sexual contact and injection drug use (male-to-male sexual contact and IDU): men who have had sexual contact with other men and injected non-prescription drugs
Heterosexual contact: persons who have ever had heterosexual contact with a person known to have, or to be at high risk for, HIV infection
Perinatal: persons infected through perinatal transmission but aged 13 years and older at time of diagnosis of HIV infection. Prevalence data and tables of death data includes persons infected through perinatal transmission but aged 13 years and older during the specified year or at death.
Other: all other transmission categories (e.g., blood transfusion, hemophilia, risk factor not reported or not identified).

Cases of HIV infection reported without a risk factor listed in the hierarchy of transmission categories are classified as “no identified risk (NIR).” Cases classified as NIR include cases that are being followed up by local health department staff; cases in persons whose risk-factor information is missing because they died, declined to be interviewed, or were lost to follow-up; and cases in persons who were interviewed or for whom other follow-up information was available but for whom no risk factor was identified.

Because a substantial proportion of cases of HIV infection are reported to CDC without an identified risk factor, multiple imputation is used to assign a transmission category to these cases [7]. Multiple imputation is a statistical approach in which each missing transmission category is replaced with a set of plausible values that represent the uncertainty about the true, but missing, value [8]. Each resulting data set containing the plausible values is analyzed by using standard procedures, and the results from these analyses are then combined to produce the final results. In tables displaying transmission categories, multiple imputation was used for adults and adolescents, but not for children (because the number of cases in children is small, missing transmission categories were not imputed).

Data by region reflect the address at the time of diagnosis of HIV infection for figures and tables that present number of diagnoses (Figures 17, 19, 24; Tables 1a/b–7a/b). For tables presenting prevalence data (14a/b–17a/b), region is based on most recent known address as of the end of the specified year. For the death tables (10a/b–13a/b), region is based on residence at death. When information on residence at death is not available, the state where a person’s death occurred is used.

Map of US census regions. The 4 regions of residence used in this report are defined by the U.S. Census Bureau as follows: • Northeast: Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, and Vermont • Midwest: Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota, and Wisconsin • South: Alabama, Arkansas, Delaware, District of Columbia (D.C.), Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, and West Virginia • West: Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, Washington, and Wyoming

The 4 regions of residence and 6 dependent areas used in this report are defined by the U.S. Census Bureau as follows:

Northeast: Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, and Vermont
Midwest: Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota, and Wisconsin
South: Alabama, Arkansas, Delaware, District of Columbia (D.C.), Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, and West Virginia
West: Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, Washington, and Wyoming
U.S. dependent areas: American Samoa, Guam, the Northern Mariana Islands, Puerto Rico, the Republic of Palau, and the U.S. Virgin Islands

AGI: additional gender identity

AIDS: acquired immunodeficiency syndrome

CDC: Centers for Disease Control and Prevention

FTM: female-to-male

HIV: human immunodeficiency virus

IDU: injection drug use

MSA: metropolitan statistical area

MSM: gay, bisexual, and other men who have sex with men

MTF: male-to-female

NHSS: National HIV Surveillance System

NIR: no identified risk factor

OI: opportunistic illness

OMB: Office of Management and Budget

PrEP: preexposure prophylaxis

PWID: persons who inject drugs

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View Page In: Diagnoses of HIV Infection in the United States and Dependent Areas, 2018

Page last reviewed: May 7, 2020

Content source: Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention