Diagnoses of HIV Infection in the United States and Dependent Areas, 2018: Gay, Bisexual, and Other Men Who Have Sex with Men

HIV Surveillance - Gay, Bisexual, and Other Men Who Have Sex with Men

Special Focus Profiles

The Special Focus Profiles highlight trends and distribution of HIV in 5 populations of particular interest to HIV prevention programs in state and local health departments: (1) Transgender Persons, (2) Gay, Bisexual, and Other Men Who Have Sex With Men, (3) Persons Who Inject Drugs, (4) Women, and (5) Children Aged <13 Years.

Gay, bisexual, and other men who have sex with men (MSM) are the population most affected by HIV in the United States. Stigma, homophobia, and discrimination put MSM of all races/ethnicities at risk for multiple physical and mental health problems and can affect whether they seek and receive high-quality health services, including HIV testing, treatment, and other prevention services. In 2018, adult and adolescent MSM accounted for 69% (24,933 MSM and 1,372 MSM who also inject drugs) of the 37,968 new HIV diagnoses in the United States and 6 dependent areas. Many black/African American and Hispanic/Latino MSM with HIV, particularly young MSM, are unaware of their HIV infection. Lack of awareness of HIV status among young MSM may be due to recent infection, not getting testing due to underestimation of personal risk, or fewer opportunities to get tested. Persons who do not know they have HIV do not get medical care or receive treatment and can unknowingly infect others.

Age Group

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.

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 was among MSM aged 25–34 years (Figure 14). The number of diagnoses among MSM aged 25–34 years increased 6% (from 9,242 in 2014 to 9,760 in 2018) (Table 5b). From 2014 through 2018, the number of diagnoses among MSM aged 45–54 years decreased 22%, aged 13–24 years decreased 15%, and aged 35–44 years decreased 12%. The number of diagnoses among MSM aged 55 years and older remained stable.

Race/Ethnicity

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.

From 2014 through 2018 in the United States and 6 dependent areas, HIV infection diagnoses increased 71% among Native Hawaiian/other Pacific Islander MSM (from 31 in 2014 to 53 in 2018). HIV infection diagnoses decreased 44% among MSM of multiple races (from 1,096 in 2014 to 610 in 2018) and decreased 16% among white MSM (from 7,630 in 2014 to 6,372 in 2018) (Figure 15 and Table 5b). The number of diagnoses among American Indian/Alaska Native, Asian, black/African American, and Hispanic/Latino MSM remained stable.

Race/Ethnicity and Age Group

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.

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.

In 2018 in the United States and 6 dependent areas, black/African American MSM accounted for 25% (9,444) of the 37,968 HIV infection diagnoses and 38% of  diagnoses (52% of MSM aged 13–24 years and 33% of MSM aged greater than 24 years) (Figure 16) among all MSM. Hispanic/Latino MSM made up 20% (7,653) of the 37,968 new HIV diagnoses. From 2014 through 2018 in the United States and 6 dependent areas, HIV diagnoses increased among Hispanic/Latino gay and bisexual men aged 25 years and older (Table 5b). Please use caution when interpreting data for American Indian/Alaska Native and Native Hawaiian/other Pacific Islander MSM: the numbers are small.

Region and Race/Ethnicity

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.

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 (Figure 17). The largest percentage of MSM with HIV infection diagnoses in the South was among 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.

Prevalence and Race/Ethnicity

At the end of 2018 in the United States and 6 dependent areas, 576,787 MSM were living with diagnosed HIV infection. Approximately 37% of MSM living with diagnosed HIV infection were white, 31% were black/African American, and 25% were Hispanic/Latino. Males of multiple races accounted for 5% of MSM living with diagnosed HIV infection, Asians accounted for 2%, and American Indians/Alaska Natives and Native Hawaiians/other Pacific Islanders each accounted for less than 1% (Table 15b).

Data Tables, Definitions, and Acronyms Used on this Page

Table 5b. Diagnoses of HIV infection attributed to male-to-male sexual contact and male-to-male sexual contact and injection drug use, by year of diagnosis and selected characteristics, 2014–2018—United States and 6 dependent areas
Male-to-male sexual contact Male-to-male sexual contact and injection drug use
2014 2015 2016 2017 2018 2014 2015 2016 2017 2018
No. No. No. No. No. No. No. No. No. No.
American Indian/Alaska Native
     Age at diagnosis (yr)
     13–14 0 0 0 0 0 0 0 0 0 0
     15–19 5 5 2 2 8 0 1 0 0 0
     20–24 28 29 25 18 25 2 4 4 3 2
     25–29 27 21 38 34 23 1 1 6 6 8
     30–34 17 17 31 19 19 1 0 3 6 6
     35–39 6 12 10 15 12 0 3 2 1 2
     40–44 10 6 13 12 10 1 0 0 2 1
     45–49 10 5 6 7 7 2 0 1 1 3
     50–54 7 5 5 8 9 2 0 1 0 1
     55–59 2 3 3 3 3 0 0 0 0 0
     60–64 0 0 3 2 1 0 0 0 1 0
     ≥65 1 0 1 1 3 0 0 0 1 0
     Region of residencea
     Northeast 6 3 7 2 5 0 0 0 0 0
     Midwest 9 9 13 13 13 3 1 1 3 5
     South 25 30 34 29 22 0 2 5 11 4
     West 74 61 82 74 77 5 7 10 7 14
     U.S. dependent areas 0 0 0 0 0 0 0 0 0 0
     Total 113 103 136 118 117 9 10 17 21 23
Asian
     Age at diagnosis (yr)
     13–14 0 1 0 0 1 0 0 0 0 0
     15–19 15 22 20 25 22 1 0 1 0 0
     20–24 127 120 115 155 110 2 4 3 3 1
     25–29 142 170 160 156 174 2 3 2 3 4
     30–34 114 108 128 114 123 2 2 3 6 2
     35–39 93 75 80 91 75 3 3 1 1 3
     40–44 75 81 87 75 62 5 3 0 1 1
     45–49 59 63 52 67 57 0 2 1 3 0
     50–54 32 35 32 35 23 2 1 1 0 0
     55–59 10 16 20 19 18 0 0 0 0 0
     60–64 7 4 9 8 10 1 0 0 0 0
     ≥65 8 5 10 8 10 0 0 1 0 0
     Region of residencea
     Northeast 116 110 141 133 132 3 3 2 2 2
     Midwest 52 82 66 80 68 5 2 5 1 0
     South 136 152 151 155 175 3 5 0 1 2
     West 375 353 355 382 306 9 9 7 12 8
     U.S. dependent areas 2 2 1 3 4 0 0 0 0 0
     Total 681 699 713 752 685 20 19 14 15 12
Black/African American
     Age at diagnosis (yr)
     13–14 3 8 4 4 7 0 0 0 0 0
     15–19 805 860 811 853 814 12 14 16 11 8
     20–24 3,129 2,980 2,857 2,581 2,461 56 60 56 38 44
     25–29 2,301 2,465 2,592 2,543 2,556 49 52 69 65 77
     30–34 1,170 1,208 1,227 1,350 1,311 41 41 48 47 44
     35–39 667 736 737 773 750 27 36 31 38 28
     40–44 510 496 461 435 458 27 19 16 18 19
     45–49 489 462 402 366 379 16 18 17 14 12
     50–54 330 360 364 337 318 22 14 13 24 18
     55–59 227 205 220 214 205 17 13 9 11 9
     60–64 107 89 97 114 105 9 5 9 5 6
     ≥65 79 81 68 69 80 5 5 4 4 3
     Region of residencea
     Northeast 1,274 1,239 1,151 1,179 1,115 46 31 33 38 45
     Midwest 1,596 1,569 1,625 1,530 1,474 42 39 60 44 50
     South 6,153 6,293 6,144 6,076 5,975 146 167 153 143 132
     West 789 844 916 852 876 45 39 40 52 40
     U.S. dependent areas 4 5 3 2 4 0 0 0 0 0
     Total 9,815 9,950 9,839 9,638 9,444 279 275 286 276 268
Hispanic/Latinob
     Age at diagnosis (yr)
     13–14 5 1 1 5 1 0 0 0 0 0
     15–19 300 313 316 336 319 20 14 12 9 11
     20–24 1,550 1,582 1,539 1,402 1,391 59 75 76 62 66
     25–29 1,563 1,665 1,846 1,772 1,817 68 87 81 94 92
     30–34 1,242 1,244 1,358 1,353 1,344 72 70 75 65 56
     35–39 910 959 977 952 938 48 43 47 48 46
     40–44 704 633 651 605 587 33 38 35 25 24
     45–49 571 567 501 539 529 29 24 12 21 19
     50–54 303 375 376 357 353 11 13 18 15 17
     55–59 145 177 176 180 210 8 6 6 7 4
     60–64 81 69 77 77 92 3 3 4 3 5
     ≥65 60 65 54 75 71 2 4 3 2 3
     Region of residencea
     Northeast 1,300 1,290 1,234 1,266 1,161 55 57 53 36 50
     Midwest 512 490 486 503 520 18 29 30 24 25
     South 2,833 3,062 3,225 3,155 3,198 126 128 137 124 103
     West 2,468 2,506 2,639 2,499 2,521 145 140 141 154 152
     U.S. dependent areas 320 300 286 230 253 8 22 10 11 11
     Total 7,434 7,649 7,871 7,653 7,653 353 376 369 349 343
Native Hawaiian/other Pacific Islander
     Age at diagnosis (yr)
     13–14 0 0 0 0 0 0 0 0 0 0
     15–19 1 2 1 1 4 0 0 0 0 0
     20–24 5 10 3 9 7 0 0 0 0 2
     25–29 4 13 7 10 11 0 0 3 0 1
     30–34 6 10 5 8 12 1 0 2 0 1
     35–39 6 7 7 2 8 0 1 0 1 0
     40–44 4 2 3 5 2 0 0 0 0 0
     45–49 3 5 1 1 2 0 0 0 0 0
     50–54 1 5 2 2 1 0 0 0 0 0
     55–59 0 2 0 1 4 0 0 0 0 0
     60–64 0 0 0 0 1 0 0 0 0 0
     ≥65 1 0 1 0 1 0 0 1 0 0
     Region of residencea
     Northeast 0 1 3 3 2 0 0 1 0 0
     Midwest 1 1 1 2 2 0 0 0 0 0
     South 6 17 4 6 10 0 1 0 0 0
     West 22 35 18 26 38 1 0 4 1 4
     U.S. dependent areas 2 3 4 2 1 0 0 1 0 0
     Total 31 56 30 39 53 1 1 6 1 4
White
     Age at diagnosis (yr)
     13–14 3 1 0 1 0 0 0 0 0 0
     15–19 142 146 157 169 175 9 17 18 13 11
     20–24 963 943 894 947 832 85 103 98 85 69
     25–29 1,270 1,251 1,223 1,246 1,155 154 161 155 162 170
     30–34 1,003 1,003 978 902 970 119 126 123 119 132
     35–39 805 742 686 747 678 86 101 84 97 107
     40–44 806 700 625 504 532 81 52 67 60 50
     45–49 938 759 720 630 586 65 49 57 59 46
     50–54 808 800 740 695 542 51 63 41 36 42
     55–59 452 428 457 442 439 23 34 32 24 28
     60–64 233 251 237 243 255 10 12 13 16 6
     ≥65 207 192 200 184 210 3 4 8 8 6
     Region of residencea
     Northeast 1,172 1,025 964 865 789 66 73 63 79 74
     Midwest 1,311 1,254 1,209 1,233 1,110 115 129 128 105 125
     South 3,249 3,032 3,005 2,902 2,872 267 288 272 292 266
     West 1,894 1,903 1,737 1,709 1,598 237 232 230 204 203
     U.S. dependent areas 5 1 2 1 3 0 0 0 0 0
     Total 7,630 7,215 6,917 6,710 6,372 684 722 693 680 668
Multiple races
     Age at diagnosis (yr)
     13–14 0 0 0 0 0 0 0 0 0 0
     15–19 73 59 54 51 31 6 4 2 1 2
     20–24 280 270 234 172 146 25 16 17 12 6
     25–29 234 261 228 200 151 18 23 18 10 20
     30–34 150 139 135 126 96 10 20 13 6 10
     35–39 108 92 73 69 68 9 8 9 8 9
     40–44 82 59 59 49 37 9 6 2 3 0
     45–49 70 56 54 38 26 8 4 7 4 4
     50–54 54 42 36 42 27 6 1 5 5 2
     55–59 26 26 29 20 12 2 2 2 3 0
     60–64 10 16 16 12 7 0 1 2 0 0
     ≥65 10 13 8 5 10 0 1 0 0 0
     Region of residencea
     Northeast 232 230 189 153 117 18 19 15 9 4
     Midwest 140 131 107 118 83 13 10 14 10 11
     South 513 456 425 363 287 33 30 29 23 21
     West 210 216 205 149 123 28 26 19 11 19
     U.S. dependent areas 1 0 0 1 0 0 0 0 0 0
     Total 1,096 1,033 925 783 610 92 86 77 53 54
Total
     Age at diagnosis (yr)
     13–14 11 11 5 10 9 0 0 0 0 0
     15–19 1,341 1,407 1,360 1,437 1,372 47 49 50 33 32
     20–24 6,082 5,934 5,667 5,283 4,972 229 261 253 203 191
     25–29 5,541 5,846 6,093 5,961 5,886 292 328 333 339 371
     30–34 3,701 3,728 3,861 3,871 3,874 246 259 267 248 251
     35–39 2,595 2,623 2,570 2,649 2,530 173 195 173 194 195
     40–44 2,190 1,975 1,898 1,683 1,687 155 119 120 108 96
     45–49 2,140 1,916 1,737 1,647 1,585 121 97 94 101 84
     50–54 1,536 1,623 1,555 1,475 1,272 92 92 78 81 80
     55–59 862 857 904 878 891 49 55 49 46 41
     60–64 438 429 439 456 471 22 21 27 26 19
     ≥65 365 356 342 342 385 10 14 18 15 13
     Region of residencea
     Northeast 4,100 3,898 3,689 3,601 3,320 186 182 167 163 176
     Midwest 3,621 3,535 3,507 3,479 3,271 196 209 238 186 216
     South 12,915 13,042 12,987 12,686 12,540 575 621 597 594 528
     West 5,832 5,918 5,951 5,689 5,538 470 454 449 440 441
     U.S. dependent areas 334 311 296 238 264 8 22 11 11 11
Total 26,801 26,704 26,430 25,693 24,933 1,436 1,488 1,462 1,395 1,372

Note: Numbers less than 12, and trends based on these numbers, should be interpreted with caution.
Data have been statistically adjusted to account for missing transmission category, therefore values may not sum to column total.
Persons whose transmission category is classified as male-to-male sexual contact or male-to-male sexual contact and injection drug use are presented based on sex at birth and include transgender persons.
aData are based on residence at time of diagnosis of HIV infection.
bHispanics/Latinos can be of any race.

Table 15b. Persons living with diagnosed HIV infection, by race/ethnicity and selected characteristics, year-end 2018—United States and 6 dependent areas
American Indian/
Alaska
Native
Asiana Black/
African American
Hispanic/
Latinob
Native Hawaiian/
other
Pacific Islander
White Multiple races Totalc
No. No. No. No. No. No. No. No.
Gender
Male 2,285 12,354 276,028 195,367 742 263,161 35,498 785,983
Female 799 2,689 142,260 48,608 145 39,910 11,097 245,727
Transgender male-to-femaled 47 166 4,754 3,234 29 1,013 740 9,983
Transgender female-to-maled 4 7 189 81 0 94 29 404
Additional gender identitye 1 6 73 47 0 28 18 173
Age at end of year
<13 7 110 1,153 250 3 246 149 1,918
13–14 0 35 428 95 2 85 27 672
15–19 16 89 2,669 912 5 495 176 4,363
20–24 97 430 15,029 6,572 26 3,856 1,168 27,184
25–29 284 1,260 36,843 17,351 78 12,198 3,523 71,544
30–34 327 1,608 41,208 23,091 113 17,994 4,371 88,720
35–39 366 1,796 39,673 26,615 122 21,796 4,630 95,007
40–44 312 2,039 39,939 28,038 104 23,375 4,678 98,506
45–49 442 2,411 48,252 32,869 119 35,911 5,814 125,890
50–54 440 1,972 59,522 38,453 117 53,007 7,481 161,131
55–59 401 1,417 57,527 32,358 99 57,320 6,943 156,237
60–64 235 961 41,837 20,654 63 38,262 4,490 106,641
≥65 209 1,094 39,224 20,079 65 39,661 3,932 104,457
Transmission categoryf
     Male adult or adolescentg
     Male-to-male sexual contact 1,624 10,477 178,761 142,672 649 216,006 26,221 576,787
     Injection drug use 224 447 32,655 22,674 26 13,503 2,624 72,227
     Male-to-male sexual contact
and injection drug use
299 399 15,538 13,370 46 22,757 4,055 56,517
     Heterosexual contacth 164 1,040 49,723 18,048 44 9,898 2,856 81,803
     Perinatali 5 44 2,783 1,310 3 547 305 5,005
     Otherj 14 73 812 451 2 1,371 131 2,858
     Subtotal 2,330 12,480 280,271 198,525 770 264,082 36,192 795,198
     Female adult or adolescentg
     Injection drug use 252 181 23,680 10,336 22 12,498 2,841 49,885
     Heterosexual contacth 528 2,329 114,056 36,552 120 26,276 7,802 187,793
     Perinatali 8 57 3,347 1,400 0 622 321 5,761
     Otherj 11 65 797 274 1 482 78 1,715
     Subtotal 799 2,632 141,880 48,562 143 39,878 11,041 245,154
     Child (<13 yrs at end of year)
     Perinatal 7 72 934 223 3 172 133 1,544
     Otherj 0 38 219 27 0 74 16 374
     Subtotal 7 110 1,153 250 3 246 149 1,918
Region of residencek
Northeast 152 3,288 90,762 72,151 64 54,699 14,461 235,944
Midwest 366 1,514 53,000 14,806 41 47,483 5,514 122,844
South 769 3,115 247,002 77,304 147 115,688 19,456 463,643
West 1,847 7,243 32,230 67,056 629 86,261 7,932 203,313
U.S. dependent areas 2 62 310 16,020 35 75 19 16,526
Total 3,136 15,222 423,304 247,337 916 304,206 47,382 1,042,270

Note: Data for the year 2018 are preliminary and based on deaths reported to CDC as of December 2019. Numbers less than 12 should be interpreted with caution.
aIncludes Asian/Pacific Islander legacy cases (see Technical Notes).
bHispanics/Latinos can be of any race.
cIncludes persons whose race/ethnicity is unknown.
d“Transgender male-to-female” includes individuals who were assigned “male” sex at birth but have ever identified as “female” gender. “Transgender female-to-male” includes individuals who were assigned “female” sex at birth but have ever identified as “male” gender.
eAdditional gender identity examples include “bigender,” “gender queer,” and “two-spirit.”
fData have been statistically adjusted to account for missing transmission category, therefore values may not sum to column subtotals and total.
gData presented based on sex at birth and includes transgender persons.
hHeterosexual contact with a person known to have, or to be at high risk for, HIV infection.
iIncludes individuals ≥13 years of age at time of diagnosis of HIV infection.
jIncludes hemophilia, blood transfusion, and risk factor not reported or not identified.
kData are based on address of residence at the end of the specified year (i.e., most recent known address).

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).

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.

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.

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