Diagnoses of HIV Infection in the United States and Dependent Areas, 2018: Persons Who Inject Drugs

HIV Surveillance - Persons Who Inject Drugs

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.

Persons who inject drugs (PWID) are at high risk for getting HIV if they use and share needles, syringes, or other drug injection equipment (e.g., cookers) that someone with HIV has used. Persons who inject drugs account for about 1 in 15 HIV diagnoses in the United States. In recent years, the opioid (including prescription and synthetic opioids) and heroin crisis has led to increased numbers of PWID. HIV diagnoses among PWID have increased in the 50 states and District of Columbia. IDU in nonurban areas has created prevention challenges and placed new populations at risk for HIV.

Diagnoses of HIV Infection

Sex (at Birth) and Race/Ethnicity

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.

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, the percentage of diagnoses of HIV infection attributed to injection drug use increased. In 2018, among 1,434 male adult and adolescent PWID with diagnosed HIV infection, approximately 41% were white, 30% were black/African American, and 24% were Hispanic/Latino (Figure 18). Among 1,058 female adult and adolescent PWID with diagnosed HIV infection, 50% were white, 30% black/African American, and 15% Hispanic/Latino. Please use caution when interpreting data for American Indian/Alaska Native, Asian, and Native Hawaiian/other Pacific Islander PWID, and persons of multiple races who inject drugs: the numbers are small.

Region and Race/Ethnicity

Figure 19. Diagnoses of HIV Infection among Persons Who Inject Drugs, by Region 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.

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.

In 2018 in the United States and 6 dependent areas, 2,492 diagnosed HIV infections were among PWID. Of these, the largest number of HIV infection diagnoses were in the South (976), followed by the Northeast (595) (Figure 19). In all regions, the largest percentage of diagnosed HIV infections among PWID was among whites. In the South, whites accounted for 436 diagnosed HIV infections among PWID (45%), blacks/African Americans accounted for 359 (37%), and Hispanics/Latinos accounted for 143 (15%) (Table 6b). In the Northeast, whites accounted for 212 diagnosed HIV infections among PWID (36%), blacks/African Americans accounted for 206 (35%), and Hispanics/Latinos accounted for 152 (26%). Please use caution when interpreting data for American Indian/Alaska Native, Asian, and Native Hawaiian/other Pacific Islander PWID, and persons of multiple races who inject drugs: the numbers are small.

Prevalence and Race/Ethnicity

At the end of 2018 in the United States and 6 dependent areas, approximately 122,112 adult and adolescent PWID were living with diagnosed HIV infection. Approximately 46% were black/African American, 27% were Hispanic/Latino, and 21% were white. Persons of multiple races accounted for approximately 5% of those living with diagnosed HIV infection among PWID. American Indians/Alaska Natives, Asians, and Native Hawaiians/other Pacific Islanders each accounted for less than 1% of those living with diagnosed HIV infection among PWID (Table 15b).

Data Tables, Definitions, and Acronyms Used on this Page

Table 6b. Diagnoses of HIV infection attributed to injection drug use, by year of diagnosis and selected characteristics, 2014–2018—United States and 6 dependent areas
Male Female
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 0 0 0 0 1 0 0 0 0 0
    20–24 0 0 3 0 0 0 1 1 1 0
    25–29 2 2 4 6 0 2 2 3 2 2
    30–34 0 2 0 3 2 2 1 1 1 3
    35–39 0 2 1 0 0 2 1 1 2 4
    40–44 3 0 2 1 0 2 2 1 2 0
    45–49 2 0 2 0 1 1 2 1 2 1
    50–54 3 1 0 3 2 0 0 4 2 0
    55–59 0 1 3 0 0 0 2 0 0 1
    60–64 0 0 1 1 0 1 1 1 0 1
    ≥65 0 0 0 1 0 0 0 0 1 0
     Region of residencea
    Northeast 0 0 0 1 1 0 0 0 1 0
    Midwest 1 1 0 2 2 2 0 1 1 3
    South 4 2 3 3 0 3 3 1 4 5
    West 4 6 13 11 6 6 8 12 8 5
    U.S. dependent areas 0 0 0 0 0 0 0 0 0 0
    Total 10 9 17 17 8 10 12 13 13 13
Asian
     Age at diagnosis (yr)
    13–14 0 0 0 0 0 0 0 0 0 0
    15–19 1 0 0 0 0 0 0 0 0 0
    20–24 1 0 0 0 1 0 0 1 0 0
    25–29 1 1 1 0 1 1 1 1 2 0
    30–34 4 7 1 2 3 0 1 1 0 2
    35–39 4 2 4 3 0 2 0 1 1 0
    40–44 3 4 1 2 3 1 0 0 0 0
    45–49 2 2 3 2 1 1 0 1 0 0
    50–54 2 2 3 1 1 0 0 0 1 0
    55–59 0 0 1 0 1 2 0 0 1 1
    60–64 0 1 0 0 1 1 2 0 0 0
    ≥65 1 1 1 0 1 0 0 0 0 0
     Region of residencea
    Northeast 6 8 3 3 5 2 1 1 1 1
    Midwest 1 0 2 0 2 2 1 0 1 0
    South 8 3 3 2 4 1 1 2 1 2
    West 4 9 7 6 1 2 2 3 3 1
    U.S. dependent areas 0 1 0 0 0 0 0 0 0 0
    Total 20 21 15 11 13 7 5 7 6 4
Black/African American
     Age at diagnosis (yr)
    13–14 0 0 0 0 0 0 1 1 0 0
    15–19 5 4 5 4 6 9 7 9 10 8
    20–24 31 25 21 21 23 31 25 24 28 22
    25–29 36 34 33 37 47 39 43 42 39 29
    30–34 39 42 36 53 49 37 34 39 39 39
    35–39 36 39 47 45 64 43 34 38 41 36
    40–44 47 45 43 37 37 38 33 27 38 30
    45–49 66 42 42 48 47 48 44 30 41 35
    50–54 62 64 60 47 47 50 40 52 39 34
    55–59 74 62 45 56 50 47 35 39 31 37
    60–64 43 32 38 33 33 21 26 28 25 26
    ≥65 38 30 31 28 33 18 14 16 19 17
     Region of residencea
    Northeast 152 119 115 131 123 107 91 74 91 83
    Midwest 44 48 52 60 61 47 50 51 58 42
    South 248 207 186 182 207 189 162 177 164 152
    West 30 45 48 35 45 38 36 44 37 36
    U.S. dependent areas 3 0 0 0 1 0 0 0 0 0
    Total 477 419 402 408 436 382 339 346 350 313
Hispanic/Latinob
     Age at diagnosis (yr)
    13–14 0 0 0 0 0 0 0 0 0 0
    15–19 3 2 3 5 3 7 4 4 4 3
    20–24 22 25 20 19 23 22 27 14 17 20
    25–29 39 39 35 43 37 18 16 32 19 18
    30–34 42 51 50 59 65 24 18 27 32 25
    35–39 41 56 46 40 45 24 22 15 24 24
    40–44 54 43 30 43 40 30 18 19 16 13
    45–49 59 42 38 45 41 18 15 17 19 19
    50–54 42 43 42 48 45 16 16 18 13 15
    55–59 34 35 33 27 25 17 9 14 9 9
    60–64 18 11 14 16 14 5 2 8 9 7
    ≥65 9 15 17 18 11 8 6 5 5 4
     Region of residencea
    Northeast 99 102 98 115 104 63 48 54 48 48
    Midwest 11 19 13 16 14 13 8 9 9 8
    South 90 94 80 91 97 52 51 54 47 46
    West 106 97 99 108 111 48 38 46 53 51
    U.S. dependent areas 57 49 38 34 25 14 7 10 9 2
    Total 363 361 327 363 350 189 152 172 166 155
Native Hawaiian/other Pacific Islander
     Age at diagnosis (yr)
    13–14 0 0 0 0 0 0 0 0 0 0
    15–19 0 0 0 0 0 0 0 0 0 0
    20–24 0 0 0 0 0 0 0 0 0 0
    25–29 0 0 0 0 0 0 1 0 0 0
    30–34 0 0 0 0 0 0 0 0 0 0
    35–39 0 1 0 1 0 0 0 0 0 0
    40–44 0 1 0 0 0 0 0 0 0 0
    45–49 0 0 0 0 1 0 0 0 0 0
    50–54 0 0 0 1 0 0 0 2 0 0
    55–59 0 0 0 0 0 0 0 0 0 0
    60–64 1 0 0 0 0 0 0 0 0 0
    ≥65 0 0 0 0 0 0 0 0 0 0
     Region of residencea
    Northeast 1 1 0 0 0 0 0 0 0 0
    Midwest 0 0 0 0 0 0 0 0 0 0
    South 0 0 0 0 0 0 0 0 0 0
    West 0 1 0 2 1 0 1 2 0 0
    U.S. dependent areas 0 0 1 0 1 0 0 0 0 0
    Total 1 3 1 2 2 0 1 2 0 0
White
     Age at diagnosis (yr)
    13–14 0 0 0 0 0 0 1 0 0 0
    15–19 2 1 4 4 4 13 9 5 9 8
    20–24 24 41 30 37 37 40 50 43 52 49
    25–29 41 81 79 87 98 56 90 94 88 79
    30–34 55 78 61 94 111 62 86 66 97 100
    35–39 45 50 67 78 114 47 55 58 81 94
    40–44 57 53 45 47 63 38 61 45 53 71
    45–49 51 66 50 56 50 36 49 43 37 44
    50–54 51 56 51 38 51 29 42 39 40 41
    55–59 29 32 27 38 36 19 25 22 31 28
    60–64 20 20 18 20 18 7 10 13 10 10
    ≥65 13 9 16 16 7 6 5 8 5 6
     Region of residencea
    Northeast 67 74 84 98 117 62 74 85 92 95
    Midwest 52 139 83 95 122 40 134 87 94 108
    South 146 153 160 204 217 169 195 179 222 219
    West 122 122 121 118 135 82 80 84 94 108
    U.S. dependent areas 0 1 0 0 0 0 0 0 0 0
    Total 387 489 448 515 591 353 482 435 502 529
Multiple races
     Age at diagnosis (yr)
    13–14 0 0 0 0 0 0 0 0 0 0
    15–19 0 0 1 0 1 1 1 1 2 3
    20–24 1 2 2 1 4 5 2 3 5 7
    25–29 10 5 8 6 6 5 3 6 6 10
    30–34 8 8 0 3 5 8 9 3 4 3
    35–39 5 0 6 4 4 7 4 7 5 3
    40–44 4 2 6 4 3 6 3 5 5 4
    45–49 4 2 2 4 2 6 4 6 3 3
    50–54 6 5 7 2 6 6 5 4 4 4
    55–59 3 4 3 3 3 3 7 5 3 1
    60–64 3 2 2 1 1 2 1 1 0 2
    ≥65 2 4 1 0 1 2 1 1 0 2
     Region of residencea
    Northeast 10 8 8 8 6 12 7 8 12 11
    Midwest 9 7 3 5 7 4 7 6 4 7
    South 15 14 15 9 13 27 16 18 13 15
    West 11 6 12 5 10 9 10 10 7 10
    U.S. dependent areas 0 0 0 0 0 0 0 0 0 0
    Total 45 34 38 26 36 51 40 41 36 43
Total
     Age at diagnosis (yr)
    13–14 0 0 0 0 0 1 2 1 0 0
    15–19 10 7 12 14 16 31 22 19 25 22
    20–24 79 94 76 78 88 98 105 85 103 98
    25–29 129 162 160 179 189 120 155 178 156 138
    30–34 147 188 150 214 235 133 150 138 172 173
    35–39 130 151 171 171 227 124 116 121 153 161
    40–44 168 148 126 135 147 115 117 97 113 118
    45–49 183 154 137 156 144 110 114 98 102 103
    50–54 165 172 162 139 153 101 103 119 99 95
    55–59 141 134 114 123 115 88 77 80 75 76
    60–64 86 67 72 71 68 37 43 50 44 46
    ≥65 63 59 66 64 53 34 27 30 29 29
     Region of residencea
    Northeast 334 312 307 355 356 246 221 221 246 239
    Midwest 118 214 153 178 207 107 200 155 166 168
    South 512 472 448 489 537 439 428 430 452 439
    West 278 285 299 285 308 186 174 200 201 210
    U.S. dependent areas 60 51 39 34 26 15 8 10 9 2
Total 1,302 1,334 1,247 1,342 1,434 992 1,031 1,016 1,072 1,058

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 subtotals and total.
Persons whose transmission category is classified as 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).

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