Diagnoses of HIV Infection in the United States and Dependent Areas 2019: Special Focus Profiles

Special Focus Profiles

The Special Focus Profiles highlight trends and distribution of HIV in 6 populations of particular interest to HIV prevention programs in state and local health departments: (1) Gay, Bisexual, and Other Men Who Have Sex With Men, (2) Persons Who Inject Drugs, (3) Transgender Persons, (4) Women, (5) Adolescents and Young Adults, and (6) Children Aged <13 Years.

Gay, Bisexual, and Other Men Who Have Sex With Men

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 make MSM of all races/ethnicities susceptible to 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 2019, MSM accounted for 69% (24,084 MMSC and 1,468 MMSC and IDU) of the 36,801 new HIV diagnoses in the United States and 6 dependent areas (Table 1b). 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 tested 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.

Diagnoses of HIV infection:

Age group: From 2015 through 2019 in the United States and 6 dependent areas, the largest number of diagnoses of HIV infection attributed to MMSC was among MSM aged 25–34 years (Figure 11). The number of diagnoses among MSM aged ≥55 years increased 5% (from 1,635 in 2015 to 1,718 in 2019) (Table 5b). From 2015 through 2019, the number of diagnoses among MSM aged 45–54 years decreased 27%, aged 13–24 years decreased 16%, and aged 35–44 years decreased 8%. The number of diagnoses among MSM aged 25–34 years remained stable.

Figure 11. Diagnoses of HIV Infection among Men Who Have Sex with Men, by Age Group, 2015–2019—United States and 6 Dependent Areas

From 2015 through 2019 in the United States and 6 dependent areas, the largest number of diagnoses of HIV infection attributed to MMSC was among MSM aged 25–34 years.

Note: Data have been statistically adjusted to account for missing transmission category. See section D4 in the Technical Notes for more information on transmission categories.

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Race/ethnicity: From 2015 through 2019 in the United States and 6 dependent areas, Black/African American MSM accounted for more than 36% and White MSM accounted for more than 30% of HIV diagnoses among MSM annually (Figure12). From 2015 through 2019, HIV diagnoses increased 24% among American Indian/Alaska Native MSM (from 102 in 2015 to 126 in 2019) (Table 5b). HIV diagnoses decreased 46% among multiracial MSM (from 1,072 in 2015 to 577 in 2019), decreased 18% among White MSM (from 7,074 in 2015 to 5,805 in 2019), decreased 16% among Asian MSM (from 690 in 2015 to 579 in 2019), and decreased 5% among Black/African American MSM (from 9,630 in 2015 to 9,123 in 2019). The number of diagnoses among Hispanic/Latino and Native Hawaiian/other Pacific Islander MSM remained stable.

Figure 12. Percentages of Diagnoses of HIV Infection among Men Who Have Sex with Men, by Race/Ethnicity, 2015–2019—United States and 6 Dependent Areas

From 2015 through 2019 in the United States and 6 dependent areas, Black/African American MSM accounted for more than 36&#37; and White MSM accounted for more than 30&#37; of HIV diagnoses among MSM annually.

Note: Data have been statistically adjusted to account for missing transmission category. See sections D3 and D4 in the Technical Notes for more information on race/ethnicity and transmission categories.
aHispanic/Latino persons can be of any race.

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Race/ethnicity and Age Group: In 2019, in the United States and 6 dependent areas, Black/African American MSM accounted for 25% of the 36,801 HIV diagnoses and 38% of diagnoses (51% of MSM aged 13–24 years and 33% of MSM aged >24 years) among all MSM (Figure 13). Hispanic/Latino MSM made up 21% (7,820) of the 36,801 new HIV diagnoses. From 2015 through 2019 among MSM >24 years, HIV diagnoses increased among American Indian/Alaska Native and Native Hawaiian/other Pacific Islander MSM (Table 5b). Among MSM aged 13–24 years, HIV diagnoses decreased or were stable among all racial/ethnic groups. Please use caution when interpreting data for Native Hawaiian/other Pacific Islander MSM aged 13–24 years: the numbers are small.

Figure 13. Percentages of Diagnoses of HIV Infection among Men Who Have Sex with Men, by Age Group and Race/Ethnicity, 2019—United States and 6 Dependent Areas

In 2019, in the United States and 6 dependent areas, Black/African American MSM accounted for 25&#37; of the 36,801 HIV diagnoses and 38&#37; of diagnoses (51&#37; of MSM aged 13–24 years and 33&#37; of MSM aged &gt;24 years) among all MSM.

Note: Data have been statistically adjusted to account for missing transmission category. See sections D3 and D4 in the Technical Notes for more information on race/ethnicity and transmission categories.
aHispanic/Latino persons can be of any race.

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Region and Race/Ethnicity: In 2019 in the United States and 6 dependent areas, the South had more diagnoses of HIV infection (12,325) among MSM than any other region and accounted for 51% of all diagnoses of HIV infection among MSM (Figure 14 and Table 5b). The largest percentage of MSM with HIV diagnoses in the South was among Black/African American MSM (47%), followed by Hispanic/Latino (28%), and White (21%) MSM. The largest percentage of MSM with HIV diagnoses in the West was among Hispanic/Latino MSM (48%), followed by White (28%), and Black/African American MSM (15%). The largest percentage of MSM with HIV diagnoses in the Northeast was among Hispanic/Latino (35%), followed by Black/African American (35%) and White MSM (22%).  The largest percentage of MSM with HIV diagnoses in the Midwest was among Black/African American MSM (47%), followed by White (32%), and Hispanic/Latino MSM (17%). Multiracial MSM 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.

Figure 14. Diagnoses of HIV Infection among Men Who Have Sex with Men, by Region of Residence and Race/Ethnicity, 2019—United States and 6 Dependent Areas

In 2019 in the United States and 6 dependent areas, the South had more diagnoses of HIV infection (12,325) among MSM than any other region and accounted for 51&#37; of all diagnoses of HIV infection among MSM.

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Prevalence and Race/Ethnicity: At year-end 2019 in the United States and 6 dependent areas, 592,579 MSM were living with diagnosed HIV infection (Table 16b). Approximately 36% of MSM living with diagnosed HIV infection were White, followed by Black/African American (31%), and Hispanic/Latino (26%) MSM. Multiracial males accounted for 5% of MSM living with diagnosed HIV infection, Asian MSM accounted for 2%, and American Indian/Alaska Native and Native Hawaiian/other Pacific Islander MSM each accounted for less than 1%.

Persons Who Inject Drugs

Persons who inject drugs (PWID) can get 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 brought attention to populations who would benefit from HIV prevention efforts.

Diagnoses of HIV infection:

Sex (at birth) and Race/ethnicity: From 2015 through 2019 in the United States and 6 dependent areas, the percentage of diagnoses of HIV infection attributed to IDU increased (Table 6b). In 2019, among 1,397 male PWID with diagnosed HIV infection, approximately 43% were White, 29% were Black/African American, and 23% were Hispanic/Latino persons (Figure 15). Among 1,111 female PWID with diagnosed HIV infection, 49% were White, 29% Black/African American, and 16% Hispanic/Latino persons. Please use caution when interpreting data for Asian and Native Hawaiian/other Pacific Islander PWID: the numbers are small.

Figure 15. Percentages of Diagnoses of HIV Infection among Persons Who Inject Drugs, by Sex at Birth and Race/Ethnicity, 2019—United States and 6 Dependent Areas

In 2019, among 1,397 male PWID with diagnosed HIV infection, approximately 43&#37; were White, 29&#37; were Black/African American, and 23&#37; were Hispanic/Latino persons.

Note: Data have been statistically adjusted to account for missing transmission category. See sections D3 and D4 in the Technical Notes for more information on race/ethnicity and transmission categories.
aHispanic/Latino persons can be of any race.

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Region and race/ethnicity: In 2019 in the United States and 6 dependent areas, 2,508 diagnosed HIV infections were among PWID (Table 6b). Of these, the largest number of HIV diagnoses were in the South (1,081), followed by the Northeast (536). White persons accounted for 537 diagnosed infections among PWID (50%) in the South, Black/African American persons accounted for 347 (32%), and Hispanic/Latino persons accounted for 160 (15%) (Figure 16). In the Northeast, Black/African American persons accounted for 203 diagnosed infections among PWID (38%), White persons accounted for 175 (33%), and Hispanic/Latino persons accounted for 134 (25%). Please use caution when interpreting data for American Indian/Alaska Native, Asian, and Native Hawaiian/other Pacific Islander PWID: the numbers are small.

Figure 16. HIV Diagnoses Among Persons Who Inject Drugs, by Region and Race/Ethnicity, 2019—United States and 6 Dependent Areas

White persons accounted for 537 diagnosed infections among PWID (50&#37;) in the South, Black/African American persons accounted for 347 (32&#37;), and Hispanic/Latino persons accounted for 160 (15&#37;).

Note: Data have been statistically adjusted to account for missing transmission category. See sections C, D3, D4, and E1 in the Technical Notes for more information on interpreting numbers, race/ethnicity, transmission categories and U.S. Census Regions.
aHispanic/Latino persons can be of any race.

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Prevalence and race/ethnicity: At year-end 2019 in the United States and 6 dependent areas, approximately 120,490 PWID were living with diagnosed HIV infection (Table 16b). Approximately 45% of PWID living with diagnosed HIV infection were Black/African American, 28% were Hispanic/Latino, and 22% were White persons. Multiracial persons accounted for approximately 5% of those living with diagnosed HIV infection among PWID. American Indian/Alaska Native, Asian, and Native Hawaiian/other Pacific Islander persons each accounted for less than 1% of those living with diagnosed HIV infection among PWID.

Transgender Persons

Transgender is an umbrella term that is used to identify persons whose sex assigned at birth does not match current gender identity or expression. Gender identity refers to one’s internal understanding of one’s own gender, or the gender with which a person identifies. Gender expression is a term used to describe people’s outward presentation of their gender. Gender identity and sexual orientation are different facets of identity. Everyone has a gender identity and a sexual orientation, but a person’s gender does not determine a person’s sexual orientation. Transgender persons may identify as heterosexual, homosexual, bisexual, or none of the above. Transgender persons face numerous prevention challenges, including lack of public/provider knowledge about transgender issues and social rejection and exclusion, and are understudied in HIV prevention (e.g., pre-exposure prophylaxis, [PrEP]) and treatment interventions.

Diagnoses of HIV infection:

Gender: From 2015 through 2019 in the United States and 6 dependent areas, the number of diagnoses of HIV infection for transgender adults and adolescents increased (Table 4b). In 2019, among all adults and adolescents, diagnoses of HIV infection among transgender persons accounted for approximately 2% of diagnoses. In 2019, among transgender adults and adolescents, the largest percentage (93%) of diagnoses of HIV infections was for transgender MTF.

Age group: From 2015 through 2019 in the United States and 6 dependent areas, the number of diagnoses of HIV infection among transgender persons aged 25–34 and 35–44 years increased (Figure 17). The number for transgender persons aged 13–24 and 45–54 years decreased. In 2019, the largest percentage (24%) of diagnoses of HIV infection was among transgender MTF aged 20–24 years, followed by transgender MTF aged 25–29 years (23%), and transgender MTF aged 30–34 years (19%) (Table 4b). Please use caution when interpreting data for transgender persons 13–14, ≥55 years, and transgender FTM aged 20–24, 35–39, and 45–54 years: the numbers are small.

Figure 17. Diagnoses of HIV Infection among Transgender Adults and Adolescents, by Age at Diagnosis, 2015–2019—United States and 6 Dependent Areas

From 2015 through 2019 in the United States and 6 dependent areas, the number of diagnoses of HIV infection among transgender persons aged 25–34 and 35–44 years increased. The number for transgender persons aged 13–24 and 45–54 years decreased.

Note: See section D2.2 in the Technical Notes for more information on gender.

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Race/ethnicity: From 2015 through 2019 in the United States and 6 dependent areas, the number of diagnoses of HIV infection among White transgender adults and adolescents increased (Figure 18). The number of diagnoses of HIV infection for Asian and multiracial transgender adults and adolescents decreased. The number of diagnoses of HIV infection for Black/African American and Hispanic/Latino transgender adults and adolescents remained stable. Please use caution when interpreting data for American Indian/Alaska Native and Native Hawaiian/other Pacific Islander transgender adults and adolescents: the numbers are small.

Figure 18. Diagnoses of HIV Infection among Transgender Adults and Adolescents, by Race/Ethnicity, 2015–2019—United States and 6 Dependent Areas

From 2015 through 2019 in the United States and 6 dependent areas, the number of diagnoses of HIV infection among White transgender adults and adolescents increased.

Note: See sections D2.2 and D3 in the Technical Notes for more information on gender and race/ethnicity.

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In 2019 in the United States and 6 dependent areas, among transgender MTF adults and adolescents, the largest percentage of diagnoses of HIV infection was for Black/African American persons (46%), followed by Hispanic/Latino (35%), and White (13%) persons (Figure 19 and Table 4b). The largest percentage of diagnoses of HIV infection among transgender FTM was for Black/African American persons (41%), followed by Hispanic/Latino (26%), and White (24%) persons.  Please use caution when interpreting data for American Indian/Alaska Native, Asian, Native Hawaiian/other Pacific Islander, and multiracial transgender persons: the numbers are small.

Figure 19. Percentages of Diagnoses of HIV Infection among Transgender Adults and Adolescents, by Race/Ethnicity, 2019—United States and 6 Dependent Areas

In 2019 in the United States and 6 dependent areas, among transgender MTF adults and adolescents, the largest percentage of diagnoses of HIV infection was for Black/African American persons (46&#37;), followed by Hispanic/Latino (35&#37;), and White (13&#37;) persons.

Note: See sections D2.2 and D3 in the Technical Notes for more information on gender and race/ethnicity.
aHispanic/Latino persons can be of any race.

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Region: From 2015 through 2019 in the United States and 6 dependent areas, the number of diagnoses of HIV infection among transgender adults and adolescents increased in the South and West; and decreased in the Northeast and Midwest (Table 4b). In 2019, the largest percentage (43%) of diagnoses of HIV infection was for transgender adults and adolescents in the South, followed by 28% in the West, 16% in the Northeast, and 13% in the Midwest. Overall, the larger percentage of diagnoses of HIV infection in each of the 4 regions was for transgender MTF adults and adolescents.

Women

Though HIV diagnoses among women have declined in recent years, approximately 7,000 women received an HIV diagnosis in the United States and 6 dependent areas in 2019. One in nine women with HIV are unaware they have it. Because some women may be unaware of their male partner’s risk factors for HIV (such as injection drug use or having sex with men), they may not use condoms or medicines to prevent HIV. Additionally, HIV testing rates within the past year were low among women with sexual behaviors that increase their risk of acquiring HIV and especially low among those who reported anal sex.

Diagnoses of HIV infection

Figure 20. Rates of Diagnoses of HIV Infection among Female Adults and Adolescents, 2019—United States and 6 Dependent Areas

In 2019 in the United States and 6 dependent areas, the rate of diagnoses of HIV infection among female adults and adolescents was 4.9. Rates ranged from a low of 0.0 in American Samoa, Guam, and the Republic of Palau to a high of 18.1 in the District of Columbia, followed by 10.2 in Georgia, 9.9 in Maryland, 9.7 in Florida, and 9.6 in Louisiana.

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In 2019 in the United States and 6 dependent areas, the rate of diagnoses of HIV infection among female adults and adolescents was 4.9 (Figure 20). Rates ranged from a low of 0.0 in American Samoa, Guam, and the Republic of Palau to a high of 18.1 in the District of Columbia, followed by 10.2 in Georgia, 9.9 in Maryland, 9.7 in Florida, and 9.6 in Louisiana.

Race/ethnicity: In 2019 in the United States, Black/African American female adults and adolescents made up 13% of the female population but accounted for 55% of diagnoses of HIV infection among females (Figure 21). White female adults and adolescents made up 62% of the female population and accounted for 22% of diagnoses of HIV infection. Hispanic/Latino female adults and adolescents made up 17% of the female population and accounted for 18% of diagnoses of HIV infection. Asian female adults and adolescents made up 6% of the female population but accounted for 1% of HIV diagnoses. Multiracial females made up 2% of the female population and accounted for 3% of HIV diagnoses. Native Hawaiian/other Pacific Islander and American Indian/Alaska Native female adults and adolescents each made up 1% or less of the female population and each accounted for less than 1% of HIV diagnoses. Please use caution when interpreting data for Native Hawaiian/other Pacific Islander female adults and adolescents: the number is small.

Figure 21. Percentages of Diagnoses of HIV Infection and Population among Female Adults and Adolescents, by Race/Ethnicity, 2019—United States

In 2019 in the United States, Black/African American female adults and adolescents made up 13&#37; of the female population but accounted for 55&#37; of diagnoses of HIV infection among females. White female adults and adolescents made up 62&#37; of the female population and accounted for 22&#37; of diagnoses of HIV infection. Hispanic/Latino female adults and adolescents made up 17&#37; of the female population and accounted for 18&#37; of diagnoses of HIV infection. Asian female adults and adolescents made up 6&#37; of the female population but accounted for 1&#37; of HIV diagnoses. Multiracial females made up 2&#37; of the female population and accounted for 3&#37; of HIV diagnoses. Native Hawaiian/other Pacific Islander and American Indian/Alaska Native female adults and adolescents each made up 1&#37; or less of the female population and each accounted for less than 1&#37; of HIV diagnoses.

Note: See section D3 in the Technical Notes for more information on race/ethnicity.
aHispanic/Latino persons can be of any race.

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From 2015 through 2019 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 4,262 in 2015 to 3,812 in 2019 (Figure 22). White female adults and adolescents was the only race/ethnicity group among females where the number of diagnoses of HIV infection increased (from 1,364 in 2015 to 1,508 in 2019). In 2019, 44 diagnoses of HIV infection were among American Indian/Alaska Native, 97 among Asian, 1,326 among Hispanic/Latino, 10 among Native Hawaiian/other Pacific Islander females, and 202 among multiracial female adults and adolescents. Please use caution when interpreting data for Native Hawaiian/other Pacific Islander female adults and adolescents: the numbers are small.

Figure 22. Diagnoses of HIV Infection among Female Adults and Adolescents, by Race/Ethnicity, 2015–2019—United States and 6 Dependent Areas

From 2015 through 2019 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 4,262 in 2015 to 3,812 in 2019. White female adults and adolescents was the only race/ethnicity group among females where the number of diagnoses of HIV infection increased (from 1,364 in 2015 to 1,508 in 2019).

Note: See section D3 in the Technical Notes for more information on race/ethnicity.
aHispanic/Latino persons can be of any race.

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Race/ethnicity and Transmission category: In 2019 in the United States and 6 dependent areas, Asian female adults and adolescents had the largest percentage (93%) of diagnoses of HIV infection attributed to heterosexual contact, followed by Black/African American (91%), and Hispanic/Latino (87%) female adults and adolescents (Figure 23). The percentage (40%) of diagnoses of HIV infection attributed to injection drug use was largest among American Indian/Alaska Native female adults and adolescents, followed by White (36%) and multiracial (20%) female adults and adolescents. The perinatal and “Other” transmission categories accounted for 1% or less of diagnoses among each racial/ethnic group. Please use caution when interpreting data for Native Hawaiian/other Pacific Islander female adults and adolescents: the numbers are small.

Figure 23. Percentages of Diagnoses of HIV Infection among Female Adults and Adolescents, by Transmission Category and Race/Ethnicity, 2019—United States and 6 Dependent Areas

In 2019 in the United States and 6 dependent areas, Asian female adults and adolescents had the largest percentage (93&#37;) of diagnoses of HIV infection attributed to heterosexual contact, followed by Black/African American (91&#37;), and Hispanic/Latino (87&#37;) female adults and adolescents. The percentage (40&#37;) of diagnoses of HIV infection attributed to injection drug use was largest among American Indian/Alaska Native female adults and adolescents, followed by White (36&#37;) and multiracial (20&#37;) female adults and adolescents.

Note: Data have been statistically adjusted to account for missing transmission category. See sections D3 and D4 in the Technical Notes for more information on race/ethnicity and transmission categories.
aHispanic/Latino persons can be of any race.

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Region: In 2019 in the United States among female adults and adolescents, the South had the highest number of diagnoses (3,848) of HIV infection (Figure 24). The highest rates of diagnoses of HIV infection among American Indian/Alaska Native (8.3), Asian (1.5), Black/African American (22.2), and White (2.4) female adults and adolescents were in the South. The highest rate of diagnoses of HIV infection among Hispanic/Latino (8.0) and multiracial (13.5) female adults and adolescents were in the Northeast. Please use caution when interpreting data for Native Hawaiian/other Pacific Islander female adults and adolescents: the numbers are small.

Figure 24. Rates of HIV Diagnoses among Female Adults and Adolescents by Race/Ethnicity and Region, 2019—United States

In 2019 in the United States among female adults and adolescents, the South had the highest number of diagnoses (3,848) of HIV infection. The highest rates of diagnoses of HIV infection among American Indian/Alaska Native (8.3), Asian (1.5), Black/African American (22.2), and White (2.4) female adults and adolescents were in the South. The highest rate of diagnoses of HIV infection among Hispanic/Latino (8.0) and multiracial (13.5) female adults and adolescents were in the Northeast.

Note: See sections D3 and E1 in the Technical Notes for more information on race/ethnicity and U.S. Census Regions.
aHispanic/Latino persons can be of any race.

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Prevalence and race/ethnicity: At year-end 2019 in the United States and 6 dependent areas, 248,144 female adults and adolescents were living with diagnosed HIV infection, of whom 57% were Black/African American, 21% Hispanic/Latino, and 16% White (Table 17b). Multiracial female adults and adolescents accounted for 5% of females living with diagnosed HIV infection, followed by Asian female adults and adolescents (1%), and American Indian/Alaska Native and Native Hawaiian/other Pacific Islander female adults and adolescents who each accounted for 1% or less.

Adolescents and Young Adults

Adolescents (persons aged 13–19 years) and young adults (persons aged 20–24 years) accounted for 21% of the 36,801 diagnoses of HIV infection in 2019 in the United States and 6 dependent areas. They are the least likely of any age group to be aware of their HIV infection, retained in care, or have a suppressed viral load. Lack of awareness of HIV status may be due to recent infection or low rates of HIV testing. Persons who do not know they have HIV do not get medical care or receive treatment and can unknowingly infect others. In addition, adolescents and young adults have high rates of STDs and low rates of condom use, greatly increasing the chance of getting or transmitting HIV. Addressing HIV among adolescents and young adults requires that they have access to the information and tools they need to make healthy decisions, reduce their risk factors, get treatment, and stay in care.

Gender: From 2015 through 2019 in the United States and 6 dependent areas, the number of diagnoses of HIV infection among adolescents and young adults for males, females, and transgender MTF decreased (Figure 25). In 2019, diagnoses of HIV infection among adolescent and young adult males (85%) and females (12%) accounted for approximately 97% of HIV diagnoses (Table 8b). Transgender MTF adolescents and young adults accounted for 3% of annual diagnoses. Please use caution when interpreting data for transgender FTM and AGI adolescents and young adults: the numbers are small.

Figure 25. Diagnoses of HIV Infection among Adolescents and Young Adults, by Gender, 2015–2019— United States and 6 Dependent Areas

From 2015 through 2019 in the United States and 6 dependent areas, the number of diagnoses of HIV infection among adolescents and young adults for males, females, and transgender MTF decreased.

Note: See section D2.2 in the Technical Notes for more information on gender.

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Age group: From 2015 through 2019 in the United States and 6 dependent areas, the number of diagnoses of HIV infection among adolescents and young adults for each 2- and 3-year age group decreased (Figure 26). In 2019, of the 7,648 diagnoses of HIV infection among adolescents and young adults, the largest percentages (44%) were for persons aged 20–22 years, followed by 34% for persons aged 23–24, 17% for persons aged 18–19, 5% for persons aged 15–17, and less than 1% for persons aged 13–14 years (Table 8b).

Figure 26. Diagnoses of HIV Infection among Adolescents and Young Adults, by 2-year and 3-year Age Groups, 2015–2019—United States and 6 Dependent Areas

From 2015 through 2019 in the United States and 6 dependent areas, the number of diagnoses of HIV infection among adolescents and young adults for each 2- and 3-year age group decreased.

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Race/ethnicity: From 2015 through 2019 in the United States, the rate of diagnosis of HIV infection for Asian, Black/African American, and multiracial adolescents decreased (Figure 27). The rates of diagnosis of HIV infection for Hispanic/Latino and White adolescents remained stable. In 2019, the highest rate was 23.5 for Black/African American adolescents, followed by 6.3 for Hispanic/Latino, and 4.2 for multiracial adolescents. Please use caution when interpreting data for American Indian/Alaska Native and Native Hawaiian/other Pacific Islander adolescents: the numbers are small.

Figure 27. Rates of Diagnoses of HIV Infection among Adolescents, by Year of Diagnosis and Race/Ethnicity, 2015–2019—United States

From 2015 through 2019 in the United States, the rate of diagnosis of HIV infection for Asian, Black/African American, and multiracial adolescents decreased. The rates of diagnosis of HIV infection for Hispanic/Latino and White adolescents remained stable.

Note: See section D3 in the Technical Notes for more information on race/ethnicity.
aHispanic/Latino persons can be of any race.

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From 2015 through 2019 in the United States, the rate of diagnosis of HIV infection for American Indian/Alaska Native young adults increased (Figure 28). The rates of diagnosis of HIV infection for Asian, Black/African American, Hispanic/Latino, White and multiracial young adults decreased. In 2019, the highest rate was 97.3 for Black/African American young adults, followed by 34.0 for Hispanic/Latino, 23.0 for multiracial, and 20.4 for American Indian/Alaska Native young adults. Please use caution when interpreting data for Native Hawaiian/other Pacific Islander young adults: the numbers are small.

Figure 28. Rates of Diagnoses of HIV Infection among Young Adults, by Year of Diagnosis and Race/Ethnicity, 2015–2019—United States

From 2015 through 2019 in the United States, the rate of diagnosis of HIV infection for American Indian/Alaska Native young adults increased. The rates of diagnosis of HIV infection for Asian, Black/African American, Hispanic/Latino, White and multiracial young adults decreased.

Note: See section D3 in the Technical Notes for more information on race/ethnicity.
aHispanic/Latino persons can be of any race.

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Sex (at birth) and Transmission category: From 2015 through 2019 in the United States and 6 dependent areas, the annual number of diagnosed HIV infections for male adolescents and young adults attributed to MMSC, IDU, MMSC and IDU, and heterosexual contact decreased (Figure 29). The perinatal and “Other” transmission categories accounted for less than 1% of diagnoses. Among female adolescents and young adults, the number of infections attributed to IDU and heterosexual contact decreased. The perinatal and “Other” transmission categories accounted for less than 1% of diagnoses.

Figure 29. Diagnoses of HIV Infection among Adolescents and Young Adults, by Sex at Birth and Transmission Category, 2015–2019—United States and 6 Dependent Areas

From 2015 through 2019 in the United States and 6 dependent areas, the annual number of diagnosed HIV infections for male adolescents and young adults attributed to MMSC, IDU, MMSC and IDU, and heterosexual contact decreased.

Data have been statistically adjusted to account for missing transmission category. See section D4 in the Technical Notes for more information on transmission categories.

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In 2019, diagnoses of HIV infection for  adolescents and young adults attributed to MMSC (approximately 83%, including 3% MMSC and IDU) and those attributed to heterosexual contact (13%) accounted for approximately 97% of diagnoses in the United States (Figure 30 and Table 8b).

Figure 30. Diagnoses of HIV Infection among Adolescents and Young Adults, by Sex at Birth and Transmission Category, 2019—United States and 6 Dependent Areas

In 2019, diagnoses of HIV infection for adolescents and young adults attributed to MMSC (approximately 83&#37;, including 3&#37; MMSC and IDU) and those attributed to heterosexual contact (13&#37;) accounted for approximately 97&#37; of diagnoses in the United States.

Note: Data have been statistically adjusted to account for missing transmission category. See section D4 in the Technical Notes for more information on transmission categories.

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Children Aged < 13 Years

To make informed decisions about antiretroviral therapy to reduce perinatal transmission of HIV to their infants, pregnant women should know their HIV infection status. In 1995, the first recommendations for HIV counseling and voluntary testing for pregnant women were published. In 2006, CDC released revised recommendations for HIV testing which specified that opt-out HIV screening should be included in the routine panel of prenatal screening tests for all pregnant women.

Diagnoses of HIV infection

Figure 31. Diagnoses of Perinatally Acquired HIV Infection among Children Born During 2018—United States and 6 Dependent Areas

In the United States and Puerto Rico, a total of 35 children born during 2018 had HIV infection attributed to perinatal transmission. Florida and Texas reported the largest numbers of diagnosed HIV infections attributed to perinatal transmission in infants born in 2018.

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In the United States and Puerto Rico, a total of 35 children born during 2018 had HIV infection attributed to perinatal transmission (Figure 31). Florida and Texas reported the largest numbers of diagnosed HIV infections attributed to perinatal transmission in infants born in 2018. Thirty-six areas reported no perinatally acquired infections among infants born in 2018. 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 Puerto Rico during 2018, regardless of year of diagnosis.

Age Group: From 2015 through 2019 in the United States and 6 dependent areas, a total of 524 children received a diagnosis of HIV infection (Figure 32). Approximately 35% of children 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.

Figure 32. Diagnoses of HIV Infection among Children, by Age at Diagnosis, 2015–2019—United States and 6 Dependent Areas

From 2015 through 2019 in the United States and 6 dependent areas, a total of 524 children received a diagnosis of HIV infection. Approximately 35&#37; of children had their HIV infection diagnosed within the first 6 months of life (i.e., 0–5 months), and an additional 4&#37; during months 6–11.

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 Exposure: From 2015 through 2018 in the United States and Puerto Rico, among the 214 children born with diagnosed, perinatally acquired HIV infection, 47% were born to mothers who were tested before pregnancy, 18% were born to mothers who were tested during pregnancy, and 9% to mothers tested at the time of birth (Figure 33). An additional 19% of children with diagnosed, perinatally acquired HIV infection were born to mothers who were tested after the child’s birth, and 7% were born to mothers whose time of maternal HIV testing was unknown.

Figure 33. Time of Maternal HIV Testing among Children with Diagnosed Perinatally Acquired HIV Infection and Children Exposed to HIV, Birth Years 2015–2018—United States and Puerto Rico

From 2015 through 2018 in the United States and Puerto Rico, among the 214 children born with diagnosed, perinatally acquired HIV infection, 47&#37; were born to mothers who were tested before pregnancy, 18&#37; were born to mothers who were tested during pregnancy, and 9&#37; to mothers tested at the time of birth. An additional 19&#37; of children with diagnosed, perinatally acquired HIV infection were born to mothers who were tested after the child’s birth, and 7&#37; were born to mothers whose time of maternal HIV testing was unknown.

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From 2015 through 2018 in the United States and Puerto Rico, among the 11,106 children born who were exposed but not perinatally infected with HIV, the majority (81%) were born to mothers who were tested before pregnancy, while 16% were born to mothers who were tested during pregnancy, 1% to mothers tested at the time of birth, less than 1% to mothers tested after birth, and 1% 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 is likely a minimum count of 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.

Race/ethnicity: From 2015 through 2019 in the United States and 6 dependent areas, among children, the percentage of diagnosed HIV infection in Black/African American children ranged from 55% to 61% (Figure 34). In 2019, Black/African American children accounted for 57% of diagnoses of HIV infection. Please use caution when interpreting trend data for American Indian/Alaska Native, Asian, Hispanic/Latino, Native Hawaiian/ other Pacific Islander, and multiracial children: the numbers are small.

Figure 34. Percentages of Diagnoses of HIV Infection among Children, by Race/Ethnicity, 2015–2019—United States and 6 Dependent Areas

From 2015 through 2019 in the United States and 6 dependent areas, among children, the percentage of diagnosed HIV infection in Black/African American children ranged from 55&#37; to 61&#37;.

Note: See section D3 in the Technical Notes for more information on race/ethnicity.
aHispanic/Latino persons can be of any race.

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In 2019 in the United States, Black/African American children made up approximately 14% of the population of children but accounted for 57% of diagnoses of HIV infection among children (Figure 35). Hispanic/Latino children made up 26% of the population of children but accounted for 13% of diagnoses. White children made up 50% of the population of children but accounted for 11% of diagnoses.

Figure 35. Percentages of Diagnoses of HIV Infection and Population among Children, by Race/Ethnicity, 2019—United States

In 2019 in the United States, Black/African American children made up approximately 14&#37; of the population of children but accounted for 57&#37; of diagnoses of HIV infection among children. Hispanic/Latino children made up 26&#37; of the population of children but accounted for 13&#37; of diagnoses. White children made up 50&#37; of the population of children but accounted for 11&#37; of diagnoses.

Note: See section D3 in the Technical Notes for more information on race/ethnicity.
aHispanic/Latino persons can be of any race.

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Prevalence: At the end of 2019 in the United States and 6 dependent areas, approximately 1,698 children aged less than 13 years were living with diagnosed HIV infection (Figure 36). Areas with the highest rates of children aged less than 13 years living with diagnosed HIV infection at the end of 2019 were the District of Columbia (14.7), the U.S. Virgin Islands (10.7), Maine (7.5), and Vermont (6.3). Data for the year 2019 are preliminary and based on deaths reported to CDC as of December 2020.

Figure 36. Rates of Children Living with Diagnosed HIV infection, year-end 2019—United States and 6 Dependent areas

At the end of 2019 in the United States and 6 dependent areas, approximately 1,698 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 2019 were the District of Columbia (14.7), the U.S. Virgin Islands (10.7), Maine (7.5), and Vermont (6.3). Data for the year 2019 are preliminary and based on deaths reported to CDC as of December 2020.

Note: Data for the year 2019 are preliminary and based on deaths reported to CDC as of December 2020. Data are based on address of residence as of December 31, 2019 (i.e., most recent known address). Asterisk (*) indicates incomplete reporting. See section C1.3 in Technical Notes for more information on prevalence.

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At the end of 2019 in the United States and 6 dependent areas, there were 12,355 persons living with diagnosed perinatally acquired HIV infection (Figure 37). The number of persons living with diagnosed, perinatally acquired HIV infections ranged from 0 in American Samoa, the Northern Mariana Islands, and the Republic of Palau to 2,398 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 2019, regardless of their age at year-end 2019. Data for the year 2019 are preliminary and based on deaths reported to CDC through December 2020.

Figure 37. Persons Living with Diagnosed Perinatally Acquired HIV Infection, Year-end 2019—United States and 6 Dependent Areas

At the end of 2019 in the United States and 6 dependent areas, there were 12,355 persons living with diagnosed perinatally acquired HIV infection. The number of persons living with diagnosed, perinatally acquired HIV infections ranged from 0 in American Samoa, the Northern Mariana Islands, and the Republic of Palau to 2,398 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 2019, regardless of their age at year-end 2019. Data for the year 2019 are preliminary and based on deaths reported to CDC through December 2020.

Note: Data for the year 2019 are preliminary and based on deaths reported to CDC as of December 2020. Data are based on address of residence as of December 31, 2019 (i.e., most recent known address). Asterisk (*) indicates incomplete reporting. See section C1.3 in Technical Notes for more information on prevalence.

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