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Diagnoses of HIV Infection in the United States and Dependent Areas 2021: Figures

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The annual number of HIV diagnoses in 2020 was 17% lower than in 2019, likely due to disruptions in clinical care services, patient hesitancy in accessing clinical services, and shortages in HIV testing reagents/materials during the COVID-19 pandemic. During 2021, the overall number of HIV diagnoses rebounded and was 18% higher than in 2020; the partial rebound in the number of HIV diagnoses may be due to the identification and reporting of HIV cases missed in 2020.

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In 2021, in the United States and 6 dependent areas, there were 36,136 HIV diagnoses (rate: 12.7 per 100,000) among persons aged ≥13 years.

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In 2021, compared to 2017, in the United States and 6 dependent areas, the number of diagnoses of HIV infection increased among transgender women, transgender men, and additional gender identity persons aged ≥13 years and decreased among male and female persons aged ≥13 years.

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In 2021, compared to 2017, in the United States and 6 dependent areas, the rates among persons aged 13–24, 45–54, and ≥55 years decreased. The rates among persons aged 25–34 and 35-44 years remained stable.

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If the rate of HIV diagnoses among persons aged 25–34 years was similar to the rate among persons aged ≥ 55 years, then diagnoses could have been reduced by 25 cases per 100,000 population. The rate of diagnoses among persons aged 25–34 years was 7.6 times the rate among persons aged ≥ 55 years.

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From 2017 to 2021 in the United States and 6 dependent areas, the number of diagnoses of HIV infection among American Indian/Alaska Native and Native Hawaiian/other Pacific Islander persons aged ≥13 years increased. The number of diagnoses of HIV infection among Asian, Black/African American, White, and multiracial persons aged ≥13 years decreased. The number of diagnoses of HIV infection among Hispanic/Latino persons aged ≥13 years remained stable.

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In 2021, in the United States and 6 dependent areas, 67% of HIV diagnoses were attributed to male-to-male sexual contact (MMSC).

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In 2021, in the United States and 6 dependent areas, there were 19,985 deaths (rate: 7.1 per 100,000) among persons aged ≥13 years with diagnosed HIV infection.

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In 2021, in the United States and 6 dependent areas, 62% of the deaths of persons aged ≥13 years with a diagnosis of HIV infection were among persons aged ≥ 55 years, 42% were among Black/African American persons, and 48% were among persons residing in the South.

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If the rate of deaths among persons aged ≥55 years with diagnosed HIV infection was similar to the rate among persons aged 25–34 years (3.0), then deaths could have been reduced by 9 per 100,000 population. The rate of death among persons aged ≥55 years was 4.1 times the rate among persons aged 25–34 years.

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At year-end 2021 in the United States and 6 dependent areas, 1,087,503 persons aged≥13 years (rate: 383.7) were living with diagnosed HIV infection.

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In 2021, in the United States and 6 dependent areas, the percentage of persons aged ≥13 years living with diagnosed HIV infection was 35% among Black/African American males (assigned sex at birth) and 57% among Black/African American females (assigned sex at birth).

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In 2021, compared to 2017, in the United States and 6 dependent areas, the number of diagnoses of HIV infection attributed to male-to-male sexual contact (MMSC) among persons aged ≥55 years increased. The number of diagnoses of HIV infection attributed to MMSC among persons aged 13-24 and 45-54 years decreased. The number of diagnoses of HIV infection attributed to MMSC among persons aged 25-34 and 35-44 years remained stable.

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In 2021, in the United States and 6 dependent areas, 40% of diagnoses of HIV infection attributed to male-to-male sexual contact (MMSC) were among persons aged 25-34 years, 37% were among Black/African American persons, and 51% were among persons residing in the South.

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In 2021, among diagnoses of HIV infection among males attributed to male-to-male sexual contact (MMSC), Black/African American males had the highest percentage (52%) among those aged 13-24 years, and Hispanic/Latino males had the highest percentage (35%) among those aged >24 years.

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In 2021, among diagnoses of HIV infection among males attributed to male-to-male sexual contact (MMSC), Hispanic/Latino males had the highest number of diagnoses in the Northeast, West, and U.S. dependent areas. Black/African American males had the highest number of diagnoses in the Midwest and South.

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In 2021 in the United States and 6 dependent areas, 31% of diagnoses of HIV infection attributed to injection drug use were among persons aged 25-34 years, 49% were among White persons, and 44% were among those residing in the South.

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In 2021, among diagnoses of HIV infection attributed to injection drug use, White males and females had the highest percentage of diagnoses by race, 47% and 51%, respectively.

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In 2021, among diagnoses of HIV infection attributed to injection drug use, White persons had the highest number of diagnoses in the Northeast, Midwest, South, and West. Hispanic/Latino persons had the highest number of diagnoses in U.S. dependent areas.

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In 2021, in the United States and 6 dependent areas, 42% of diagnoses of HIV infection among transgender and additional gender identity persons were among those aged 25-34 years, 44% were among Black/African American persons, 88% were attributed to sexual contact, and 42% were among those residing in the South.

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In 2021 in the United States and 6 dependent areas, 46% of transgender women diagnosed with HIV infection were Black/African American, 34% of transgender men diagnosed with HIV infection were White, and 34% of additional gender identity persons diagnosed with HIV infection were White.

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In 2021, in the United States and 6 dependent areas, infections attributed to sexual contact had the highest percentage for exposure categories among transgender women (88%), transgender men (84%), and additional gender identity persons (86%).

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In 2021, in the United States and 6 dependent areas, there were 6,666 HIV diagnoses (rate: 4.6 per 100,000) among females (based on assigned sex at birth) aged ≥13 years.

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In 2021 in the United States, Black/African American females (assigned sex at birth) aged ≥ 13 years made up 13% of the female population, but HIV infection among this group accounted for 54% of diagnoses. White females (assigned sex at birth) aged ≥ 13 years made up 61% of the female population, and HIV infection among this group accounted for 23% of diagnoses. Hispanic/Latino females (assigned sex at birth) aged ≥ 13 years made up 17% of the female population, and HIV infection among this group accounted for 18% of diagnoses.

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In If the rate of HIV diagnoses among females aged 25–34 years was similar to the rate among females aged ≥ 55 years, then diagnoses could have been reduced by 6 cases per 100,000 population. The rate of diagnoses among females aged 25–34 years was 4.0 times the rate among females aged ≥ 55 years.

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In 2021, in the United States and 6 dependent areas, infections attributed to heterosexual contact had the highest percentage for transmission categories among all females (assigned sex at birth) by race: American Indian/Alaska Native (63%), Asian (91%), Black/African American (91%), Hispanic/Latino (87%), Native Hawaiian/other Pacific Islander (67%), White (63%), and multiracial (83%).

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In 2021 in the United States, the rate of HIV diagnosis among females (assigned sex at birth) aged ≥13 years was highest for White females in the Northeast (20.4 per 100,000 population) and Black/African American females in the Midwest (15.2), South (20.9), and West (18.0).

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In 2021, the rates of diagnosis of HIV infection among persons aged ≥13 years were highest in the South (17.5 per 100,000 population), followed by the U.S. dependent areas (13.0) and the West (10.9).

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In 2021, Black/African American persons aged ≥ 13 years made up 19% of the South population, but HIV infection among this group accounted for 49% of diagnoses. White persons aged ≥ 13 years made up 57% of the South population, but HIV infection among this group accounted for 23% of diagnoses. Hispanic/Latino persons aged ≥ 13 years made up 18% of the South population, but HIV infection among this group accounted for 24% of diagnoses.

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If the rate of HIV diagnoses among persons aged 25–34 years in the South was similar to the rate among persons aged ≥ 55 years in the South, then diagnoses could have been reduced by 35 cases per 100,000 population. The rate of HIV diagnoses among persons aged 25–34 years in the South was 7.8 times the rate among persons aged ≥ 55 years in the South.

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For the difference between rates of HIV diagnoses among a select race/ethnicity and the rates among White persons, there was a wider gap (or greater disparity) in 2017 than 2021 (except for American Indian/Alaska Native–White and Asian–White). For the rates of HIV diagnoses among a select race/ethnicity divided by the rates among White persons, there was a wider gap (or greater disparity) in 2017 than in 2021 (except for American Indian/Alaska Native–White and Asian–White).

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In 2021, for diagnoses of HIV infection among males aged ≥13 years in the South, the highest percentage of infections were attributed to male-to-male sexual contact (MMSC) for all racial/ethnic groups (ranging from 76% among White males to 94% among Native Hawaiian/other Pacific Islander males). For diagnoses among females aged ≥13 years in the South, the highest percentage of infections were attributed to heterosexual for all racial/ethnic groups, except Native Hawaiian/other Pacific Islander (50% heterosexual contact and 50% injection drug use).

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In 2021, among persons aged 13-24 years in the United States and 6 dependent areas, 84% of diagnoses of HIV infection were among male gender, 45% were among persons aged 20-22 years, 53% were among Black/African American persons, and 56% were among persons residing in the South.

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If the rate of HIV diagnoses among persons aged 23–24 years was similar to the rate among persons aged 18‒19 years (13.2), then diagnoses could have been reduced by 14 cases per 100,000 population. The rate of diagnosis among persons aged 23–34 years was 2.1 times the rate among persons aged 18–19 years.

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In 2021, diagnoses of HIV infection among persons 13-24 years attributed to male-to-male sexual contact (MMSC) (approximately 84%, including 2% MMSC and injection drug use) and attributed to heterosexual contact (10% among female assigned sex at birth, 3% among male assigned sex at birth) accounted for 97% of diagnoses in the United States and 6 dependent areas.

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In the United States and 6 dependent areas, a total of 36 children born during 2020 received a diagnosis of HIV infection attributed to perinatal transmission. Forty-two areas in the United States and 6 dependent areas reported no perinatally acquired infections among infants born.

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In 2021, compared to 2017, in the United States and Puerto Rico, among the 189 children born with diagnosed, perinatally acquired HIV infection, 47% were born to mothers who were tested before pregnancy. Among the 12,569 children born who were exposed to but not perinatally infected with HIV, 84% were born to mothers who were tested before pregnancy.

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In 2021, among children in the United States, Black/African American children made up approximately 14% of the population of children but accounted for 62% of diagnoses of HIV infection. Hispanic/Latino children made up 26% of the population of children, but HIV infection among this group accounted for 21% of diagnoses. White children made up 49% of the population of children, but HIV infection among this group accounted for 9% of diagnoses.

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At year-end 2021 in the United States and 6 dependent areas, approximately 1,266 children were living with diagnosed HIV infection. The overall rate of persons aged < 13 years living with diagnosed HIV infection was 2.4 per 100,000 population.

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At year-end 2021 in the United States and 6 dependent areas, there were 12,628 persons living with diagnosed, perinatally acquired HIV infection.

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