Diagnoses of HIV Infection in the United States and Dependent Areas 2021: Special Focus Profiles

Special Focus Profiles

The Special Focus Profiles highlight the distribution of HIV in 7 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) Persons Residing in the Southern Region of the United States, (6) Persons Aged 13–24 Years, and (7) Children Aged < 13 Years. See suggested readings for references and additional information, including HIV risk behaviors, barriers to care, and prevention challenges for each population of particular interest.

GAY, BISEXUAL, AND OTHER MEN WHO HAVE SEX WITH MEN

msm men icon

Gay, bisexual, and other men (based on assigned male sex at birth) who report male-to-male sexual contact (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 2021, infection attributed to MMSC accounted for 67% (24,107 MMSC, excluding MMSC and IDU) of the 36,189 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 (aged 13‒24 years), 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 transmit HIV to others through sex and sharing of drug equipment, e.g., needles.

Diagnoses of HIV infection among MSM

Age group

In 2021, compared with 2017, changes in numbers of diagnoses of HIV infection attributed to MMSC were as follows (Figure 12):

  • Increase—persons aged ≥ 55 (8%) years
  • Decrease—persons aged 13–24 (-15%) and 45–54 (-23%) years
  • Stable—persons aged 25–34 and 35–44 years

In 2021, numbers and percentages of diagnoses of HIV infection attributed to MMSC were as follows (Figure 13):

  • 13–24 years—5,715 (24%)
  • 25–34 years—9,730 (40%)
  • 35–44 years—4,476 (19%)
  • 45–54 years—2,375 (10%)
  • ≥ 55 years—1,810 (8%)

 Race/ethnicity

In 2021, compared with 2017, changes in numbers of diagnoses of HIV infection attributed to MMSC were as follows (Table 5b):

  • Increase—American Indian/Alaska Native (31%) and Native Hawaiian/other Pacific Islander (79%)
  • Decrease—Asian (-22%), Black/African American (-6%), White (-11%), and multiracial (-35%)
  • Stable—Hispanic/Latino

In 2021, numbers and percentages of diagnoses of HIV infection attributed to MMSC were as follows (Figure 13, Table 5b):

  • American Indian/Alaska Native—141 (1%)
  • Asian—574 (2%)
  • Black/African American—8,883 (37%)
  • Hispanic/Latino—8,000 (33%)
  • Native Hawaiian/other Pacific Islander—59 (< 1%)
  • White—5,762 (24%)
  • Multiracial—688 (3%)

 Region of residence

In 2021, compared with 2017, changes in numbers of diagnoses of HIV infection attributed to MMSC were as follows (Table 5b):

  • Increase—none
  • Decrease—Northeast (-15%), Midwest (-7%), and West (-6%)
  • Stable—South and U.S. dependent areas

In 2021, numbers and percentages of diagnoses of HIV infection attributed to MMSC were as follows (Figure 13, Table 5b):

  • Northeast—3,025 (13%)
  • Midwest—3,244 (13%)
  • South—12,286 (51%)
  • West—5,300 (22%)
  • U.S. dependent areas—252 (1%)

Age group and race/ethnicity

In 2021, the highest percentages by age group (Figure 14):

  • Aged 13–24 years—Black/African American (53%)
  • Aged > 24 years—Hispanic/Latino (35%)

Region of residence and race/ethnicity—highest numbers and percentages by region (Figure 15):

  • Northeast—Hispanic/Latino (1,124; 37%)
  • Midwest—Black/African American (1,393; 43%)
  • South—Black/African American (5,660; 46%)
  • West—Hispanic/Latino (2,608; 49%)
  • U.S. dependent areas—Hispanic/Latino (243; 96%)

Prevalence and race/ethnicity among MSM

At year-end 2021 in the United States and 6 dependent areas, 620,421 MSM (Table 16b) were living with diagnosed HIV infection attributed to MMSC.

Prevalence by race/ethnicity was as follows (Table 16b):

  • American Indian/Alaska Native—1,774 (< 1%)
  • Asian—11,716 (2%)
  • Black/African American—192,718 (31%)
  • Hispanic/Latino—164,187 (26%)
  • Native Hawaiian/other Pacific Islander—704 (< 1%)
  • White—217,295 (35%)
  • Multiracial—31,698 (5%)

PERSONS WHO INJECT DRUGS

lighter spoon syringe icon

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. In 2021, infections attributed to injection drug use (IDU) accounted 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 among PWID

In 2021 in the United States and 6 dependent areas, 2,512 diagnoses of HIV infection were attributed to IDU (1,436 among male and 1,076 among female PWID) (Table 6b).

Age group

In 2021, compared with 2017, changes in numbers of diagnoses of HIV infection attributed to IDU were as follows (Table 6b):

  • Increase—persons aged 25–34 (9%) and 35–44 (25%) years
  • Decrease—persons aged 13–24 (-25%), 45–54 (-11%), and ≥ 55 (-7%) years
  • Stable—none

In 2021, numbers and percentages of diagnoses of HIV infection attributed to IDU were as follows (Figure 16):

  • 13–24 years—175 (7%)
  • 25–34 years—789 (31%)
  • 35–44 years—719 (29%)
  • 45–54 years—444 (18%)
  • ≥ 55 years—386 (15%)

magnifying glass For additional data by 5-year age groups, see Table 6b.

Race/ethnicity

In 2021, compared with 2017, changes in numbers of diagnoses of HIV infection attributed to IDU were as follows (Table 6b):

  • Increase—Asian (33%) and White (22%)
  • Decrease—American Indian/Alaska Native (-18%), Black/African American (-10%), Hispanic/Latino (-13%), and multiracial (-14%)
  • Stable—none

In 2021, numbers and percentages of diagnoses of HIV infection attributed to IDU were as follows (Figure 16):

  • American Indian/Alaska Native—27 (1%)
  • Asian—20 (1%)
  • Black/African American—673 (27%)
  • Hispanic/Latino—480 (19%)
  • Native Hawaiian/other Pacific Islander—4 (< 1%)
  • White—1,232 (49%)
  • Multiracial—76 (3%)

 Region of residence

In 2021, compared with 2017, changes in numbers of diagnoses of HIV infection attributed to IDU were as follows (Table 6b):

  • Increase—Midwest (11%), South (15%), and West (6%)
  • Decrease—Northeast (-21%) and U.S. dependent areas (-50%)
  • Stable—none

In 2021, numbers and percentages of diagnoses of HIV infection attributed to IDU were as follows (Figure 16):

  • Northeast—468 (19%)
  • Midwest—392 (16%)
  • South—1,113 (44%)
  • West—518 (21%)
  • U.S. dependent areas—22 (1%)

ASAB and race/ethnicity

In 2021, the highest percentages of diagnoses of HIV infection attributed to IDU were as follows (Figure 17):

  • Male—White (47%)
  • Female—White (51%)

Region of residence and race/ethnicity

In 2021, the highest numbers and percentages of diagnoses of HIV infection attributed to IDU were as follows (Figure 18):

  • Northeast—White (185; 40%)
  • Midwest—White (232; 59%)
  • South—White (593; 53%)
  • West—White (221; 43%)
  • U.S. dependent areas—Hispanic/Latino (20; 91%)

Prevalence and race/ethnicity among PWID

At year-end 2021 in the United States and 6 dependent areas, 116,350 PWID were living with diagnosed HIV infection. Prevalence by race/ethnicity was as follows (Table 16b):

  • American Indian/Alaska Native—495 (< 1%)
  • Asian—663 (< 1%)
  • Black/African American—51,368 (44%)
  • Hispanic/Latino—31,657 (27%)
  • Native Hawaiian/other Pacific Islander—51 (< 1%)
  • White—26,233 (23%)
  • Multiracial—5,748 (5%)

TRANSGENDER AND ADDITIONAL GENDER IDENTITY PERSONS

trans icon

Transgender is an umbrella term that is used to identify persons whose assigned sex at birth does not match their 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. Additional gender identity (AGI) is a term used to identify persons assigned “male” or “female” sex at birth who does not identify as male, female, transgender woman, or transgender man (e.g., those identifying as “bigender,” “gender queer,” and “two-spirit”). 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. Transgender and AGI persons are understudied in HIV prevention (e.g., preexposure prophylaxis [PrEP]) and treatment interventions and face numerous prevention challenges, including social rejection and exclusion and lack of public/provider knowledge about transgender and AGI issues.

Diagnoses of HIV infection among transgender and AGI persons

In 2021 in the United States and 6 dependent areas, diagnoses of HIV infection among transgender persons accounted for approximately 2% of diagnoses, while diagnoses among AGI persons accounted for < 1%. Of the 912 diagnoses of HIV infection among transgender and AGI persons in 2021 (Table 4b), transgender women accounted for the highest percentage of diagnoses (89%).

In 2021, numbers and percentages of HIV diagnoses among transgender and AGI persons aged ≥ 13 years were as follows (Figure 19):

Age group

  • 13–24 years—326 (36%)
  • 25–34 years—381 (42%)
  • 35–44 years—140 (15%)
  • 45–54 years—42 (5%)
  • ≥ 55 years—23 (3%)

 Race/ethnicity

  • American Indian/Alaska Native—10 (1%)
  • Asian—19 (2%)
  • Black/African American—404 (44%)
  • Hispanic/Latino—286 (31%)
  • Native Hawaiian/other Pacific Islander—6 (1%)
  • White—146 (16 %)
  • Multiracial—41 (4%)

 Exposure category

  • Sexual contact—802 (88%)
  • IDU—3 (< 1%)
  • Sexual contact and IDU—62 (7%)
  • Other—45 (5%)

 Region of residence

  • Northeast—131 (14%)
  • Midwest—157 (17%)
  • South—383 (42%)
  • West—240 (26%)
  • U.S. dependent areas—1 (< 1%)

Gender and race/ethnicityhighest percentages

In 2021, the highest percentages of HIV diagnoses among persons aged ≥ 13 years were as follows (Figure 20):

  • Transgender women—Black/African American (46%)
  • Transgender men—White (34%)
  • AGI—White (34%)

Gender and exposure categoryhighest percentages

In 2021, the highest percentages of HIV diagnoses among persons aged ≥ 13 years were as follows (Figure 21):

  • Transgender women—sexual contact (88%)
  • Transgender men—sexual contact (84%)
  • AGI—sexual contact (86%)

WOMEN

women icon

More than 6,000 women (based on assigned sex at birth) received an HIV diagnosis in the United States and 6 dependent areas in 2021. 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, PrEP is highly effective for preventing HIV, yet PrEP use among women is very low.

Diagnoses of HIV infection

In 2021 in the United States and 6 dependent areas, the rate of diagnoses of HIV infection among females (based on assigned sex at birth) aged ≥ 13 years was 4.6 (Figure 22). Rates ranged from a low of 0.0 in American Samoa, Guam, Northern Mariana Islands, and the Republic of Palau to a high of 15.2 in the District of Columbia, followed by 10.5 in Louisiana, 10.0 in Georgia, 8.8 in Mississippi, and 8.6 in Florida.

In 2021 in the United States (Figure 23):

  • Black/African American females aged ≥ 13 years made up 13% of the female population, but HIV infection among this group accounted for 54% of diagnoses.
  • White females aged ≥ 13 years made up 61% of the female population, and HIV infection among this group accounted for 23% of diagnoses.
  • Hispanic/Latino females aged ≥ 13 years made up 17% of the female population, and HIV infection among this group accounted for 18% of diagnoses.

Age group

In 2021, rates for HIV diagnoses among females aged ≥ 13 years were as follows (United States only) (Figure 24):

  • 13–24 years—3.3
  • 25–34 years—8.0
  • 35–44 years—7.9
  • 45–54 years—6.0
  • ≥ 55 years—2.0

magnifying glass For additional data by 5-year age groups, see Table 3a.

Disparities by age group (Figure 24)

  • Absolute disparity (rate difference)—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.
  • Relative disparity (rate ratio)—The rate of diagnoses among females aged 25–34 years was 4.0 times the rate among females aged ≥ 55 years.

 Race/ethnicity

In 2021, rates for HIV diagnoses among females aged ≥ 13 years were as follows (United States only) (Figure 24):

  • American Indian/Alaska Native—4.4
  • Asian—1.1
  • Black/African American—19.5
  • Hispanic/Latino—4.8
  • Native Hawaiian/other Pacific Islander—3.9
  • White—1.8
  • Multiracial—7.6

Disparities by race/ethnicity

  • Absolute disparity (rate difference)—If the rate of HIV diagnoses among Black/African American females aged ≥ 13 years was similar to the rate among White females aged ≥ 13 years, then diagnoses could have been reduced by 18 per 100,000 population.
  • Relative disparity (rate ratio)—The rate of diagnoses among Black/African American females aged ≥ 13 years was 10.8 times the rate among White females aged ≥ 13 years.

 Region of residence

In 2021, rates for HIV diagnoses among females aged ≥ 13 years were as follows (United States only) (Figure 24):

  • Northeast—4.2
  • Midwest—3.0
  • South—6.8
  • West—2.8

Disparities by region

  • Absolute disparities (rate difference)—If the rate of HIV diagnoses among females aged ≥ 13 years in the South was similar to the rate among females aged ≥ 13 years in the West, then diagnoses could have been reduced by 4 cases per 100,000 population.
  • Relative disparities (rate ratio)—The rate of HIV diagnoses among females aged ≥ 13 years in the South was 2.4 times the rate among females aged ≥ 13 years in the West.

Transmission category and race/ethnicity

In 2021, the highest percentages of HIV diagnoses among females aged ≥ 13 years were as follows (Figure 25):

  • IDU—American Indian/Alaska Native (37%)
  • Heterosexual contact—Asian (91%)
  • Other—Asian (2%)

Region of residence and race/ethnicity

In 2021, the highest rates of HIV diagnoses among females aged ≥ 13 years were as follows (United States only) (Figure 26):

  • Northeast—Native Hawaiian/other Pacific Islander (20.4)
  • Midwest—Black/African American (15.2)
  • South—Black/African American (20.9)
  • West—Black/African American (18.0)

Prevalence and race/ethnicity

At year-end 2021 in the United States and 6 dependent areas, 250,785 females aged ≥ 13 years were living with diagnosed HIV infection. Prevalence by race/ethnicity was as follows (Table 17b):

  • American Indian/Alaska Native—796 (< 1%)
  • Asian—2,863 (1%)
  • Black/African American—142,511 (57%)
  • Hispanic/Latino—50,639 (20%)
  • Native Hawaiian/other Pacific Islander—158 (< 1%)
  • White—40,649 (16%)
  • Multiracial—12,975 (5%)

PERSONS RESIDING IN THE SOUTHERN REGION OF THE UNITED STATES

map of southern united states

In 2021, among the four main regions in the United States (the Northeast, Midwest, South, and West) and dependent areas, 52% (18,728) of HIV diagnoses were in the South (Table 1b). The rate of HIV diagnoses among those aged ≥ 13 years was 17.5, greater than any other U.S. region (Figure 27). Socioeconomic factors, such as poverty and median household income, contribute to HIV transmission. In comparison to other regions in the United States, the South has both the highest rate of poverty and the lowest median household income. Additionally, in 2019, for every 100 people with HIV (aged ≥ 13 years) in the South, 15 did not know their status. This gap in knowledge of status is among the highest in the country and can result in fewer people living with HIV receiving timely HIV medical care and treatment and having a suppressed viral load.

Diagnoses of HIV infection

In 2021 in the South (Figure 28):

  • 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.

Age group

In 2021, rates for HIV diagnoses among persons aged ≥ 13 years in the South were as follows (Figure 29):

  • 13–24 years—19.5
  • 25–34 years—39.8
  • 35–44 years—23.1
  • 45–54 years—13.9
  • ≥ 55 years—5.1

Disparities by age group

  • Absolute disparity (rate difference)—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 35 cases per 100,000 population.
  • Relative disparity (rate ratio)—The rate of HIV diagnoses among persons aged 25–34 years was 7.8 times the rate among persons aged ≥ 55 years.

 Race/ethnicity

In 2021, rates for HIV diagnoses among persons aged ≥ 13 years in the South were as follows (Figure 29):

  • American Indian/Alaska Native—8.1
  • Asian—5.2
  • Black/African American—45.7
  • Hispanic/Latino—23.5
  • Native Hawaiian/other Pacific Islander—22.6
  • White—6.9
  • Multiracial—31.4

Disparities by race/ethnicity

Absolute disparity (rate difference)—If the rates of HIV diagnoses among a select race/ethnicity with HIV diagnoses were similar to the rates among White persons aged ≥ 13 years, then diagnoses could have been reduced by the following number of cases per 100,000 population:

  • American Indian/Alaska Native—1
  • Asian—no reduction in cases
  • Black/African American—39
  • Hispanic/Latino—17
  • Native Hawaiian/other Pacific Islander—16
  • Multiracial—25

Relative disparity (rate ratio)—The rates of diagnoses among a select race/ethnicity were ___ times the rates of White persons aged ≥ 13 years as follows:

  • American Indian/Alaska Native—1.2
  • Asian—0.8
  • Black/African American—6.6
  • Hispanic/Latino—3.4
  • Native Hawaiian/other Pacific Islander—3.3
  • Multiracial—4.6

Changes in disparities by race/ethnicity

In 2021, compared with 2017, changes in rates of HIV diagnoses by race/ethnicity among persons aged ≥ 13 years were as follows (Figure 30):

  • Absolute disparity (rate difference)―for the difference between rate of HIV diagnoses among a select race/ethnicity minus the rate 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).
  • Relative disparity (rate ratio)―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).

Transmission category and race/ethnicity by ASAB

In 2021, the racial/ethnic group with the highest percentages of HIV diagnoses for each transmission category among persons aged ≥ 13 years were as follows (Figure 31):

  • Male
    • MMSC—Native Hawaiian/other Pacific Islander (94%)
    • IDU—White (9%)
    • MMSC/IDU—White (8%)
    • Heterosexual contact—Black/African American (14%)
  • Female
    • Heterosexual contact—Native Hawaiian/other Pacific Islander (50%)
    • IDU—Black/African American (93%)

Prevalence and race/ethnicity

At year-end 2021 in the South, 493,509 persons were living with diagnosed HIV infection. Prevalence by race/ethnicity was as follows (Table 16b):

  • American Indian/Alaska Native—803 (< 1%)
  • Asian—3,600 (1%)
  • Black/African American—255,815 (52%)
  • Hispanic/Latino—89,718 (18%)
  • Native Hawaiian/other Pacific Islander—167 (< 1%)
  • White—119,022 (24%)
  • Multiracial—24,228 (5%)

PERSONS AGED 13–24 YEARS

teens icon

HIV infections among persons aged 13–24 years accounted for 19% of the 36,189 diagnoses of HIV in 2021 in the United States and 6 dependent areas. They are the least likely of any age group to be aware of their HIV infection, be 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 that they have HIV do not get medical care or receive treatment and can unknowingly transmit HIV through sex or sharing drug equipment. In addition, persons aged 13–24 years have high rates of sexually transmitted diseases (STDs) and low rates of condom use, greatly increasing the chance of getting or transmitting HIV. Addressing HIV among persons aged 13–24 years 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.

Diagnoses of HIV infection

In 2021 in the United States and 6 dependent areas, there were 6,987 diagnoses of HIV infection among persons aged 13–24 years. Numbers and percentages of HIV diagnoses among persons aged 13–24 years were as follows (Figure 32, Table 8b):

Gender

  • Male—5,837 (84%)
  • Female—824 (12%)
  • Transgender woman/girl—286 (4%)
  • Transgender man/boy—15 (< 1%)
  • AGI—25 (< 1%)

 Age group

  • 13–14 years—15 (< 1%)
  • 15–17 years—324 (5%)
  • 18–19 years—1,136 (16%)
  • 20–21 years—3,167 (45%)
  • 23–24 years—2,345 (34%)

Rates (United States only) (Figure 33)

  • Highest—persons aged 23–24 years (27.2)
  • Lowest—persons aged 13–14 years (0.2)

Disparities by age group

  • Absolute disparity (rate difference)—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.
  • Relative disparity (rate ratio)—The rate of diagnosis among persons aged 23–34 years was 2.1 times the rate among persons aged 18–19 years.

Race/ethnicity

In 2021, numbers and percentages of HIV diagnoses among persons aged 13–24 years were as follows (Table 8b, Figure 32):

  • American Indian/Alaska Native—33 (< 1%)
  • Asian—117 (2%)
  • Black/African American—3,698 (53%)
  • Hispanic/Latino—1,913 (27%)
  • Native Hawaiian/other Pacific Islander—11 (< 1%)
  • White—971 (14%)
  • Multiracial—244 (3%)

Rates (United States only) (Figure 33, Table 8a)

  • Highest—Black/African American (51.5)
  • Lowest—White (3.6)

Disparities by race/ethnicity

  • Absolute disparity (rate difference)—If the rate of HIV diagnoses among Black/African American persons aged 13–24 years was similar to the rate among White persons aged 13–24 years, then diagnoses could have been reduced by 48 cases per 100,000 population.
  • Relative disparity (rate ratio)—The rate of diagnoses among Black/African American persons aged 13–24 years was 14.3 times the rate among White persons aged 13–24 years.

Region of residence

In 2021, numbers and percentages of HIV diagnoses among persons aged 13–24 years were as follows (Figure 32):

  • Northeast—876 (13%)
  • Midwest—985 (14%)
  • South—3,911 (56%)
  • West—1,155 (17%)
  • U.S. dependent areas—60 (1%)

Rates (United States only) (Figure 33)

  • Highest—South (19.5)
  • Lowest—Midwest (9.0)

Disparities by region

  • Absolute disparity (rate difference)—If the rate of HIV diagnoses among persons aged 13–24 in the South was similar to the rate among persons aged 13–24 in the Midwest, diagnoses could have been reduced by 11 cases per 100,000 population.
  • Relative disparity (rate ratio)—the rate of diagnoses among persons aged 13–24 in the South was 2.2 times the rate among persons aged 13–24 in the Midwest.

ASAB and transmission category

In 2021, the highest percentages of HIV diagnoses among persons aged 13–24 years were as follows (Figure 34):

  • Male—MMSC (82%)
  • Female—heterosexual contact (10%)

CHILDREN AGED < 13 YEARS

children icon

To make informed decisions about antiretroviral therapy to reduce perinatal transmission of HIV to infants, pregnant persons should know their HIV infection status. In 1995, the first recommendations for HIV counseling and voluntary testing for pregnant persons 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 persons. The annual number of diagnoses of perinatal HIV in the United States and dependent areas has declined by more than 95% since the early 1990s. The availability of effective interventions to prevent mother-to-child HIV transmission and the significant reduction in the number of HIV-infected infants in the United States have led CDC to develop goals to support the elimination of mother-to-child HIV transmission in the United States.

In 2020, 42 areas in the United States and 6 dependent areas reported no perinatally acquired infections among infants born (Figure 35). 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 from 2020 to be reported to CDC. Data reflect all infants with diagnosed, perinatally acquired HIV infection who were born in the United States and 6 dependent areas during 2020, regardless of year of diagnosis.

Diagnoses of HIV infection

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 (Figure 35).

Infected infants

From 2017 through 2020 in the United States and Puerto Rico, among the 189 children born with diagnosed, perinatally acquired HIV infection, time of maternal HIV testing was as follows (Figure 36):

  • 47% were born to mothers who were tested before pregnancy
  • 16% were born to mothers who were tested during pregnancy
  • 7% were born to mothers tested at the time of birth
  • 21% were born to mothers who were tested after the child’s birth
  • 8% were born to mothers whose time of maternal HIV testing was unknown

Exposed but not infected

From 2017 through 2020 in the United States and Puerto Rico, among the 12,569 children born who were exposed but not perinatally infected with HIV, time of maternal HIV testing was as follows (Figure 36):

  • 84% were born to mothers who were tested before pregnancy
  • 14% were born to mothers who were tested during pregnancy
  • 1% were born to mothers tested at the time of birth
  • < 1% were born to mothers tested after birth
  • 1% were born to mothers whose time of maternal HIV testing was unknown

magnifying glass Note. 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.

Diagnoses

In 2021, among children in the United States (Figure 37):

  • Black/African American children made up approximately 14% of the population of children, but HIV infection among this group accounted for 62% of diagnoses.
  • 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.

Prevalence

At year-end 2021 in the United States and 6 dependent areas, children living with diagnosed HIV infection were as follows:

Overall (Figure 38)

  • Approximately 1,266 children were living with diagnosed HIV infection.
  • The overall rate of children living with diagnosed HIV infection was 2.4.

Prevalence and race/ethnicity (Table 16b)

  • American Indian/Alaska Native—<1%
  • Asian—7%
  • Black/African American—58%
  • Hispanic/Latino—14%
  • Native Hawaiian/other Pacific Islander—<1%
  • White—12%
  • Multiracial—8%

Prevalence, perinatally acquired HIV infection

At year-end 2021, in the United States and 6 dependent areas, among those living with perinatally acquired HIV infection, percentages were as follows:

Overall (Figure 39, Table 16b)

  • There were 12,628 persons living with diagnosed, perinatally acquired HIV infection.
  • Data reflect all persons (i.e., children, adolescents, and adults) with diagnosed, perinatally acquired HIV infection who were alive at year-end 2021, regardless of their age at year-end 2021.

Prevalence and race/ethnicity (Table 16b)

  • American Indian/Alaska Native—< 1%
  • Asian—2%
  • Black/African American—57%
  • Hispanic/Latino—24%
  • Native Hawaiian/other Pacific Islander—1%
  • White—11%
  • Multiracial—7%