Diagnoses of HIV Infection among Adolescents and Young Adults United States and 6 Dependent Areas 2014–2018

SURVEILLANCE OF HIV INFECTION

In 2018, persons aged 13–24 years accounted for 21% of all HIV diagnoses, with those aged 20–24 years having the second highest rate of diagnoses (27.9 per 100,000 population) among all age groups [1]. As such, adolescents and young adults in the United States account for a substantial number of HIV infections. Understanding the burden of HIV among different subgroups of young persons can help HIV programs to focus on populations and areas at greatest need for HIV prevention and treatment services. Data presented for persons aged 13–24 years were reported (after the removal of personally identifiable information) to the Centers for Disease Control and Prevention (CDC) through December 2019. Please use caution when interpreting the following:

• Data on diagnoses of HIV infection. HIV surveillance reports may not be representative of all persons with HIV because not all infected persons have been (1) tested or (2) tested at a time when the infection could be detected and diagnosed. Also, some states offer anonymous HIV testing; the results of anonymous tests are not reported to the confidential, name-based HIV registries of state and local health departments. Therefore, reports of confidential test results may not represent all persons who tested positive for HIV infection.
• Deaths and prevalence-based data. Data for the year 2018 are preliminary and based on deaths reported to CDC as of December 31, 2019.
• Numbers less than 12 and trends based on these numbers.

Data re-release agreements between CDC and state/local HIV surveillance programs require specific levels of cell suppression at the state and county level in order to ensure confidentiality of personally identifiable information.

TABULATION AND PRESENTATION OF DATA

The data are presented for adolescents and young adults aged 13–24 years with HIV infection diagnosed during 2014–2018. The tables also present data for persons living with diagnosed HIV infection (prevalence) as of December 31 of the specified year. Tables are presented in 2 formats. Tables in the first format—labeled “a”—exclude data from the dependent areas (American Samoa, Guam, the Northern Mariana Islands, Puerto Rico, the Republic of Palau, and the U.S. Virgin Islands). Tables in the second format—labeled “b”—include data from the dependent areas.

Diagnoses of HIV Infection

Diagnoses of HIV infection are the numbers of persons aged ≥13 years with HIV diagnosed during the specified years (Tables 1a/b–5a/b, and 10). The term diagnosis of HIV infection is defined as a diagnosis of HIV infection regardless of the stage of disease (stage 0, 1, 2, 3 [AIDS], or unknown) and refers to all persons with a diagnosis of HIV infection. For tables presenting diagnosis data, region or area of residence reflects the address at the time of HIV diagnosis.

More information on counting diagnoses of HIV infection can be found in the Technical Notes of the 2018 HIV Surveillance Report at https://www.cdc.gov/hiv/library/reports/hiv-surveillance/vol-31/index.html.

Prevalence: Persons Living with Diagnosed HIV Infection

Prevalence trends and data reflect persons living with diagnosed HIV infection, regardless of the stage of disease, at the end of a given year during 2014–2018 (Tables 6a/b–9, 11, and 12). For tables presenting prevalence data, region or area of residence is based on most recent known address as of the end of the specified year. Data for the year 2018 are preliminary and based on death data received by CDC as of December 31, 2019. Trends through 2018 should be interpreted with caution. Due to incomplete reporting of deaths for the year 2018, prevalence data for Alabama, Oklahoma, South Carolina, and the U.S. Virgin Islands should be interpreted with caution.

Rates

Rates per 100,000 population were calculated for (1) the numbers of diagnoses of HIV infection and (2) the numbers of persons living with diagnosed HIV infection.

The population denominators used to compute these rates for the 50 states, the District of Columbia, and Puerto Rico were based on the Vintage 2018 postcensal estimates file (for years 2014–2018) from the U.S. Census Bureau [2]. The population denominators for American Samoa, Guam, the Northern Mariana Islands, the Republic of Palau, and the U.S. Virgin Islands were based on estimates and projections from the U.S. Census Bureau’s International Data Base [3]. Each rate was calculated by dividing the total number of diagnoses (or prevalence) for the calendar year by the population for that calendar year and then multiplying the result by 100,000. The denominators used for calculating the rates specific to age, sex, and race/ethnicity were computed by applying the appropriate vintage estimates for age, sex, and race/ethnicity for the 50 states and the District of Columbia [2]. The same method was used to calculate the denominators for Puerto Rico, with the exception of race/ethnicity estimates; these data are not available for Puerto Rico (see next paragraph). For the other 5 U.S. dependent areas, estimates from the U.S. Census Bureau’s International Data Base were used for age- and sex-specific population denominators [3].

CDC currently does not provide subpopulation rates by race/ethnicity for the 6 U.S. dependent areas because the U.S. Census Bureau does not collect information from all U.S. dependent areas. Rates for gender and transmission categories are not provided in the tables because of the absence of denominator data from the U.S. Census Bureau, the source of data used for calculating all rates in the tables.

Age

The designation “adolescents” refers to persons aged 13 to 19 years; the designation “young adults” refers to persons aged 20 to 24 years. For presentations of data on persons living with diagnosed HIV infection (Tables 6a/b–9, 11, and 12), age-group assignment (i.e., 13–19 years or 20–24 years) and age designation (i.e., “adolescents” or “young adults”) are based on the person’s age as of December 31 of the specified year. For all other tables, the specific age-group assignment or age designation is based on the person’s age at the time of diagnosis.

Age-group designations for transmission categories in tables displaying data on prevalence are based on a person’s age at the end of the specified year. That is, the transmission categories among “adolescents and young adults” in these tables include persons who were children at the time of diagnosis but who were aged 13–24 years at the end of the specified year.

Geographic Designations: U.S. Census Regions

Geographic designations reflect the area of residence at the time of diagnosis of HIV infection (Tables 1a/b–4a/b). Prevalence data reflects the area of residence based on the most recent known address as of the end of the specified year (Tables 6a/b–8).

The 4 regions of residence and 6 dependent areas 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, 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

Metropolitan Statistical Areas

In the Federal Register for June 28, 2010, the Office of Management and Budget (OMB) published revised standards for defining metropolitan statistical areas (MSAs) in federal statistical activities [4]. These standards, which provided for the identification of MSAs in the United States and Puerto Rico, replaced the 2000 standards. The adoption of the revised standards was effective as of June 28, 2010. On February 28, 2013, OMB announced new MSA delineations based on the new standards and Census 2010 data [5]. The MSAs listed in these tables were defined according to OMB’s most recent update (February 2013) of statistical areas. Tables 5a (Diagnoses of HIV infection attributed to male-to-male sexual contact, by age group, population of area of residence, and race/ethnicity, 2014–2018—United States) and Table 5b (Diagnoses of HIV infection attributed to injection drug use, by age group, population of area of residence, and race/ethnicity, 2014–2018—United States) present numbers of diagnoses by MSA. Table 9 (Adolescents and young adults living with diagnosed HIV infection, by population of area of residence, age group, and selected characteristics, year-end 2018—United States) presents numbers and rates of prevalence by MSA. The MSAs listed in these tables were defined according to OMB’s most recent update (February 2013) of statistical areas [5].

References

1. HIV Surveillance Report, 2018 (Updated); vol. 31. http://www.cdc.gov/hiv/library/reports/hiv-surveillance.html. Published May 2020. Accessed June 15, 2020.
2. US. Census Bureau. Population and Housing Unit Estimates Datasets. https://go.usa.gov/xn4ccexternal icon. Accessed June 15, 2020.
3. US. Census Bureau. International Data Base. https://www.census.gov/data-tools/demo/idbexternal icon. Updated December 2019. Accessed June 15, 2020.
4. Office of Management and Budget. 2010 Standards for delineating metropolitan and micropolitan statistical areas. Federal Register 2010;75(123):37246–39052. http://www.gpo.gov/fdsys/pkg/FR-2010-06-28/html/2010-15605.htmexternal icon. Accessed June 15, 2020.
5. Office of Management and Budget. Revised delineations of metropolitan statistical areas, micropolitan statistical areas, and combined statistical areas, and guidance on uses of the delineations of these areas. OMB Bulletin 13-01. https://www.whitehouse.gov/wp-content/uploads/legacy_drupal_files/omb/bulletins/2013/b13-01.pdf. pdf iconexternal icon Published February 28, 2013. Accessed June 15, 2020.

Suggested Citation

Centers for Disease Control and Prevention. Diagnoses of HIV infection among adolescents and young adults—United States and 6 dependent areas, 2014–2018. HIV Surveillance Data Tables 2020;1(No. 4). http://www.cdc.gov/hiv/library/reports/hiv-surveillance.html. Published August 2020. Accessed [date].

On the Web: http://www.cdc.gov/hiv/library/reports/hiv-surveillance.html

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Acknowledgments

Publication of HIV Surveillance Data Tables was made possible with the contributions of the state and territorial health departments and the HIV surveillance programs that provided surveillance data to CDC.

HIV Surveillance Data Tables was prepared by the following staff and contractors of the Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC: André Dailey, M. Cheryl Bañez Ocfemia, Xiaohong Hu, Daneisha Hawkins, Zhenyu Gan, Anna Satcher Johnson, Michael Friend and the Prevention Communication Branch, Web & Consumer Services Team (desktop publishing).

Note. Numbers less than 12, and rates and trends based on these numbers, should be interpreted with caution.
^a Rates are per 100,000 population. Rates are not calculated by gender or transmission category because of the lack of denominator data.
^b 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.
^c Additional gender identity examples include “bigender,” “gender queer,” and “two-spirit.”
^d Hispanics/Latinos can be of any race.
^e Data have been statistically adjusted to account for missing transmission category; therefore, values may not sum to column subtotals and total.
^f Heterosexual contact with a person known to have, or to be at high risk for, HIV infection.
^g Individuals were ≥13 years of age at time of diagnosis of HIV infection.
^h Includes hemophilia, blood transfusion, and risk factor not reported or not identified.
ⁱ Data are based on residence at time of diagnosis of HIV infection.

Note. Numbers less than 12, and rates and trends based on these numbers, should be interpreted with caution.
^a Rates are per 100,000 population. Rates are not calculated by gender or transmission category because of the lack of denominator data.
^b 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.
^c Additional gender identity examples include “bigender,” “gender queer,” and “two-spirit.”
^d Hispanics/Latinos can be of any race.
^e Data have been statistically adjusted to account for missing transmission category; therefore, values may not sum to column subtotals and total.
^f Heterosexual contact with a person known to have, or to be at high risk for, HIV
^g Individuals were ≥13 years of age at time of diagnosis of HIV infection.
^h Includes hemophilia, blood transfusion, and risk factor not reported or not identified.
ⁱ Data are based on residence at time of diagnosis of HIV infection.

Note. Numbers less than 12, and rates based on these numbers, should be interpreted with caution.
^a Hispanics/Latinos can be of any race.
^b Rates are per 100,000 population. Rates are not calculated by transmission category because of the lack of denominator data.
^c Data have been statistically adjusted to account for missing transmission category; therefore, values may not sum to column subtotals and total.
^d Heterosexual contact with a person known to have, or to be at high risk for, HIV infection.
^e Individuals were ≥13 years of age at time of diagnosis of HIV infection.
^f Includes hemophilia, blood transfusion, and risk factor not reported or not identified.
^g Data are based on residence at time of diagnosis of HIV infection.

Note. Numbers less than 12 should be interpreted with caution.
^a Hispanics/Latinos can be of any race.
^b Data have been statistically adjusted to account for missing transmission category; therefore, values may not sum to column subtotals and total.
^c Heterosexual contact with a person known to have, or to be at high risk for, HIV infection.
^d Individuals were ≥13 years of age at time of diagnosis of HIV infection.
^e Includes hemophilia, blood transfusion, and risk factor not reported or not identified.
^f Data are based on residence at time of diagnosis of HIV infection.

Note. Numbers less than 12 should be interpreted with caution.
^a Hispanics/Latinos can be of any race.
^b 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.
^c Data are based on residence at time of diagnosis of HIV infection.

Note. Numbers less than 12 should be interpreted with caution.
^aHispanics/Latinos can be of any race.
^bTransgender 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.
^cData are based on residence at time of diagnosis of HIV infection.

Note. Numbers less than 12, and rates based on these numbers, should be interpreted with caution.
^aRates are per 100,000 population. Rates are not calculated by gender or transmission category because of the lack of denominator data.
^bTransgender 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.
^cAdditional gender identity examples include “bigender,” “gender queer,” and “two-spirit.”
^dHispanics/Latinos can be of any race.
^eData have been statistically adjusted to account for missing transmission category; therefore, values may not sum to column subtotals and total.
^fHeterosexual contact with a person known to have, or to be at high risk for, HIV infection.
^gIndividuals were ≥13 years of age at time of diagnosis of HIV infection.
^hIncludes hemophilia, blood transfusion, and risk factor not reported or not identified.
ⁱData are based on residence at time of diagnosis of HIV infection.

Note. Numbers less than 12 should be interpreted with caution.
^aTransgender 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.
^bAdditional gender identity examples include “bigender,” “gender queer,” and “two-spirit.”
^cHispanics/Latinos can be of any race.
^dData have been statistically adjusted to account for missing transmission category; therefore, values may not sum to column subtotals and total.
^eHeterosexual contact with a person known to have, or to be at high risk for, HIV infection.
^fIndividuals were ≥13 years of age at time of diagnosis of HIV infection.
^gIncludes hemophilia, blood transfusion, and risk factor not reported or not identified.
^hData are based on residence at time of diagnosis of HIV infection.

Note. Numbers less than 12, and trends based on these numbers, should be interpreted with caution.
Data have been statistically adjusted to account for missing transmission category; therefore, values may not sum to column total.
Data are based on residence at the time of diagnosis of HIV infection.
^aHispanics/Latinos can be of any race.
^bIncludes persons whose county of residence is unknown.

Note. Numbers less than 12, and trends based on these numbers, should be interpreted with caution.
Data have been statistically adjusted to account for missing transmission category; therefore, values may not sum to column total.
Data are based on residence at the time of diagnosis of HIV infection.
^a Hispanics/Latinos can be of any race.
^b Includes persons whose county of residence is unknown.

Note. Numbers less than 12, and rates and trends based on these numbers, should be interpreted with caution. Data for the year 2018 are preliminary and based on death data received by CDC through December 2019.
^a Rates are per 100,000 population. Rates are not calculated by gender or transmission category because of the lack of denominator data.
^b 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.
^c Additional gender identity examples include “bigender,” “gender queer,” and “two-spirit.”
^d Includes Asian/Pacific Islander legacy cases.
^e Hispanics/Latinos can be of any race.
^f Data have been statistically adjusted to account for missing transmission category; therefore, values may not sum to column subtotals and total.
^g Heterosexual contact with a person known to have, or to be at high risk for, HIV infection.
^h Individuals were ≥13 years of age at time of diagnosis of HIV infection.
ⁱ Includes hemophilia, blood transfusion, and risk factor not reported or not identified.
^j Data are based on address of residence at the end of the specified year (i.e., most recent known address).
^k Includes persons whose race/ethnicity is unknown.

Note. Numbers less than 12, and rates and trends based on these numbers, should be interpreted with caution. Data for the year 2018 are preliminary and based on death data received by CDC through December 2019.
^a Rates are per 100,000 population. Rates by race/ethnicity are not provided because U.S. census information for U.S. dependent areas is limited. Rates are not calculated by gender or transmission category because of the lack of denominator data.
^b 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.
^c Additional gender identity examples include “bigender,” “gender queer,” and “two-spirit.”
^d Includes Asian/Pacific Islander legacy cases.
^e Hispanics/Latinos can be of any race.
^f Data have been statistically adjusted to account for missing transmission category; therefore, values may not sum to column subtotals and total.
^g Heterosexual contact with a person known to have, or to be at high risk for, HIV infection.
^h Individuals were ≥13 years of age at time of diagnosis of HIV infection.
ⁱ Includes hemophilia, blood transfusion, and risk factor not reported or not identified.
^j Data are based on address of residence at the end of the specified year (i.e., most recent known address).
^k Includes persons whose race/ethnicity is unknown.

Note. Numbers less than 12, and rates and trends based on these numbers, should be interpreted with caution. Data for the year 2018 are preliminary and based on death data received by CDC through December 2019.
^a Rates are per 100,000 population. Rates are not calculated by gender or transmission category because of the lack of denominator data.
^b 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.
^c Additional gender identity examples include “bigender,” “gender queer,” and “two-spirit.”
^d Includes Asian/Pacific Islander legacy cases.
^e Hispanics/Latinos can be of any race.
^f Data have been statistically adjusted to account for missing transmission category; therefore, values may not sum to column subtotals and total.
^g Heterosexual contact with a person known to have, or to be at high risk for, HIV infection.
^h Individuals were ≥13 years of age at time of diagnosis of HIV infection.
ⁱ Includes hemophilia, blood transfusion, and risk factor not reported or not identified.
^j Data are based on address of residence at the end of the specified year (i.e., most recent known address).
^k Includes persons whose race/ethnicity is unknown.