Status of HIV in the U.S.

HIV Prevention in the United States: Mobilizing to End the Epidemic

Today, we have an unprecedented opportunity to end America's HIV epidemic.

Annual HIV infections have stabilized, underscoring the need for immediate action. This overall stability masks important disparities.

Progress in reducing new HIV infections has slowed in recent years, to about 38,000 new infections
each year between 2014 and 2018.5

Annual HIV Infections in the U.S., 2014-2018

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During this period, gay and bisexual men, Black/African Americans and Hispanics/Latinos bore the greatest burden of new HIV infections.6

New HIV Infections by Race and Transmission Group, U.S., 2014 vs. 2018*

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* Subpopulations representing 2.0% or less of new HIV infections in 2018 are not represented in this chart
** Decline in new infections from 2014 to 2018 deemed a statistically significant decrease

HIV treatment and prevention efforts are not reaching everyone who needs them.

Although HIV remains a threat in every part of the United States, certain populations—and parts of the country—bear most of the burden, signaling where HIV prevention efforts must be focused.

HIV By Population

Black and Hispanic/Latino communities are disproportionately affected by HIV compared to other racial/ethnic groups.

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In all regions of the U.S., gay and bisexual men are the group most affected by HIV.

They account for about 70 percent of new HIV infections each year,9 even though they make up only 2 percent of the population,10 with the highest burden among Black and Hispanic/Latino gay and bisexual men and young men.

  • In 2018, 26 percent of new HIV infections were among Black gay and bisexual men; 22 percent among Hispanic/Latino gay and bisexual men; and 46 percent among gay and bisexual men under the age of 35.11
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By age group, people ages 25-34 have the highest rate of annual HIV infections.

In 2018, they accounted for 40 percent of new HIV infections, primarily reflecting the higher number of infections among gay and bisexual men in this age group. Youth with HIV (people ages 13-24) account for 21 percent of new HIV infections each year and are the least likely of any age group to have a suppressed viral load.12,13

Among women, disparities persist.

Black women are disproportionately affected by HIV compared to women of other races/ethnicities. Although annual HIV infections remained stable among Black women from 2014-2018, the rate of new HIV infections among Black women is 13 times that of White women and 4 times that of Hispanic/Latina women.14

Transgender women are also heavily affected by HIV. Available evidence suggests that in relation to their population size, transgender women are among the groups most affected by HIV in the U.S.: estimated HIV prevalence for transgender women is 14 percent15 – a striking difference when compared to HIV prevalence estimates for adults in the U.S overall (<0.5%).16,17

In 2018, 7 percent of new HIV infections in the U.S.* were among people who inject drugs (PWID).**

Long-term declining trends in HIV incidence among PWID have stalled, and new infections have begun to increase in some demographic groups and geographies. For example, in 2018 compared with 2014, the number of HIV infections attributed to injection drug use increased 97 percent for White males.18 Localized outbreaks have contributed to these trends.

*Does not include Puerto Rico
**Excludes men who have sex with men (MSM) and inject drugs

HIV By Geography

Most of the nation’s HIV diagnoses are concentrated in certain geographic areas, with the majority of diagnoses occurring in southern states.

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In 2016 and 2017, more than half of new HIV diagnoses were concentrated in geographic hotspots across the U.S.: 48 counties plus Washington, D.C. and San Juan, Puerto Rico.19

Seven states also have a substantial rural burden: Alabama, Arkansas, Kentucky, Missouri, Mississippi, Oklahoma, and South Carolina.20

These 57 jurisdictions are prioritized for the Ending the HIV Epidemic initiative.

HIV transmission is driven by gaps in the HIV care continuum.

By ensuring that everyone with HIV is aware of their status, receives the treatment they need, and achieves and maintains viral suppression—key steps in the HIV care continuum—we can preserve the health of people with HIV and drive down new HIV infections, which is essential because:

  • One in seven people with HIV (14%*) still don’t know they have it, meaning they are not receiving the care they need to stay healthy and prevent transmission to others.
  • One in three people with HIV (35%*) are not receiving needed HIV care. 80 percent of new HIV infections are transmitted by people who are not aware they have HIV or not receiving any HIV care.
  • 44 percent* of people in HIV care have not reached viral suppression through treatment.21

*Based on 2018 data

The proportion of people with undiagnosed HIV is high in some parts of the country, especially in the South, likely contributing to the high burden of HIV in the region.

Percent of People with Undiagnosed HIV by State, 201822

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To help gauge progress and direct HIV prevention resources most effectively, CDC tracks the HIV care continuum – a series of steps from the time a person receives an HIV diagnosis through successful treatment with HIV medications. Gaps in the care continuum highlight the urgent need to improve early detection of HIV and increase the proportion of people with diagnosed HIV who are receiving treatment and have a suppressed viral load.

Prevalence-based HIV Care Continuum, 201823

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