HIV in the United States by Geography

In the United States, HIV diagnoses are not evenly distributed across states and regions. Southern states accounted for more than half of new HIV diagnoses in 2016, while making up 38% of the national population.^a In all regions of the United States, the majority of people who receive an HIV diagnosis live in urban areas. But in the South, 23% of new HIV diagnoses are in suburban and rural areas, and in the Midwest 21% are suburban or rural—higher proportions than in the North and West. The South’s larger and more geographically dispersed population of people living with HIV creates unique challenges for prevention and treatment.

Understanding the places and populations that are most affected by HIV and AIDS allows the federal government to allocate its resources to the geographic areas where they are needed most while still supporting a basic level of HIV education and prevention for everyone across the country.

HIV Infections^b

There were an estimated 38,500 new HIV infections in the United States in 2015. Southern states accounted for half of them.

HIV Diagnoses, by Race/Ethnicity, Region, and State

The rates (per 100,000 people) of HIV diagnoses in 2016 were 16.8 in the South, 11.2 in the Northeast, 10.2 in the West, and 7.5 in the Midwest.

Rates of HIV Diagnoses Among Adults and Adolescents in the US by State, 2016

Source: CDC. Diagnoses of HIV infection in the United States and dependent areas, 2016. HIV Surveillance Report 2017;28.

New Diagnoses in the US by Race/Ethnicity and Region of Residence, 2016

Source:  CDC. Diagnoses of HIV infection in the United States and dependent areas, 2016. HIV Surveillance Report 2017;28.

AIDS, by Region

New AIDS diagnoses: In 2016, the South accounted for 53% (9,584) of the 18,160 new AIDS diagnoses in the United States, followed by the West (17%, 3,129), the Northeast (17%, 3,088), and the Midwest (13%, 2,359).

In 2016, the rate of AIDS diagnoses was 7.8 in the South, 5.5 in the Northeast, 4.1 in the West, and 3.5 in the Midwest.

Living With HIV and Deaths, by Region

Southern states account for approximately 46% of all people with HIV (diagnosed and undiagnosed). States reporting the highest rates of people living with HIV are predominantly in the South and the Northeast.

At the end of 2015, the overall prevalence of people with diagnosed HIV in the United States was 303.5 per 100,000 people. By region, prevalence was 417.8 in the Northeast, 359.3 in the South, 248.6 in the West, and 170.6 in the Midwest.

Knowledge of HIV status and the health of people with HIV vary widely across the United States, with Southern states generally behind other regions in some key HIV prevention and care indicators.

• Nationally, in 2015, 86% of people with HIV knew they were HIV-positive. But 12 out of 17 Southern states fell below this mark.
• Half (51%) of people with undiagnosed HIV live in the South.
• Linking people to care within 1 month after an HIV diagnosis improves their health and reduces the risk of transmission. Overall, 75% of people diagnosed in 2015 were linked to care within 1 month. Half of the states that fell below that mark were in the South.^c
• In some Southern states, people living with diagnosed HIV are 3 times as likely to die as those living with HIV in some other states.

HIV deaths: Of the 6,465 deaths attributed directly to HIV disease in 2015, 3,451 (53%) were in the South; 1,204 (19%) were in the Northeast; 1,109 (17%) were in the West; and 701 (11%) were in the Midwest.

What CDC Is Doing

Because HIV prevalence and diagnoses are not evenly distributed across populations, CDC is pursuing a high-impact prevention approach to invest prevention resources in the places and populations most affected by HIV and maximize the effectiveness of HIV prevention efforts. For example,

• Funding for state and local health departments is CDC’s most significant investment in HIV prevention. CDC allocates its HIV funding for health departments to align with the geographic areas and populations most affected by HIV.
  • A new funding opportunity directs resources to the populations and geographic areas of greatest need, while supporting core HIV surveillance and prevention efforts across the United States.
  • In 2015, CDC added a new health department demonstration project to provide pre-exposure prophylaxis (PrEP) support services and data-to-care activities for gay and bisexual men and transgender persons of color who are at risk for or living with HIV in metropolitan areas with a high burden of the disease.
• CDC is awarding funds to community-based organizations to implement high-impact prevention programs in the geographic areas most affected by HIV.
• Through its Act Against AIDS initiative, CDC provides effective and culturally appropriate prevention and treatment messages to reduce the HIV risk among the populations and communities most affected by the disease. Through Partnering and Communicating Together (PACT) to Act Against AIDS, CDC and organizations representing some of the populations hardest hit by HIV are raising awareness about testing, prevention, and retention in care.

^a Regions defined by the US Census Bureau and used in CDC’s National HIV Surveillance System:
Northeast: CT, ME, MA, NH, NJ, NY, PA, RI, VT
Midwest: IL, IN, IA, KS, MI, MN, MO, NE, ND, OH, SD, WI
South: AL, AR, DE, DC, FL, GA, KY, LA, MD, MS, NC, OK, SC, TN, TX, VA, WV
West: AK, AZ, CA, CO, HI, ID, MT, NV, NM, OR, UT, WA, WY.
^bEstimated annual HIV infections are the estimated number of new infections (HIV incidence) that occurred in a particular year, regardless of when those infections were diagnosed. HIV and AIDS diagnoses refers to the number of people diagnosed with HIV infection and AIDS during a given time period, not when the people were infected.
^c Restricted to 32 states and the District of Columbia with complete laboratory reporting.