State of the HIV EpidemicSUBSTANTIAL PROGRESS
AND
THE CHALLENGES THAT REMAIN
In the 40 years since the beginning of the HIV epidemic, the United States has been able to make incredible strides in HIV prevention, treatment, and care.1 HIV was once the leading cause of death for young people, but because of scientific advances, fewer people are acquiring HIV, and those who do are living longer and healthier lives.2-5 Despite the uptake of pre-exposure prophylaxis (PrEP) medicine being slow—with too many people remaining unaware of their HIV status—the rate of estimated new HIV infections has declined 75% between 1984 and 2021.6-10,*
Progress has been made to bring the epidemic to its current state, but there is still work to be done.
- In 2021, there were approximately 1.2 million people aged 13 and older living with HIV in the US9
- In 2021, there were an estimated 32,100 new HIV infections in the US, which represented a 12% decrease since 20179,*
- In 2021, an estimated 1 in 8 people living with HIV in the US did not know they had it11
- In 2021, for every 100 people diagnosed with HIV, about 75% received some HIV care,† 54% were retained in care,‡ and 66% were virally suppressed9,§
- In 2022, an estimated 1.2 million people in the US could benefit from PrEP, but only 382,364 individuals filled prescriptions12
Estimated Annual HIV
Infections in the
US, 2015-2021
- Sources: Centers for Disease Control and Prevention. Estimated HIV incidence and prevalence in the United States, 2015–2019. HIV Surveillance Supplemental Report 2021;26(No. 1). https://stacks.cdc.gov/view/cdc/112160. Published May 2021. Accessed October 17, 2024. Centers for Disease Control and Prevention. NCHHSTP AtlasPlus. https://gis.cdc.gov/grasp/nchhstpatlas/main.html. Accessed January 24, 2024.
Despite the advancements in HIV prevention and care,4 the state of the epidemic today reminds us of the role stigma and discrimination play in increasing risk. There are many social, economic, and structural barriers that continue to prevent some people from accessing the care they need.13
As a result, progress has been unevenly distributed, with already marginalized groups continuing to bear the brunt of the HIV epidemic.8 These widening disparities can be seen when looking at the data below, which show rates of new infections, treatment, and death among those groups most impacted by HIV.
- *CDC notes that HIV estimates for 2020 and 2021 should be interpreted with caution due to adjustments made to CDC’s CD4-based depletion model to account for the impact of COVID-19 on HIV testing and diagnosis in the United States.9
- †At least 1 viral load or CD4 test.14
- ‡Had 2 viral load or CD4 tests at least 3 months apart.14
- §Based on most recent viral load test. Viral suppression is defined as having less than 200 copies of HIV per milliliter of blood.15
Men who have sex with men (MSM) have been the population most impacted by the epidemic since the beginning.16 MSM of color are even more disproportionately impacted by HIV, as issues of stigma and discrimination on the basis of sexual orientation intersect with racism and other social determinants of health. In the US, it is estimated that 1 in 6 MSM will be infected with HIV at some point in their lives.17
According to the CDC:
- MSM make up an estimated 2% of the US population but accounted for 70% of the estimated new HIV infections in 202118
- In 2022, gay and bisexual men ages 13 to 34 made up ~63% of new HIV diagnoses among all gay and bisexual men19
- As of 2022, an estimated 1 in 7 MSM living with HIV was unaware of their status19
- From 2008 to 2019, Black MSM and Hispanic/Latino MSM experienced a 2% decrease and 18% increase, respectively, in new HIV diagnoses, compared to a 34% decrease among White MSM20
New HIV
Diagnoses Among
GAY AND BISEXUAL MEN in the US
AND DEPENDENT AREAS by Race/Ethnicity, 2021*,†
- Source: CDC. Diagnoses of HIV infection in the United States and dependent areas, 2021. HIV Surveillance Report. 2023;34.
- *Among people aged 13 and older.
- †Includes infections attributed to male-to-male sexual contact and injection drug use (men who reported both risk factors).
Black Americans in this country deal with structural racism and inequality that impacts every aspect of their lives from economic stability to education, housing, food security, and healthcare.13 Together, this impact may leave individuals at increased risk for HIV and make them less likely to receive the care they need.4,21 It is not surprising, therefore, that survival after an AIDS diagnosis is lower for Black Americans than for most other racial/ethnic groups or that Black Americans have had the highest age-adjusted death rate due to HIV disease throughout most of the epidemic.4
- In 2021, Black/African American people made up 12% of the US population but accounted for 40% of new HIV infections22
- As of 2021, an estimated 40% of people living with HIV in the US were Black/African American22
- In 2021, Black/African American people had the highest rate of new HIV infections at 37 infections per 100,000 people, which was more than 7 times the rate for White people22
- In 2022, only 11% of Black/African American people who were eligible for PrEP were prescribed it in the US, compared to 82% of eligible White people12
- In 2021, for every 100 Black/African American people living with diagnosed HIV in the US, 73 received some HIV care,* 52 were retained in care,† and 62 were virally suppressed.‡ In comparison, for every 100 people overall living with diagnosed HIV, 75 received some care, 54 were retained in care, and 66 were virally suppressed14,§
New HIV
DIAGNOSES IN THE US AND DEPENDENT AREAS, 2021†
BLACK/AFRICAN AMERICANS Accounted For
40% of new
HIV diagnoses in 2021.
- Source: CDC. Diagnoses of HIV infection in the United States and dependent areas, 2021. HIV Surveillance Report. 2023;34.
- *At least 1 viral load or CD4 test.
- †Had 2 viral load or CD4 tests at least 3 months apart in a year.
- ‡Based on most recent viral load test. Viral suppression is defined as having less than 200 copies of HIV per milliliter of blood.15
- §Among people aged 13 and older.
Hispanic/Latino American communities deal with disproportionate poverty, lower educational levels, and language barriers that can make it harder for people to access the care and services they need. Hispanic Americans are also more likely to be uninsured than any other community. Moreover, some Hispanic/Latino Americans may not utilize the HIV prevention and care services in their area out of fear of disclosing their immigration status.18,19
- In 2021, Hispanic/Latino people made up 18% of the US population but accounted for 29% of HIV infections22
- In 2021, Hispanic/Latino people in the US had the second highest rate of new HIV infections at 19 infections per 100,000 people, which was 4 times the rate for White people22
- Between 2010 and 2022, the estimated number of new HIV infections for Hispanic/Latino people in the US went up by 12%, while the estimated number overall went down 19%23,*
- In 2022, Latino MSM (men who have sex with men) accounted for more estimated new HIV infections than Black/African American or White MSM, with an estimated HIV incidence of 830023,*
- As of 2019, approximately 1 in 6 Hispanic/Latino people living with HIV in the US was unaware of their status24
- In 2022, 54% of Latinos living with HIV were not retained for HIV care, 46% were not virally suppressed at some point (in 2022), and 16% of Latinos living with HIV were unaware of their status25,*,†
- In 2022, only 21% of Hispanic/Latino people who were eligible for PrEP were prescribed it, compared to 82% of eligible White people12
New hiv Diagnoses Among Hispanic/Latino males in the us
by Transmission Category, 2021‡
The Majority of new
hiv diagnoses
among Hispanic/Latino males in 2021 were through male-to-male sexual contact.
- Source: Centers for Disease Control and Prevention. NCHHSTP AtlasPlus. https://www.cdc.gov/nchhstp/atlas/index.htm. Accessed January 22, 2024.
- *Ages 13 and older.
- †Based on most recent viral load test. Viral suppression is defined as having less than 200 copies of HIV per milliliter of blood.15
- ‡Among males aged 13 and older.
Data have not historically captured transgender people, so there is still not a complete understanding of HIV among this group.26,27 Data across many fields show that transphobia impacts all aspects of life for transmen and transwomen, from housing and employment to health and safety and puts them at increased risk for HIV.26 Transgender people also face high rates of violence including sexual assault, which can further increase the HIV risk, and are less likely to receive hospital care, including postexposure prophylaxis, after an assault.28
- In 2021, transgender people accounted for 2% of new HIV diagnoses in the US9
- A study of trans women in 7 major US cities from 2019 to 2020 found that 42% of those interviewed were living with HIV29
- According to a systematic review and meta-analysis of international studies among 48,604 transfeminine individuals between 2000 and 2019, they were 66 times more likely to be living with HIV compared to the general population over 15 years of age30
- In 2021, among the transgender people newly diagnosed with HIV in the US, 45% were Black/African American and 31% were Hispanic/Latino9
In the US, women accounted for approximately 1 in 4 people living with HIV in 2021, yet the narrative of the HIV epidemic often excludes their stories.31,32 Biological factors (heterosexual sex is more likely to transmit HIV to a woman from her male partner than vice versa) and social factors (including gender discrimination and barriers to accessing reproductive care) put women at increased risk of HIV.33,34 In addition, women are more likely to experience intimate partner violence, which also increases their HIV risk. Women of color are further disproportionately impacted by HIV as they experience stigma and discrimination based on both gender and race.35
- In 2021, 18% of new HIV diagnoses were among women9
- The majority of new HIV diagnoses among women (83%) in 2021 were attributed to heterosexual contact, while another 16% were attributed to injection drug use31
- In 2021, 82% of women diagnosed with HIV were linked to HIV care,* 75% received some care,† and 65% were virally suppressed.‡ In comparison, 82% of people diagnosed with HIV overall were linked to HIV care, 75% received some care, and 66% were virally suppressed31
- In 2021, Black/African American females made up only 13% of the US female population aged 13 and older and accounted for over half (54%) of new HIV diagnoses among this group. In comparison, White females accounted for 23% and Hispanic/Latina females accounted for 18% of new HIV diagnoses36,§
- In 2021, the rate of Black/African American females living with an HIV diagnosis was 17 times that of White females31
- Although annual HIV infections remained stable overall among Black/African American women from 2017 to 2021, the rate of new HIV infections among Black/African American women is 10 times that of White women and 4 times that of Hispanic/Latina women17
- In 2022, less than 12% of women in the US who were eligible for PrEP medicine were prescribed the preventative regimen12
New HIV
Diagnoses Among Females by Race/Ethnicity in the US and dependent areas, 2021§
- Source: CDC. Diagnoses of HIV Infection in the United States and Dependent Areas 2021: Special Focus Profiles. HIV Surveillance Report. 2023;34.
- *AIDSVu defines linkage to care as having a visit with a healthcare provider and getting a CD4 or viral load test within one month of being diagnosed with HIV.
- †Receipt of HIV care is defined as those living with diagnosed HIV who received medical care for HIV and had at least one CD4 count or HIV viral load test in that year.
- ‡Viral suppression is defined as having less than 200 copies of HIV per milliliter of blood.15
- §Among females aged 13 and older.
Young people ages 13 to 24 are among those most affected by HIV as a result of numerous social, biological, and behavioral factors.37,38 The CDC estimated that youth aged 15-24 accounted for almost half of the 26 million new sexually transmitted infections (STIs) that occurred in the United States in 2018, and having certain kinds of STIs can increase the risk of acquiring HIV.39,40 Young people may also have difficulty gaining access to HIV testing, treatment, and prevention for HIV and other STIs because of lack of transportation, inability to pay, or privacy concerns.37,41 Young people who are members of other marginalized communities—including young Black American men and young MSM—face increased stigma and higher risk.4,20
- In 2021, 19% of estimated new HIV infections in the US were among young people aged 13 to 2442
- Young people in the US are less likely to know their HIV status. As of 2021, for every 100 young people aged 13 to 24 living with HIV, only 56 knew their status. In comparison, for every 100 people of all ages living with HIV, 87 knew their status43,*
- In 2021, for every 100 people aged 13 to 24 with diagnosed HIV, 80 received some care,† 55 were retained in care,‡ and 65 were virally suppressed.§ In comparison, for every 100 people of all ages with diagnosed HIV, 75 received some care, 54 were retained in care, and 66 were virally suppressed44
- According to the CDC, only 20% of young people aged 16 to 24 in the US who could benefit from PrEP medicine were prescribed the prevention regimen in 202145
New HIV
Diagnoses Among Young People in
the US
and dependent areas, 2021
Young people ages 13 to 24 accounted for 19% of new HIV diagnoses in 2021.
- Source: CDC. Diagnoses of HIV infection in the United States and dependent areas, 2021. HIV Surveillance Report. 2023;34.
- *Data not available for children aged 12 and under.
- †At least 1 viral load or CD4 test.
- ‡Had 2 viral load or CD4 tests at least 3 months apart in a year.
- §Based on most recent viral load test. Viral suppression is defined as having less than 200 copies of HIV per milliliter of blood.15
HIV is more prevalent in the South, where the epidemic is largely driven by poverty, racism, and lack of access to healthcare. The South has the highest poverty rate, lowest median household income, and greatest percentage of uninsured people (ie, nearly half of Americans without insurance live in the South) in the country.46,47 Yet, fewer people in the South are aware they have HIV, which means they do not access care or reach viral suppression.* In addition, non-urban areas in the South are bearing the brunt of the nation’s opioid crisis, which puts residents at additional risk of HIV. The HIV epidemic in the South illustrates the increased risk among those who identify with more than one marginalized group as HIV is more likely among Black Americans in the South and particularly among Black American MSM.46
- In 2021, more than half (52%) of all new HIV diagnoses occurred in people living in the South even though only 38% of the US population lives in this region48
- In 2021, the rate of HIV diagnoses among people in the South was 2.1 times the rate among people in the Midwest49
- In 2021, the South had a greater number of new HIV diagnoses than all other regions combined9
- In 2021, the South accounted for 48% of deaths among people with diagnosed HIV infection49
- In 2022, Southerners accounted for only 38% of PrEP medicine users48
- Black/African American people aged 13 and older accounted for 49% of new HIV diagnoses in the region in 202136
- In 2021, Black/African American male-to-male sexual contact accounted for the largest percentage of new HIV diagnoses (46%) in the South36
- New HIV diagnoses among Hispanic/Latino MSM in the South increased 37% between 2012 and 2019 while they decreased by 23% for White MSM in the region during that same time period50,51
- In 2019, among people living with HIV, the highest percentage of people living with undiagnosed HIV infection was in the Midwest (14.9%) and the South (14.8%), followed by the West (13.9%) and Northeast (8.6%)52
- In 2021, 82% of new HIV diagnoses among men in the South were transmitted through male-to-male sexual contact, 10% through heterosexual contact, 4% through injection drug use, and 4% through injection drug use and male-to-male sexual contact53
- In 2021, 86% of new HIV diagnoses among women in the South were transmitted through heterosexual contact and 13% through injection drug use53
Rates of People Living with HIV,
2021
- Source: AIDSVu. Rates of people living with HIV, 2021. Local Data: United States. Map data available through J Med Internet Res, 2020. https://aidsvu.org/local-data/united-states/
Rates of People
Newly Diagnosed
with HIV, 2021
- Source: AIDSVu. Rates of people newly diagnosed with HIV, 2021. View the Map. Interactive map data available through J Med Internet Res, 2020. https://map.aidsvu.org/map
- *Based on most recent viral load test. Viral suppression is defined as having less than 200 copies of HIV per milliliter of blood.15
MOVING FORWARD, TOGETHER
HIV has gone from a death sentence to a manageable chronic condition with treatment options.5,54 But, as the data show, access to these prevention and treatment options is not always evenly distributed.55 Moving forward, we must collectively focus on ways to lessen the burden of HIV on marginalized communities and recognize that doing so will take working together to overcome the societal barriers that prevent too many members of these communities from accessing the care they need.
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https://www.cdc.gov/mmwr/preview/mmwrhtml/00022174.htm - Centers for Disease Control and Prevention. CDC fact sheet: proven HIV prevention methods. May 2016. Accessed May 7, 2024.
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- Centers for Disease Control and Prevention. HIV Mortality 2021. Updated May 31, 2023. Accessed February 7, 2024.
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- 118th Congress (2023-2024). H.R.4392 - PrEP access and coverage act of 2023. Updated August 8, 2023. Accessed February 9, 2024.
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