The United States has made enormous strides in HIV treatment, care, and prevention since the epidemic began 40 years ago.1 HIV was once the leading cause of death for young people, but because of scientific advances, fewer people are becoming infected with HIV, and those who do are living longer and healthier lives.2-5 The rate of new HIV infections declined 73% between 1984 and 2019, and the age-adjusted death rate has dropped more than 80% since its peak in 1995.4,6
In some ways, however, progress has stalled; too many people remain unaware of their HIV status, and the uptake of pre-exposure prophylaxis (PrEP) medicine has been slow.7,8
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.11
As a result, progress has been unevenly distributed, with already marginalized groups continuing to bear the brunt of the HIV epidemic.6 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.
*Viral suppression means the amount of virus in the blood is so low it cannot be measured by a test (<200 copies/mL). This is sometimes referred to as undetectable. Viral suppression is the ultimate goal of HIV care and treatment.12
Men who have sex with men (MSM) have been the population most impacted by the epidemic since the beginning.13 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. If current rates continue, it is estimated that 1 in 6 MSM will be diagnosed with HIV at some point in their lives.14
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.11 Together, this impact may leave individuals at increased risk for HIV and make them less likely to receive the care they need.4,17 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
Black Americans Accounted For
nearly HALF of new
HIV diagnoses in 2018.
*Viral suppression means the amount of virus in the blood is so low it cannot be measured by a test (<200 copies/mL). This is sometimes referred to as undetectable. Viral suppression is the ultimate goal of HIV care and treatment.12
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
The Majority of new
hiv diagnoses
among Hispanic/Latino AMERICAN men in 2018 WERE through male-to-male sexual contact.
*Viral suppression means the amount of virus in the blood is so low it cannot be measured by a test (<200 copies/mL). This is sometimes referred to as undetectable. Viral suppression is the ultimate goal of HIV care and treatment.12
Data have not historically captured transgender people, so there is still not a complete understanding of HIV among this group.22,23 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.22 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.24
In the US, women accounted for approximately 1 in 5 people living with HIV in 2018, yet the narrative of the HIV epidemic often excludes their stories.28 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.29,30 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.28
Young people ages 13 to 24 are among those most at risk for HIV as a result of numerous social, biological, and behavioral factors.33,34 In 2008, prevalence data suggested that half of new sexually transmitted infections (STIs) occur in young people (aged 15 to 24), and having certain kinds of STIs can increase the risk of acquiring HIV.35,36 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.33,37 Young people who are members of other marginalized communities—including young Black American men and young MSM—face increased stigma and higher risk.4,17
Young people ages 13 to 24 accounted for 21% of new HIV diagnoses in 2018.
*Viral suppression means the amount of virus in the blood is so low it cannot be measured by a test (<200 copies/mL). This is sometimes referred to as undetectable. Viral suppression is the ultimate goal of HIV care and treatment.12
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.39,40 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 put 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.39
*Viral suppression means the amount of virus in the blood is so low it cannot be measured by a test (<200 copies/mL). This is sometimes referred to as undetectable. Viral suppression is the ultimate goal of HIV care and treatment.12
HIV has gone from a death sentence to a manageable chronic condition with treatment options.5,43 But, as the data show, access to these prevention and treatment options is not always evenly distributed.10 Moving forward, we must focus on ways to lessen the burden of HIV on marginalized communities and recognize that doing so will take collective efforts to overcome the societal barriers that prevent too many members of these communities from accessing the care they need.