With each passing year, the numbers paint a more positive picture about HIV, the infection that can lead to AIDS. AIDS, or acquired immunodeficiency syndrome, is the third and last stage of HIV, following acute and chronic HIV infection.
Medications can stop or slow the progress of HIV and keep AIDS at bay. But these drugs can only help people who know their HIV status and start to take them early. Approximately 1.2 million people in the U.S. have HIV, but 13 percent of them don’t know it. That’s why guidelines say everyone should get an HIV test at least once in their lives. People at higher risk for exposure to HIV should get the test at least once a year, and sexually active gay and bisexual men should get the test every 3 to 6 months.
Annual HIV Cases in the U.S.
According to the CDC, annual infections in the U.S. have been cut by more than two-thirds since the highs in the 1980s. In just the 4 years from 2015 to 2019, new infections went down by 8%, from 37,800 new cases to 34,800. That puts the current national rate at 12.6 per 100,000 people per year.
HIV Infection by Age
People of every age continue to get HIV, but there are some differences from one age group to another. The numbers have gone down among people ages 13 to 24 and ages 45 to 54. But younger people are less likely to know their HIV status. About 30 percent of new cases are among people ages 25 to 34, and 16.5 percent are among those ages 35 to 44.
Sources of HIV Infection
Each year, 69 percent of new cases of HIV occur in men who are gay, bisexual, or have sex with men.
About 2 percent of new yearly HIV diagnoses are in transgender teens and adults. Most of these are among people who transitioned from male to female. Close to half are between 20 and 29 years old.
Straight men account for 7 percent of new HIV diagnoses and straight women account for 16 percent. Though the total number of men infected is going down, the number of women is staying the same.
People who inject drugs account for 7 percent of new HIV infections or roughly 2,500 cases per year. Four percent are men, 3 percent women.
HIV Infection by Race and Ethnicity
Despite declines in HIV in men of all races, the number of African American and Hispanic people with HIV continues to be far higher than the number of white people with it.
African American people make up 13% of the population but are 40% of people with HIV and 44% of new diagnoses. Black men account for three-quarters of new HIV infections among all Black people. In this group, researchers ascribe 82% of infections to male-to-male sexual contact.
The HIV infection rate among African American women is the highest compared to women of all other races and ethnicities. Ninety-one percent of the new HIV infections in this group come from heterosexual contact. African American transgender women account for 62% of HIV infections among transgender women in seven major U.S. cities.
Hispanic/Latinx people are 18% of the population, but they make up 25% of those with HIV and 30% of new diagnoses.
The numbers tell the story: For the year 2019, among new infections in gay or bisexual men, 8,900 were Black, 7,900 were Hispanic/Latino, and 5,100 were white. Among heterosexual men, 1,400 were Black, 530 were Hispanic/Latino, and 450 were white. Among heterosexual women, 3,100 were Black, 1,000 were Hispanic/Latina, and 930 were white.
HIV Around the U.S.
Although people have been diagnosed with HIV in all 50 states, the District of Columbia, and U.S. dependencies, HIV numbers differ from state to state and region to region. The District of Columbia has the highest rate in the nation, at 42.2 per 100,000. The highest regional rate continues to be the South at 15.2 for every 100,000 people. In the Northeast it’s 9.4, in the West, 9.2, and 7.2 in the Midwest.
Two-thirds of new HIV cases happen in just 10 states – California, Florida, Georgia, Illinois, New Jersey, New York, North Carolina, Ohio, Pennsylvania, and Texas – and mostly within large metro areas like Miami, Orlando, and Atlanta. Georgia has the highest rate of all the states with 27.6 per 100,00 people.
Deaths Among People With HIV
Because of ART, or antiretroviral therapy, the number of people with HIV who die from AIDS has decreased dramatically in the past 25 years. People on ART can expect to live to age 71 on average. But without testing and treatment, HIV will lead to AIDS and early death.
Many people are diagnosed too late for ART to be effective. Current numbers show that every year there are between 15,400-15,800 deaths among people who have HIV. African American account for 43% of these deaths. About 73% are in people over age 50. But over half the deaths of people with HIV are not actually from the infection, but from illnesses not related to AIDS, such as liver or cardiovascular disease.
An End to the HIV Epidemic
The CDC has an initiative to end the HIV epidemic. One goal is to lower new cases by 75% by 2025, and then by at least 90% by 2030. The CDC plan includes more HIV testing, better access to care for people with HIV, and access to HIV prevention with drugs like PrEP. PrEP, or pre-exposure prophylaxis, is a special medication for HIV-negative people at high risk for HIV, such as a person in a sexual relationship with someone living with HIV, who injects drugs, or who doesn’t always use condoms.
But not everyone who could benefit from PrEP gets it. For instance, far more white people than African American people are being prescribed PrEP. This is despite the fact that African American gay and bisexual men have a much higher need. And just 16% of at-risk young people ages 16 to 24 are taking it.
Another challenge is that many at-risk people who start on PrEP don’t stick with it even though they remain at risk. This happens most often among African American and Hispanic people, young adults, and people with a substance use disorder. If the CDC can work to overcome these obstacles, HIV rates can keep coming down.
HIVInfo.nih.gov: “HIV Overview: The Stages of HIV Infection,” “Pre-Exposure Prophylaxis.”
HIV.gov: “US Statistics,” “Impact on Racial and Ethnic Minorities,” “What Is Ending the HIV Epidemic in the U.S.?”
CDC: “HIV and Black/African American People in the US,” “Fact Sheet: Today’s HIV/AIDS Epidemic,” “HIV in the United States and Dependent Areas,” “Fact Sheet: PrEP for HIV Prevention in the US,” “HIV Infection, Risk, Prevention, and Testing Behaviors Among Transgender Women.”
Kaiser Family Foundation: “The HIV/AIDS Epidemic in the United States: The Basics.”
National Institutes of Health: “National HIV Curriculum: Epidemiology of HIV.”
JAMA Open Network: “Characterization of HIV Preexposure Prophylaxis Use Behaviors and HIV Incidence Among US Adults in an Integrated Health Care System.”