The HIV/AIDS epidemic was first recognized in the United States in 1981. Since that time, all states and U.S. dependent areas have conducted AIDS surveillance using a standardized, confidential name-based reporting system. Since 1985, many states and U.S. dependent areas have also implemented HIV case reporting as part of their comprehensive HIV/AIDS surveillance programs. This report presents estimated numbers of cases of HIV/AIDS (cases of HIV infection, regardless whether they have progressed to AIDS) from the 37 areas (33 states and 4 U.S. dependent areas) that have had confidential name-based HIV infection reporting long enough (i.e., since at least 2001) for data collection to stabilize and for adjustment of the data to monitor trends. According to the number of reported AIDS cases, these 33 states represent approximately 63% of the epidemic in the United States. From 2001 through 2005, the total number of new cases of HIV/AIDS in the 33 states decreased slightly; however, HIV/AIDS prevalence (i.e., the number of persons living with HIV/AIDS) increased during this time. At the end of 2005, an estimated 475,220 persons in the 33 states had been given a diagnosis and were living with HIV/AIDS. The figure on the cover depicts the estimated number of new cases of HIV/AIDS from 2001 through 2005, by race/ethnicity, for adults and adolescents residing in the 33 states.

Surveillance data on HIV infections provide a more complete picture of the epidemic and the need for prevention and care services than does the picture provided by AIDS data alone. However, the number of new HIV diagnoses does not necessarily reflect trends in HIV incidence (i.e., new infections) because some persons were infected recently and others were infected some time in the past. One method for estimating HIV incidence is to apply the serologic testing algorithm for recent HIV seroconversion (STARHS) to the serum specimens from which the diagnosis of HIV infection was made. A total of 34 areas are using this method to estimate population-based HIV incidence: 5 areas were funded in FY 2002 to pilot this method, 19 areas were funded in FY 2003, another 9 areas were funded in FY 2004, and 1 additional area was funded in FY 2005. The monitoring of HIV incidence is critical to evaluate progress made towards CDC's goal of reducing the number of new HIV infections in the United States and in allocating resources and evaluating prevention program effectiveness.

The 2005 HIV/AIDS Surveillance Report is organized in 5 sections: (1) cases of HIV/AIDS and AIDS, (2) deaths of persons with AIDS, (3) persons living with HIV/AIDS, AIDS, or HIV infection (not AIDS), (4) length of survival after AIDS diagnosis, and (5) reports of cases of HIV/AIDS, AIDS, and HIV infection (not AIDS). In Sections 1–3, we present point estimates of case counts that have been adjusted for reporting delays and for redistribution of cases in persons initially reported without an identified risk factor. CDC routinely adjusts data for the presentation of trends in the epidemic. Data to estimate the number of cases of HIV/AIDS or AIDS; the number of persons living with HIV/AIDS, AIDS, or HIV infection (not AIDS); and the number of deaths among persons with AIDS have been statistically adjusted to correct for delays in the reporting of cases and deaths.

To assess trends in cases, deaths, or prevalence, it is preferable to use adjusted data, presented by year of diagnosis instead of year of report, to eliminate artifacts of reporting in the surveillance system. Therefore, for trends, the reader is encouraged to use the tables in Sections 1–3 that present trends by year of diagnosis, year of death, or year-end prevalence. Section 4 presents estimates of survival for persons whose AIDS diagnosis was made during 2001 (Table 13) and for persons whose diagnosis was made during 1997–2004 (Figures 2-4). Proportions of persons who survived for various lengths of time after diagnosis are presented by year of diagnosis, age group, race/ethnicity, and HIV transmission category.

Finally, Section 5 presents reports of cases of HIV infection (not AIDS) and cases of AIDS reported through 2005. The areas included in tabulations of reported cases of HIV infection (not AIDS) are based on the date that confidential name-based HIV infection reporting was implemented. For Tables 16, 18, 20, and 22, we used data from 43 areas to describe reports of HIV infection. These data have not been adjusted for delays in reporting and are presented by year of report to CDC. Tables that present cases by year of report represent the most up-to-date information reported to CDC; however, cases by year of report do not represent incident cases, the most recent diagnoses, trends, or deaths.

Highlights of Analyses

Cases of HIV/AIDS and cases of AIDS

Cases of HIV/AIDS

The estimated number of HIV/AIDS cases in the 33 states with confidential name-based HIV infection reporting decreased each year from 2001 through 2004 and then increased in 2005 (Table 1). In 2005, the estimated rate of HIV/AIDS cases in the 33 states was 19.8 per 100,000 population (Table 5b).

• Age group: From 2001 through 2005, the estimated number of HIV/AIDS cases decreased among children less than 13 years of age and in the following age groups: 13–14, 30–34, 35–39, 40–44 and 45–49 years. The estimated number of HIV/AIDS cases remained stable among persons 65 years and older and increased among persons aged 15–19, 20–24, 25–29, 50–54, 55–59, and 60–64 years. The largest number of HIV/AIDS cases occurred among persons aged 35–39 years and accounted for 16% of all HIV/AIDS cases diagnosed in 2005.
• Race/ethnicity: From 2001 through 2005, the estimated number of HIV/AIDS cases increased among whites, Asians/Pacific Islanders, and American Indians/Alaska Natives, and decreased among blacks and Hispanics. Blacks accounted for 49% of all HIV/AIDS cases diagnosed in 2005. In 2005, rates of HIV/AIDS cases were 71.3 per 100,000 in the black population, 27.8 per 100,000 in the Hispanic population, 10.4 per 100,000 in the American Indian/Alaska Native population, 8.8 per 100,000 in the white population, and 7.4 per 100,000 in the Asian/Pacific Islander population (Table 5b).
• Sex: From 2001 through 2005, the estimated number of HIV/AIDS cases decreased approximately 1% among males and 19% among females. In 2005, males accounted for 73% of all HIV/AIDS cases among adults and adolescents.
• Transmission category: From 2001 through 2005, the estimated number of HIV/AIDS cases increased among men who have sex with men (MSM). The estimated number of HIV/AIDS cases decreased among injection drug users (IDUs), MSM who were also IDUs, adults and adolescents who have high-risk heterosexual contact, and among children. MSM (49%) and persons exposed through high-risk heterosexual contact (32%) accounted for 81% of all HIV/AIDS cases diagnosed in 2005.

Of all HIV infections diagnosed in 2004 in the 33 states with confidential name-based HIV reporting, 39% were diagnosed with AIDS less than 12 months after HIV infection was diagnosed. AIDS was diagnosed less than 12 months after the diagnosis of HIV infection for larger proportions of persons aged 35 years and older and for IDUs (Table 2).

Cases of AIDS

From 2001 through 2005, the estimated number of AIDS cases increased approximately 7% (Table 3). In 2005, the estimated rate of AIDS cases in the 50 states and the District of Columbia was 13.7 per 100,000 population (Table 5a).

• Age group: From 2001 through 2005, the estimated number of AIDS cases decreased 44% among children less than 13 years of age. The estimated number of AIDS cases also decreased among persons in the age groups 30–34, and 35–39 years (Table 3). The estimated number of AIDS cases increased in the following age groups: 15–19, 20–24, 25–29, 40–44, 45–49, 50–54, 55–59, 60–64, and 65 years and older. The largest number of AIDS cases occurred among persons aged 40–44 years and accounted for 20% of all AIDS cases diagnosed in 2005 in the 50 states and the District of Columbia (Table 3).
• Race/ethnicity: From 2001 through 2005, the estimated number of AIDS cases increased among all racial and ethnic groups (Table 3). In 2005, rates of AIDS cases were 54.1 per 100,000 in the black population, 18.0 per 100,000 in the Hispanic population, 7.4 per 100,000 in the American Indian/Alaska Native population, 5.9 per 100,000 in the white population, and 3.6 per 100,000 in the Asian/Pacific Islander population (Table 5a).
• Sex: From 2001 through 2005, the estimated number of AIDS cases increased 7% among females and 7% among males. Males accounted for 73% of all AIDS cases diagnosed in 2005 among adults and adolescents in the 50 states and the District of Columbia (Table 3). Rates of AIDS cases in 2005 were 24.9 per 100,000 among males and 8.6 per 100,000 among females (Table 5a).
• Transmission category: From 2001 through 2005, among male adults and adolescents, the estimated number of AIDS cases decreased among IDUs and MSM who were also IDUs, and increased among MSM and males exposed through high-risk heterosexual contact (Table 3). Among female adults and adolescents, from 2001 through 2005, the estimated number of AIDS cases decreased among IDUs and increased among females exposed through high-risk heterosexual contact.
• Region: From 2001 through 2005, the estimated number of AIDS cases increased 24% in the Midwest, 9% in the South and 2% in the Northeast, and decreased 3% in the West.

Deaths

The estimated number of deaths of persons with AIDS who resided in the 50 states and the District of Columbia decreased 4% from 2001 through 2005 (Table 7).

• Age group: From 2001 through 2005, the estimated number of deaths decreased among children less than 13 years of age and in the following age groups: 20–24, 25–29, 30–34, 35–39, and 40–44 years. The estimated number of deaths remained stable among persons aged 15–19 years and increased in the age groups 13–14, 45–49, 50–54, 55–59, 60–64, and 65 years and older.
• Race/ethnicity: From 2001 through 2005, the estimated number of deaths of persons with AIDS decreased among whites and blacks. The estimated number of deaths among persons with AIDS remained stable among Hispanics, Asians/Pacific Islanders, and American Indians/Alaska Natives.
• Sex and transmission category: From 2001 through 2005, both among males and females, the estimated number of deaths of IDUs decreased, but the number of deaths of persons exposed through high-risk heterosexual contact increased.
• Region: From 2001 through 2005, the estimated number of deaths decreased in the Northeast, Midwest, and West and increased in the South.

Persons living with HIV/AIDS, HIV infection (not AIDS), or AIDS

Persons living with HIV/AIDS

From 2001 through 2005, the estimated number of persons living with HIV/AIDS increased steadily in the 33 states with confidential name-based HIV infection reporting (Table 8). At the end of 2005, an estimated 475,220 persons were living with HIV/AIDS in the 33 states with confidential name-based HIV infection reporting since 2001.

• By age group, the most cases (21%) were in persons aged 40–44 years.
• By race/ethnicity, 47% were black, 34% white, 17% Hispanic, and less than 1% each were American Indian/Alaska Native or Asian/Pacific Islander.
• By sex, 73% of adults and adolescents living with HIV/AIDS were male.
• Of the estimated 341,524 male adults and adolescents living with HIV/AIDS, 61% had been exposed through male-to-male sexual contact, 18% had been exposed through injection drug use, 13% had been exposed through high-risk heterosexual contact, and 7% had been exposed through both male-to-male sexual contact and injection drug use. Of the estimated 126,964 female adults and adolescents living with HIV/AIDS, 72% had been exposed through high-risk heterosexual contact, and 26% had been exposed through injection drug use. Of the estimated 6,726 children living with HIV/AIDS, 90% had been exposed perinatally.

Prevalence rates of HIV infection (not AIDS)

In the 37 areas with confidential name-based HIV infection reporting since at least 2001, the prevalence rate of HIV infection (not AIDS) among adults and adolescents was estimated at 137.0 per 100,000 at the end of 2005 (Map 1). The rate for adults and adolescents living with HIV infection (not AIDS) ranged from an estimated 2.5 per 100,000 (American Samoa) to an estimated 274.5 per 100,000 (U.S. Virgin Islands). The prevalence rate of HIV infection (not AIDS) among children residing in the 37 areas was an estimated 7.4 per 100,000 at the end of 2005 (Map 2). The rate for children living with HIV infection (not AIDS) ranged from an estimated zero per 100,000 in Idaho, New Mexico, North Dakota, American Samoa, Guam, and the Commonwealth of Northern Mariana Islands to an estimated 28.6 per 100,000 in New York.

Persons living with AIDS

AIDS prevalence has also increased steadily since 2001 (Table 10). At the end of 2005, an estimated 421,873 persons in the 50 states and the District of Columbia were living with AIDS.

• By age group, the most cases (23%) were in persons aged 40–44 years.
• By race/ethnicity, 44% were black, 35% white, 19% Hispanic, 1% Asian/Pacific Islander, and less than 1% were American Indian/Alaska Native.
• By sex, 77% of adults and adolescents living with AIDS were male.
• Of the estimated 322,125 male adults and adolescents living with AIDS, 59% had been exposed through male-to-male sexual contact, 20% had been exposed through injection drug use, 11% had been exposed through high-risk heterosexual contact, and 8% had been exposed through both male-to-male sexual contact and injection drug use. Of the estimated 95,959 female adults and adolescents living with AIDS, 65% had been exposed through high-risk heterosexual contact, and 33% had been exposed through injection drug use.
• By region, 40% resided in the South, 30% in the Northeast, 20% in the West, and 11% in the Midwest.

AIDS prevalence rates

In the United States, the prevalence rate of AIDS among adults and adolescents was estimated at 174.5 per 100,000 at the end of 2005 (Map 1). The rate for adults and adolescents living with AIDS ranged from an estimated 2.5 per 100,000 (American Samoa) to an estimated 2,060.9 per 100,000 (District of Columbia). The prevalence rate of AIDS among children in the United States was estimated at 2.7 per 100,000 at the end of 2005 (Map 2). The rate for children living with AIDS ranged from an estimated zero per 100,000 in Idaho, Montana, Utah, American Samoa, and the Commonwealth of Northern Mariana Islands to an estimated 45.0 per 100,000 in the District of Columbia.

Survival after AIDS diagnosis

Table 13 is limited to data on AIDS cases diagnosed in 2001 in order to describe the survival of persons whose diagnosis was made relatively recently, but far enough in the past to permit a meaningful measure of survival. Figures 2, 3, and 4 illustrate the proportion of surviving persons among persons whose diagnoses were made over a longer period, 1997 through 2004.

• Survival (the estimated proportion of persons surviving a given length of time after diagnosis) increased with the year of diagnosis for diagnoses made during 1997–1999. Year-to-year differences were small during 2000–2004 (Figure 2).
• Survival decreased as age at diagnosis increased among persons at least 35 years old at diagnosis and in comparison with persons younger than 35. Survival was similar for the age groups 13–24 and 25–34. Survival was greatest among children less than 13 years of age at diagnosis (Figure 3).
• Survival was greatest among MSM and among children with perinatally acquired HIV infection (Table 13). Survival was intermediate among male and female adults and adolescents who had heterosexual contact with someone known to be HIV infected or at high risk for HIV infection, as well as among MSM who also were IDUs. Survival was lowest among male and female adults and adolescents who were IDUs.
• Survival, particularly at more than 48 months after diagnosis, was greater among Asians/Pacific Islanders, whites, and Hispanics, than among blacks (Figure 4). Results were unstable or inconsistent for American Indians/Alaska Natives because the numbers of persons in this racial/ethnic category were small.

Reports of cases of HIV/AIDS, AIDS, and HIV infection (not AIDS)

Tables 14–23 describe reports of cases of HIV/AIDS, AIDS, and HIV infection (not AIDS). Tables 16, 18, 20, and 22 are based on reports of cases of HIV infection (not AIDS) through 2005 from the 43 areas that had implemented name-based HIV infection reporting. Note that not all cases of HIV infection (not AIDS) or AIDS reported in 2005 reflected diagnoses made during 2005; rather, the reported cases include cases diagnosed during earlier years.

Reports of cases of HIV infection (not AIDS)

Through 2005, a total of 249,950 persons were reported as having HIV infection (not AIDS) in the 43 areas with confidential name-based HIV infection reporting (Table 16). Five states (New York, Florida, Texas, New Jersey, and North Carolina) reported 129,444 (52%) of the 249,950 cumulative cases of HIV infection (not AIDS) reported to CDC. In 2005, 3 states (New York, Florida, and Georgia) reported 14,040 (40%) of the 35,537 cases of HIV infection (not AIDS).

• In 2005, 70% of the 35,107 reported cases of HIV infection (not AIDS) among adults and adolescents were in males, and 30% were in females (Table 18).
• In 2005, 430 cases of HIV infection (not AIDS) in children were reported.

Reports of AIDS cases

Through 2005, a total of 956,019 persons in the United States had been reported as having AIDS (Table 14). Three states (California, Florida, and New York) reported 43% of the cumulative AIDS cases, and 37% of AIDS cases reported to CDC in 2005. In the United States, the rate of reported AIDS cases in 2005 was 14.0 per 100,000 population. The rate of reported AIDS cases ranged from zero per 100,000 (American Samoa and the Commonwealth of Northern Mariana Islands) to 128.4 per 100,000 (District of Columbia).

• By sex, in 2005, males accounted for 74% and females for 26% of 41,900 reported AIDS cases among adults and adolescents (Table 17)
• In 2005, 93 AIDS cases in children were reported.

Additional Resources

The following were prepared by using HIV/AIDS surveillance data:

• Selected MMWR articles
• Public-use slides
• Other surveillance reports
• Public-use version of the AIDS surveillance data set (AIDS Public Information Data Set [APIDS])

Suggested Readings

CDC. Advancing HIV prevention: new strategies for a changing epidemic—United States, 2003. MMWR 2003;52(15):329–332.

CDC. Epidemiology of HIV/AIDS—United States,1981–2005. MMWR 2006;55(21):589–592.

CDC. Guidelines for national HIV case surveillance, including monitoring for HIV infection and AIDS. MMWR 1999;48(RR-13):1–31.

CDC. HIV Prevention Strategic Plan Through 2005. Atlanta: U.S. Department of Health and Human Services, CDC; 2001.

CDC. Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings. MMWR 2006;55(RR-14):1–17.

CDC. Twenty-five years of HIV/AIDS—United States, 1981–2006. MMWR 2006;55(21):585–589.

Janssen RS, Satten GA, Stramer SL, et al. New testing strategy to detect early HIV-1 infection for use in incidence estimates and for clinical and prevention purposes. JAMA 1998;280:42–48.

Karon JM, Fleming PL, Steketee RW, De Cock KM. HIV in the United States at the turn of the century: an epidemic in transition. Am J Public Health 2001;91:1060–1068.

Nakashima AK, Fleming PL. HIV/AIDS surveillance in the United States, 1981–2001. J Acquir Immune Defic Syndr 2003;32:68–85.