In 1981, the first cases of AIDS (acquired immunodeficiency syndrome) were reported to the Centers for Disease Control and Prevention (CDC). Since that time, the HIV (human immunodeficiency virus) epidemic has expanded to become one of the greatest public health challenges, both nationally and globally. More than 25 years after the first reports of AIDS, this issue of the HIV/AIDS Surveillance Report marks the reporting of more than 1 million AIDS cases since the beginning of the epidemic in the United States. The number of cases underscores the fact that despite significant advances in HIV testing, prevention, and treatment in the United States, the human toll has been substantial.

CDC’s national system for the surveillance of HIV infection has evolved as our understanding of the epidemic has advanced. CDC developed the serologic testing algorithm for recent HIV seroconversion (STARHS), which uses HIV testing technology to determine, at the population level, the positive HIV test results that indicate new HIV infections (those that occurred within approximately the past 5 months). The ability to distinguish recent from long-standing HIV infection by using STARHS enabled the development of national incidence surveillance, which has been integrated with the established national HIV diagnosis surveillance system. HIV diagnosis data, testing and treatment history, and STARHS results are now used to estimate national HIV incidence (the annual number of new infections). The monitoring of trends in HIV incidence will help CDC and state and local programs to better focus and evaluate prevention efforts for the populations at greatest risk—improvements that are critical in achieving progress toward CDC's goal of reducing the number of new HIV infections in the United States.

Before STARHS technology became available, HIV diagnosis data provided the best indication of trends in key populations; however, HIV diagnosis data indicate when a diagnosis was made, not when a person was infected (infection can occur many years before a diagnosis). Despite the potential limitations of using HIV diagnosis data as a proxy measurement for HIV incidence, the data on HIV diagnosis continue to provide the best information on the distribution of HIV infection in areas that do not collect data for HIV incidence surveillance and in areas without sufficient incidence data. This report presents estimated numbers, percentages, and rates of new HIV infections in the 50 states and the District of Columbia for 2006 (Table 3). Now that national HIV incidence surveillance has been established, CDC will provide an updated estimate of incidence in the United States annually.

This report presents estimated numbers of cases of diagnosed HIV infection, including cases that progressed to AIDS, from the 39 areas (34 states and 5 U.S. dependent areas) that have had confidential name-based HIV infection reporting for a sufficient length of time (i.e., since at least 2003) to allow for stabilization of data collection and for adjustment of the data in order to monitor trends. According to the number of reported AIDS cases, the 34 states with long-term HIV infection reporting represent approximately 66% of the cases in the 50 states and the District of Columbia. Georgia implemented confidential name-based HIV infection case surveillance in December 2003, and this issue of the HIV/AIDS Surveillance Report marks the first time that HIV case reports from Georgia have been included in the tabulation and presentation of estimates of HIV/AIDS. From 2004 through 2007, the total number of new cases of HIV/AIDS increased 15% in the 34 states. This increase is likely due to changes in state reporting regulations and increases in HIV testing. Recent estimates of new infections do not suggest an increase in recent years. However, it is not possible to rule out an increase in HIV infections since the estimation models include a degree of uncertainty. In the future, HIV incidence surveillance data will provide the best indication of changes in trends in new HIV infections. Data on trends in new HIV infections will be available after at least 3 years of data have been reported from the new system.

The figure on the cover depicts the race/ethnicity of adults and adolescents living with diagnosed HIV/AIDS and the race/ethnicity of the population residing in the 34 states with confidential name-based HIV infection reporting at the end of 2007. As shown in the figure, disproportionate percentages of blacks/African Americans and Hispanics/Latinos in the 34 states are living with HIV/AIDS.

The 2007 HIV/AIDS Surveillance Report is organized in 5 sections: (1) estimates of cases of HIV/AIDS, incidence of HIV infection, and AIDS cases; (2) deaths of persons with AIDS; (3) persons living with diagnosed HIV/AIDS, HIV infection (not AIDS), or AIDS; (4) length of survival after AIDS diagnosis; and (5) reports of cases of HIV infection (not AIDS), AIDS, and HIV/AIDS. Sections 1–3 present point estimates of case counts that have been adjusted for reporting delays and missing risk-factor information. CDC routinely adjusts data for the presentation of trends in the epidemic. Data to estimate the number of cases of HIV/AIDS or AIDS; HIV incidence; the number of persons living with HIV/AIDS, HIV infection (not AIDS), or AIDS; and the number of deaths among persons with AIDS have been statistically adjusted to correct for delays in the reporting of cases.

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 2002 (Table 15) and for persons whose diagnosis was made during 1998–2005 (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. Because of delays in the reporting of deaths of persons with AIDS, CDC has revised its protocol for calculating survival to allow more time for the reporting of deaths (see Technical Notes for additional information). As a result, survival after an AIDS diagnosis is presented for the same data years as in Table 13 and Figures 2–4 of the 2006 HIV/AIDS Surveillance Report.

Finally, Section 5 presents reports of cases of HIV infection (not AIDS) and cases of AIDS reported through 2007. This report marks the first time that HIV case reports from the District of Columbia, Massachusetts, and Montana have been included in the HIV/AIDS Surveillance Report. 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 18, 20, 22, and 24, data from 53 areas (47 states, the District of Columbia, and 5 U.S. dependent areas) have been used to describe reports of HIV infection. These data, which have not been adjusted for delays in reporting, 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.

For tables presenting data by race and ethnicity, the data are stratified by the following races and ethnic groups: American Indian or Alaska Native, black or African American, Hispanic or Latino, and white (these classifications have not changed). The Asian or Pacific Islander category displayed in previous HIV/AIDS surveillance reports (annual and supplemental) has been split into 2 categories: (1) Asian and (2) Native Hawaiian or other Pacific Islander.

Highlights of Analyses

Cases of HIV/AIDS, HIV Incidence, and Cases of AIDS

Cases of HIV/AIDS

From 2004 through 2007, the estimated number of newly diagnosed HIV/AIDS cases in the 34 states with confidential name-based HIV infection reporting increased 15% (Table 1). In 2007, the estimated rate of HIV/AIDS cases in the 34 states was 21.1 per 100,000 population (Table 6a).

• Age group: From 2004 through 2007, the estimated number of newly diagnosed HIV/AIDS cases decreased among children (less than 13 years of age) and persons aged 30–34 and 35–39 years (Table 1). The estimated number of HIV/AIDS cases remained stable among persons aged 13–14 years and increased among persons aged 15–19, 20–24, 25–29, 40–44, 45–49, 50–54, 55–59, 60–64, and 65 years and older. In 2007, the largest number of new HIV/AIDS diagnoses was for persons aged 40–44 years, who accounted for 15% of all HIV/AIDS cases diagnosed during that year.
• Race/ethnicity: From 2004 through 2007, the estimated number of newly diagnosed HIV/AIDS cases increased among all races and ethnicity (Table 1). Blacks/African Americans accounted for 51% of all HIV/AIDS cases diagnosed in 2007. In 2007, rates of HIV/AIDS cases were 76.7 per 100,000 in the black/African American population, 34.6 per 100,000 in the Native Hawaiian/other Pacific Islander population, 27.7 per 100,000 in the Hispanic/Latino population, 12.8 per 100,000 in the American Indian/Alaska Native population, 9.2 per 100,000 in the white population, and 7.7 per 100,000 in the Asian population (Table 6a).
• Sex: From 2004 through 2007, the estimated number of newly diagnosed HIV/AIDS cases increased approximately 18% among males and 8% among females (Table 1). In 2007, males accounted for 74% of all HIV/AIDS cases among adults and adolescents. In 2007, HIV/AIDS rates among adults and adolescents were 38.8 per 100,000 among males and 12.9 per 100,000 among females (Table 6a).
• Transmission category: Among men, from 2004 through 2007, the estimated number of newly diagnosed HIV/AIDS cases increased among men who have sex with men (MSM) and remained stable among injection drug users (IDUs) (Table 1). The estimated numbers of HIV/AIDS diagnoses increased among male and female adults and adolescents with HIV infection attributed to high-risk heterosexual contact (heterosexual contact with a person known to have, or to be at high risk for, HIV infection). The estimated numbers of newly diagnosed HIV/AIDS cases decreased among female IDUs, MSM who were also IDUs, and among children. MSM (53%) and persons exposed through high-risk heterosexual contact (32%) accounted for 85% of all HIV/AIDS cases diagnosed in the 34 states in 2007.

Of all HIV infections diagnosed in 2006 in the 34 states with confidential name-based HIV reporting, 36% progressed to AIDS within 12 months after HIV infection was diagnosed. AIDS was diagnosed within 12 months after the diagnosis of HIV infection for larger percentages of persons aged 35 years and older, Hispanics/Latinos, male IDUs, and males with HIV infection attributed to high-risk heterosexual contact (Table 2).

HIV incidence

The estimated number of new HIV infections in adults and adolescents in the 50 states and the District of Columbia in 2006 was 56,300. The overall rate of new HIV infections was 22.8 per 100,000 (Table 3).

• Sex: In 2006, males accounted for an estimated 41,400 (73%) new HIV infections, and females accounted for an estimated 15,000 (27%). The rate of new HIV infections was estimated at 34.3 per 100,000 among males and 11.9 per 100,000 among females.
• Race/ethnicity: In 2006, blacks/African Americans accounted for an estimated 24,900 (45%) new HIV infections. Whites accounted for an estimated 19,600 (35%) new HIV infections, and Hispanics/Latinos accounted for an estimated 9,700 (17%). A total of 1,200 (2%) new HIV infections occurred in Asians/Pacific Islanders, and an estimated 290 (1%) occurred in American Indians/Alaska Natives. By race/ethnicity, the highest rate of new HIV infections was that for blacks/African Americans (83.7 per 100,000); by race/ethnicity and sex, the highest rate was that for black/African American males (115.7 per 100,000).
• Age at HIV infection: In 2006, persons aged 13–29 accounted for the largest number of new HIV infections (19,200 [34%]). Persons aged 30–39 accounted for an estimated 17,400 (31%) new HIV infections, followed by persons aged 40–49 (13,900 [25%]), and persons aged 50 years and older (5,800 [10%]). Although the largest number of new HIV infections occurred in persons aged 13–29 years, the highest rate of new infections was that for persons aged 30–39 years (42.6 per 100,000).
• Transmission category: Most of the new HIV infections in 2006 (28,700 [53%]) were in MSM. Persons infected through high-risk heterosexual contact accounted for 16,800 (31%) new HIV infections, IDUs accounted for 6,600 (12%), and MSM who were also IDUs accounted for 2,100 (4%).

Cases of AIDS

From 2003 through 2007, the estimated numbers of newly diagnosed AIDS cases in the 50 states and the District of Columbia decreased (Table 4). In 2007, the estimated rate of AIDS cases in the United States was 11.9 per 100,000 population (Table 6b).

• Age group: From 2003 through 2007, the estimated number of newly diagnosed AIDS cases decreased 62% among children (less than 13 years of age) (Table 4). The estimated number of new AIDS cases also decreased among persons in the age groups 30–34, 35–39, and 40–44 years. The estimated number of new AIDS cases remained stable among persons aged 45–49 and persons aged 65 years and older and increased in the following age groups: 13–14, 15–19, 20–24, 25–29, 50–54, 55–59, and 60–64 years. In 2007, the largest number of new AIDS cases occurred among persons aged 40–44 years, who accounted for 19% of all AIDS cases diagnosed during that year in the 50 states and the District of Columbia.
• Race/ethnicity: From 2003 through 2007, the estimated number of newly diagnosed AIDS cases decreased among blacks/African Americans, American Indians/Alaska Natives, and whites, remained stable among Hispanics/Latinos, and increased among Asians and Native Hawaiians/other Pacific Islanders. In 2007, rates of AIDS cases were 47.3 per 100,000 in the black/African American population, 18.3 per 100,000 in the Native Hawaiian/other Pacific Islander population, 15.2 per 100,000 in the Hispanic/Latino population, 6.9 per 100,000 in the American Indian/Alaska Native population, 5.2 per 100,000 in the white population, and 3.6 per 100,000 in the Asian population (Table 6b).
• Sex: From 2003 through 2007, the estimated number of newly diagnosed AIDS cases decreased among male and female adults and adolescents (Table 4). Males accounted for 73% of all AIDS cases diagnosed in 2007 among adults and adolescents in the 50 states and the District of Columbia. Rates of new AIDS cases among adults and adolescents in 2007 were 21.6 per 100,000 among males and 7.5 per 100,000 among females (Table 6b).
• Transmission category: From 2003 through 2007, among male adults and adolescents, the estimated number of newly diagnosed AIDS cases decreased among IDUs and MSM who were also IDUs (Table 4). The numbers of males exposed through male-to-male sexual contact and high-risk heterosexual contact remained stable. Among female adults and adolescents, the estimated number of new AIDS cases decreased among IDUs and remained stable among females exposed through high-risk heterosexual contact.
• Region: From 2003 through 2007, the estimated number of AIDS cases decreased 14% in the Northeast, decreased 5% each in the South and the West, and remained stable in the Midwest.

Deaths

From 2003 through 2007, the estimated number of deaths of persons with AIDS who resided in the 50 states and the District of Columbia decreased 17% (Table 8).

• Age group: The estimated number of deaths decreased among children (less than 13 years of age) and in the following age groups: 25–29, 30–34, 35–39, 40–44, and 45–49 years. The estimated number of deaths remained stable among persons aged 20–24 and persons aged 50–54 years and increased among persons aged 13–14, 15–19, 55–59, 60–64, and 65 years and older.
• Race/ethnicity: The estimated number of deaths of persons with AIDS decreased among American Indians/Alaska Natives, blacks/African Americans, Hispanics/Latinos, and whites. The estimated number of deaths of persons with AIDS increased among Asians and Native Hawaiians/other Pacific Islanders.
• Sex and transmission category: The estimated number of deaths of adults and adolescents with AIDS decreased among MSM and IDUs and remained stable among persons exposed through high-risk heterosexual contact.
• Region: The estimated number of deaths of persons with AIDS decreased in all regions of the United States.

Persons Living with HIV/AIDS, HIV Infection (Not AIDS), or AIDS

Persons living with HIV/AIDS

From 2004 through 2007, the estimated number of persons living with HIV/AIDS (HIV/AIDS prevalence) increased steadily in the 34 states with confidential name-based HIV infection reporting (Table 9). At the end of 2007, an estimated 551,932 persons in these states were living with HIV/AIDS.

• By age group, 20% (the greatest percentage) were aged 40–44 years.
• By race/ethnicity, 48% were black/African American, 33% white, 17% Hispanic/Latino, and less than 1% each were American Indian/Alaska Native, Asian, or Native Hawaiian/other Pacific Islander.
• By sex, 73% of adults and adolescents living with HIV/AIDS were male.
• Of the estimated 398,057 male adults and adolescents living with HIV/AIDS, 64% had been exposed through male-to-male sexual contact, 16% through injection drug use, 12% through high-risk heterosexual contact, and 7% through both male-to-male sexual contact and injection drug use. Of the estimated 146,692 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 7,181 children living with HIV/AIDS, 91% had been exposed perinatally.

Prevalence rates of HIV infection (not AIDS)

At the end of 2007, in the 39 areas with confidential name-based HIV infection reporting since at least 2003, the prevalence rate of HIV infection (not AIDS) among adults and adolescents was estimated at 154.2 per 100,000 (Table 11). The estimated prevalence rate for adults and adolescents living with HIV infection (not AIDS) ranged from 2.2 per 100,000 (American Samoa) to 282.0 per 100,000 (New York). The estimated prevalence rate of HIV infection (not AIDS) among children residing in the 39 areas was 6.0 per 100,000. The estimated prevalence rate for children living with HIV infection (not AIDS) ranged from zero per 100,000 in New Mexico, North Dakota, American Samoa, Guam, and the Northern Mariana Islands to 22.0 per 100,000 in New York.

Persons living with AIDS

The number of persons living with AIDS (AIDS prevalence) increased steadily from 2003 through 2007 (Table 12). At the end of 2007, an estimated 455,636 persons in the 50 states and the District of Columbia were living with AIDS.

• By age group, 21% (the greatest percentage) were aged 45–49 years.
• By race/ethnicity, 44% were black/African American, 35% white, 19% Hispanic/Latino, 1% Asian, and less than 1% each were American Indian/Alaska Native or Native Hawaiian/other Pacific Islander.
• By sex, 77% of adults and adolescents living with AIDS were male.
• Of the estimated 347,284 male adults and adolescents living with AIDS, 61% had been exposed through male-to-male sexual contact, 18% through injection drug use, 11% through high-risk heterosexual contact, and 8% through both male-to-male sexual contact and injection drug use. Of the estimated 104,560 female adults and adolescents living with AIDS, 66% had been exposed through high-risk heterosexual contact, and 32% had been exposed through injection drug use.
• By region, 40% resided in the South, 29% in the Northeast, 20% in the West, and 11% in the Midwest.

Prevalence rates of AIDS

At the end of 2007, the AIDS prevalence rate among adults and adolescents in the United States was estimated at 185.1 per 100,000 (Table 11). The estimated prevalence rate for adults and adolescents living with AIDS ranged from 2.2 per 100,000 (American Samoa) to 1,750.6 per 100,000 (District of Columbia). The prevalence rate of AIDS among children in the United States was estimated at 1.7 per 100,000 at the end of 2007. The estimated prevalence rate for children living with AIDS ranged from zero per 100,000 in Idaho, Maine, Montana, Utah, American Samoa, Guam, and the Northern Mariana Islands to 29.7 per 100,000 in the District of Columbia.

Survival after AIDS Diagnosis

Table 15 is limited to data on AIDS cases diagnosed in 2002 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, 1998 through 2005.

• Survival (the estimated proportion of persons surviving a given length of time after diagnosis) increased with the year of diagnosis for diagnoses made during 1998–2000. Year-to-year differences were small during 2001–2005 (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 (Figure 3).
• Survival was greatest among MSM and among children with perinatally acquired HIV infection (Table 15). 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 AIDS diagnosis, was greater among Asians, whites, and Hispanics/Latinos than among blacks/African Americans (Figure 4). Results were unstable or inconsistent for American Indians/Alaska Natives and Native Hawaiians/other Pacific Islanders, because the numbers of persons in these categories were small.

Reports of Cases of HIV Infection (Not AIDS), AIDS, and HIV/AIDS

Tables 16–25 describe reports of cases of AIDS, HIV infection (not AIDS), and HIV/AIDS. Tables 18, 20, 22, and 24 are based on reports of cases of HIV infection (not AIDS) through 2007 from the 53 areas that had implemented name-based HIV infection reporting. Table 18 displays cases of HIV infection (not AIDS) both reported and diagnosed in 2007, by area of residence, for the 53 areas that had implemented name-based HIV infection reporting. Note that not all cases of HIV infection (not AIDS) or AIDS reported in 2007 reflect diagnoses made during 2007; rather, the reported cases include cases diagnosed during earlier years.

Reports of cases of HIV infection (not AIDS)

Through 2007, a total of 337,590 persons were reported as having HIV infection (not AIDS) in the 53 areas with confidential name-based HIV infection reporting (Table 18) (see Technical Notes for discussion of surveillance of HIV infection [not AIDS]). Six states (California, Florida, New Jersey, New York, North Carolina, and Texas) reported 172,429 (51%) of the 337,590 cumulative cases of HIV infection (not AIDS) reported to CDC. Seven states (California, Florida, Georgia, New York, North Carolina, Pennsylvania, and Texas) accounted for 57% (15,543) of the 27,126 cases of HIV infection (not AIDS) diagnosed in the 53 areas in 2007.

• In 2007, males accounted for 77% and females for 23% of the 62,573 reported cases in adults and adolescents (Table 20).
• In 2007, 657 cases in children were reported.

Reports of AIDS cases

Through 2007, a total of 1,030,832 persons in the United States and dependent areas had been reported as having AIDS (Table 16). Three states (California, Florida, and New York) reported 43% of the cumulative AIDS cases and 36% of AIDS cases reported to CDC in 2007. In the 50 states and the District of Columbia, the rate of reported AIDS cases in 2007 was 12.4 per 100,000 population. When the U.S. dependent areas were included, the rate of reported AIDS cases ranged from zero per 100,000 (American Samoa, Guam, and the Northern Mariana Islands) to 148.1 per 100,000 (District of Columbia).

• In 2007, males accounted for 74% and females for 26% of 38,297 reported AIDS cases in adults and adolescents (Table 19).
• In 2007, 87 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. Dear colleague letter: CDC recommends that all states and territories adopt confidential name-based surveillance systems to report HIV infections. Published July 5, 2005. Accessed January 29, 2009.

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. A heightened national response to the HIV/AIDS crisis among African Americans. Revised June 2007. Accessed January 29, 2009.

CDC. HIV prevalence estimates—United States, 2006. MMWR 2008;57(39):1073–1076.

CDC. HIV prevention strategic plan extended through 2010. Published October 2007. Accessed March 11, 2008.

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

CDC. Subpopulation estimates from the HIV incidence surveillance system—United States, 2006. MMWR 2008;57(36):985–989.

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

Hall HI, Song R, Rhodes P, et al. Estimation of HIV incidence in the United States. JAMA 2008;300(5):520–529.

Glynn MK, Lee LM, McKenna MT. The status of national HIV case surveillance, United States 2006.  Public Health Rep 2007;122(suppl 1):63–71.

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(1):42–48.

Lee LM, McKenna MT. Monitoring the incidence of HIV infection in the United States.  Public Health Rep 2007;122(suppl 1):72–79.