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HIV Incidence 2006
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Slide 1: Outcomes of Surveillance CDC collects data within an integrated HIV/AIDS surveillance system. Since the first reported cases of AIDS, CDC has maintained an AIDS surveillance system collecting data on the number of people diagnosed, living with, or who have died with AIDS in a certain time period. In 1994 CDC recommended that states conduct surveillance for HIV disease. HIV surveillance measures the number of people diagnosed or living with HIV disease in a certain time period, including people who are HIV-positive with or without AIDS. Reported HIV/AIDS diagnoses refers to the number of cases reported in a specific population during a specific time period irrespective of the date of diagnosis. Estimated HIV/AIDS diagnoses refers to the number of cases estimated to be diagnosed in a specific area during a certain period. Estimates of HIV/AIDS are adjusted for delays in reporting and have historically served as a marker for new HIV infection. The HIV disease prevalence estimate is the number of people estimated to be living with HIV disease in a specific area during a specific time period. Increased prevalence can result from an increase of new cases or decreased mortality or both. CDC estimates that the prevalence of HIV/AIDS in the United States at the end of 2006 was 1,106,400 adults and adolescents 13 years and older (95% Confidence Interval: 1,056,400–1,156,400). With the availability of the serologic testing algorithm for recent HIV seroconversion, or STARHS, CDC developed an HIV incidence surveillance system to measure the incidence of HIV, or the number of people newly infected with HIV in a given year. CDC reported an incidence estimate of 56,300 (95% confidence interval 48,200-64,500) new HIV diagnoses in the United States for 2006 based on a complex extrapolation from incidence data reported from 22 states. Rates represent the number of people with HIV in a given population divided by the number of people in that population and are useful for comparing the disease burden across groups. For example, the number of new cases (incidence) among Hispanics/Latinos may be lower than among whites, but the rate of new infections (incidence rate) among Hispanics/Latinos is higher because there are more whites than Hispanics/Latinos in the U.S. Rates can be calculated for new diagnoses, incidence, prevalence or other events.
Slide 1
Outcomes of Surveillance
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Slide 2: Estimated HIV Incidence—United States, 2006 Using a biological marker of recent HIV infection and a stratified extrapolation approach based on a sample survey method of estimating a population from a sample, CDC estimated the HIV incidence among people age 13 years or older in 22 states in 2006. The total was extrapolated to all 50 states and the District of Columbia by applying the HIV incidence to AIDS ratio in the 22 states to the number of AIDS cases in the non-incidence areas. Based on the stratified extrapolation approach the incidence of HIV in the US for 2006 was 56,300 new infections, with a 95% confidence interval of 48,200 to 64,500. An extended back-calculation corroboration of HIV incidence for the period 1977-2006 yielded an estimate of 55,400 new infections per year for 2003-2006. The extended back-calculation approach provides an average over 4 years and is less suited to identify very recent changes. The new national estimate of 56,300 does not reflect an increase in new HIV infections from previous years, but a more accurate direct measurement of incidence. Although these results are within the range of previous estimates, the back-calculation suggests that the previous CDC estimate of approximately 40,000 cases/year underestimated the severity of the epidemic. The 22 states with HIV incidence surveillance that provided data for the incidence estimate are Alabama, Arizona, Colorado, Connecticut, Florida, Georgia, Illinois, Indiana, Louisiana, Michigan, Mississippi, Missouri, New Jersey, New York, North Carolina, Oklahoma, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, and Washington. Data have been adjusted for reporting delay and cases without risk factor information were proportionately re-distributed.
Slide 2
Estimated HIV Incidence—United States, 2006
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Slide 3: Estimated Percentage of New HIV Infections by Sex—United States, 2006 Based on the stratified extrapolation approach, using a biological marker of recent HIV infection, CDC estimated the incidence of HIV infections in 2006 as 56,300 new infections, with a 95% confidence interval of 48,200 to 64,500.  Of the 56,300 new HIV infections in 2006, CDC estimated that 73% were in men and 27% were in women. The 22 states with HIV incidence surveillance that provided data for the incidence estimate are Alabama, Arizona, Colorado, Connecticut, Florida, Georgia, Illinois, Indiana, Louisiana, Michigan, Mississippi, Missouri, New Jersey, New York, North Carolina, Oklahoma, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, and Washington. Incidence estimates were extrapolated to the 50 states and the District of Columbia. Data have been adjusted for reporting delay.
Slide 3
Estimated Percentage of New HIV Infections by Sex—United States, 2006
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Slide 4: Estimated Percentage of New HIV Infections by Race/Ethnicity—United States, 2006 Based on a stratified extrapolation approach, using a biological marker of recent HIV infection, CDC estimated the incidence of HIV infections in 2006 as 56,300 new infections, with a 95% confidence interval of 48,200 to 64,500. Of the estimated 56,300 new HIV infections in the US in 2006, CDC estimated that 45% of the new infections were among blacks/African Americans, 35% among whites and 17% among Hispanics.  Asians/Pacific Islanders and American Indians/Alaska Natives made up 2% and 1% of new infections respectively. CDC’s incidence estimates confirm that blacks/African Americans are more severely and disproportionately affected by HIV than any other racial/ethnic group in the United States. Although blacks/African Americans comprise only 12% of the US population, 45% of new HIV infections occurred in blacks/African Americans. Hispanics/Latinos make up 15% of the US population yet 17% of new HIV infections occurred in Hispanic/Latinos. The 22 states with HIV incidence surveillance that provided data for the incidence estimate are Alabama, Arizona, Colorado, Connecticut, Florida, Georgia, Illinois, Indiana, Louisiana, Michigan, Mississippi, Missouri, New Jersey, New York, North Carolina, Oklahoma, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, and Washington. Incidence estimates were extrapolated to the 50 states and the District of Columbia. Data have been adjusted for reporting delay.
Slide 4
Estimated Percentage of New HIV Infections by Race/Ethnicity—United States, 2006
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Slide 5: Estimated Rate of New HIV Infections by Race/Ethnicity—United States, 2006 Based on a stratified extrapolation approach, using a biological marker of recent HIV infection, CDC estimated the incidence of HIV infections in 2006 as 56,300 new infections, with a 95% confidence interval of 48,200 to 64,500. Of the estimated 56,300 new HIV infections in the US in 2006, CDC estimated the rate of new infections by race was 14.6/100,000 in American Indians/Alaska Natives, 10.3/100,000 in Asians/Pacific Islanders, 83.7/100,000 in blacks/African Americans, 29.3/100,000 in Hispanics/Latinos, and 11.5/100,000 in whites. In 2006, the rate of new infections among blacks/African Americans was 7 times the rate among whites (83.7 versus 11.5 new infections per 100,000 population). The rate of new HIV infections among Hispanics/Latinos in 2006 was nearly 3 times the rate among whites (29.3 versus 11.5 per 100,000). The 22 states with HIV incidence surveillance that provided data for the incidence estimate are Alabama, Arizona, Colorado, Connecticut, Florida, Georgia, Illinois, Indiana, Louisiana, Michigan, Mississippi, Missouri, New Jersey, New York, North Carolina, Oklahoma, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, and Washington. Incidence estimates were extrapolated to the 50 states and the District of Columbia. Data have been adjusted for reporting delay.
Slide 5
Estimated Rate of New HIV Infections by Race/Ethnicity—United States, 2006
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Slide 6: Estimated Percentage of New HIV Infections by Transmission Category—United States, 2006 Based on a stratified extrapolation approach, using a biological marker of recent HIV infection, CDC estimated the incidence of HIV infections in 2006 as 56,300 new infections, with a 95% confidence interval of 48,200 to 64,500. New HIV infections were classified in a hierarchy of transmission categories based on risk factors. These categories include: Male-to-male sexual contact, Injection-drug use (IDU), Both male-to-male sexual contact and injection-drug use, Heterosexual contact (i.e., with a person of the opposite sex known to have HIV or an HIV risk factor, e.g., male-to-male sexual contact or injection drug use) Of the estimated 56,300 new HIV infections in the US in 2006, CDC estimated that 53% (28,700) were attributed to male-to-male sexual contact, 31% (16,800) to heterosexual contact, 12% to injection drug use, and 4% were attributed to male-to-male sexual contact and injection drug use.  The 22 states with HIV incidence surveillance that provided data for the incidence estimate are Alabama, Arizona, Colorado, Connecticut, Florida, Georgia, Illinois, Indiana, Louisiana, Michigan, Mississippi, Missouri, New Jersey, New York, North Carolina, Oklahoma, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, and Washington. Incidence estimates were extrapolated to the 50 states and the District of Columbia. Data have been adjusted for reporting delay and cases without risk factor information were proportionately re-distributed.
Slide 6
Estimated Percentage of New HIV Infections by Transmission Category—United States, 2006
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Slide 7: Estimated Percentage of New HIV Infections by Age—United States, 2006 Based on a stratified extrapolation approach, using a biological marker of recent HIV infection, CDC estimated the incidence of HIV infections in 2006 as 56,300 new infections, with a 95% confidence interval of 48,200 to 64,500. Of the estimated 56,300 new HIV infections in the US in 2006, CDC estimated that more than one third (34%) were in those age 13-29 years, making this the age group with the highest proportion of new infections.  Those age 30-39 years represented 31% of new infections. Those age 40-49 years accounted for 25% and those age 50 years and older represented 10% of new infections in 2006. The 22 states with HIV incidence surveillance that provided data for the incidence estimate are Alabama, Arizona, Colorado, Connecticut, Florida, Georgia, Illinois, Indiana, Louisiana, Michigan, Mississippi, Missouri, New Jersey, New York, North Carolina, Oklahoma, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, and Washington. Incidence estimates were extrapolated to the 50 states and the District of Columbia. Data have been adjusted for reporting delay.
Slide 7
Estimated Percentage of New HIV Infections by Age—United States, 2006
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Slide 8: Estimated Percentage of New HIV Infections by Sex and Race/Ethnicity—United States 2006 N = 54,230 Based on a stratified extrapolation approach, using a biological marker of recent HIV infection, CDC estimated the incidence of HIV infections in 2006 as 56,300 new infections, with a 95% confidence interval of 48,200 to 64,500. Subpopulation analysis performed on estimated HIV incidence in blacks/African Americans, Hispanics/Latinos and whites in the United States, 2006, is reported in the September 12, 2008 MMWR entitled
Slide 8
Estimated Percentage of New HIV Infections by Sex and Race/Ethnicity—United States 2006 N = 54,230
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Slide 9: Estimated Rate of New HIV Infections by Sex and Race/Ethnicity—United States, 2006 N = 54,230 Based on a stratified extrapolation approach, using a biological marker of recent HIV infection, CDC estimated the incidence of HIV infections in 2006 as 56,300 new infections, with a 95% confidence interval of 48,200 to 64,500. The disparities in HIV incidence are most striking when examining the rate of new HIV infections by sex and race for the 54,230 new HIV infections estimated in blacks/African Americans, Hispanics/Latinos and whites in the United States for 2006. The rate of new HIV infections among black/African American men (115.7/100,000) was 6 times the rate in white men (19.6/100,000) and the rate in Hispanic/Latino men (43.1/100,000) was about twice the rate in white men. The incidence rate in black/African American women (55.7/100,000) was almost 15 times that of white women (3.8/100,000). Hispanic/Latina women had an HIV incidence rate (14.4/100,000) that was almost 4 times that of white women (3.8/100,000). Please note data are presented on this slide for blacks/African Americans, Hispanics/Latinos and whites only.  Asians/Pacific Islanders and American Indians/Alaska Natives made up a combined total of 2.6% of the national estimate of new infections, and as a result, additional stratification in those populations was not possible.  The 22 states with HIV incidence surveillance that provided data for the incidence estimate are Alabama, Arizona, Colorado, Connecticut, Florida, Georgia, Illinois, Indiana, Louisiana, Michigan, Mississippi, Missouri, New Jersey, New York, North Carolina, Oklahoma, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, and Washington. Incidence estimates were extrapolated to the 50 states and the District of Columbia. Data have been adjusted for reporting delay.
Slide 9
Estimated Rate of New HIV Infections by Sex and Race/Ethnicity—United States, 2006 N = 54,230
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Slide 10: Estimated Percentage of New HIV Infections by Race/Ethnicity, Sex and Age—United States, 2006 N = 54,230 Based on a stratified extrapolation approach, using a biological marker of recent HIV infection, CDC estimated the incidence of HIV infections in 2006 as 56,300 new infections, with a 95% confidence interval of 48,200 to 64,500. Of the estimated 54,230 new HIV infections in blacks/African Americans, Hispanics/Latinos and whites in the United States in 2006, almost three-fourths (72%) occurred in men. The most new infections in black/African American and in Hispanic/Latino men occurred in the age group 13-29 years whereas the most new infections in white men occurred in those age 30-39 years. Among white men, 25% of new infections occurred in men age 13-29 years, 34% among men age 30-39 years, 29% in men age 40-49 years and 12% in men age 50 years or older. Among Hispanic/Latino men, 41% of new infections occurred in men age 13-29 years, 34% among men age 30-39 years, 19% in men age 40-49 years and 6% in men age 50 years or older. Among black/African American men, 42% of new infections occurred in men age 13-29 years, 26% among men age 30-39 years, 23% in men age 40-49 years and 9% in men age 50 years or older. Approximately one fourth (27%) of new infections occurred in women. The most new infections occurred in women of child-bearing age, raising concern about potential mother-to-child transmission and the importance of identifying HIV infected women before pregnancy and delivery. Among white women, 32% of new infections occurred in women age 13-29 years, 32% among women age 30-39 years, 25% in women age 40-49 years and 11% in women age 50 years or older. Among Hispanic/Latina women, 36% of new infections occurred in women age 13-29 years, 31% among women age 30-39 years, 19% in women age 40-49 years and 14% in women age 50 years or older. Among black/African American women, 32% of new infections occurred in women age 13-29 years, 30% among women age 30-39 years, 27% in women age 40-49 years and 11% in women age 50 years or older. Subpopulation incidence estimates can help guide local, state and national intervention measures tailored to those populations at greatest risk for HIV infection. Please note data are presented on this slide for blacks/African Americans, Hispanics/Latinos and whites only.  Asians/Pacific Islanders and American Indians/Alaska Natives made up a combined total of 2.6% of the national estimate of new infections, and as a result, additional stratification in those populations was not possible.  Data have been adjusted for reporting delay.
Slide 10
Estimated Percentage of New HIV Infections by Race/Ethnicity, Sex and Age—United States, 2006 N = 54,230
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Slide 11: Estimated Percentage of New HIV Infections by Sex and Transmission Category—United States, 2006 N = 54,230 Based on a stratified extrapolation approach, using a biological marker of recent HIV infection, CDC estimated the incidence of HIV infections in 2006 as 56,300 new infections, with a 95% confidence interval of 48,200 to 64,500. In the HIV incidence subpopulation estimates for the 54,230 new HIV cases in blacks/African Americans, Hispanics/Latinos and whites in the United States in 2006, new infections were classified in a hierarchy of transmission categories based on risk factors. These categories include: Male-to-male sexual contact, Injection-drug use (IDU), Both male-to-male sexual contact and injection-drug use, Heterosexual contact (i.e., with a person of the opposite sex known to have HIV or an HIV risk factor, e.g., male-to-male sexual contact or injection drug use) Men represented nearly three-fourths of new infections among blacks/African Americans, Hispanics/Latinos and whites in this analysis. Nearly three-fourths (72%) of the new infections in men were in the transmission category male-to-male sexual contact. The next most common transmission category among men was heterosexual contact (13% of new cases), followed by IDU (9%) and both male-to-male sexual contact and IDU (5%). Among women, 80% of new infections were the result of heterosexual contact and 20% were attributed to IDU. Please note data are presented on this slide for blacks/African Americans, Hispanic/Latinos and whites only.  Asians/Pacific Islanders and American Indians/Alaska Natives made up a combined total of 2.6% of the national estimate of new infections, and as a result, additional stratification in those populations was not possible.  The 22 states with HIV incidence surveillance that provided data for the incidence estimate are Alabama, Arizona, Colorado, Connecticut, Florida, Georgia, Illinois, Indiana, Louisiana, Michigan, Mississippi, Missouri, New Jersey, New York, North Carolina, Oklahoma, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, and Washington. Incidence estimates were extrapolated to the 50 states and the District of Columbia. Data have been adjusted for reporting delay and cases without risk factor information were proportionately re-distributed.
Slide 11
Estimated Percentage of New HIV Infections by Sex and Transmission Category—United States, 2006 N = 54,230
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Slide 12: Estimated Percentage of New HIV Infections by Race/Ethnicity, Sex, and Transmission Category—United States, 2006 N = 54,230 Based on a stratified extrapolation approach, using a biological marker of recent HIV infection, CDC estimated the incidence of HIV infections in 2006 as 56,300 new infections, with a 95% confidence interval of 48,200 to 64,500. Among the estimated 54,230 new HIV infections in blacks/African Americans, Hispanics/Latinos and whites in the United States in 2006, men made up nearly three-fourths of new infections. Although male-to-male sexual contact is the predominant transmission category in each of the three race/ethnicity categories shown, there were racial/ethnic differences in the distribution of cases among the transmission categories. Eighty-one percent of new infections in white men were in the male-to-male sexual contact transmission category, in contrast to 72% of new infections in Hispanic/Latino men and 63% of new infections in black/African American men. Heterosexual contact with an person who is HIV positive or in a high-risk category (e.g., injection drug use) accounted for 20% of new HIV infections in black/African American men, 13% in Hispanic/Latino men, and 6% in white men. Although heterosexual contact was the predominant mode of transmission among women accounting for 80% of the 14,410 new infections in women overall, there were racial/ethnic differences in the distribution of new infections by transmission category. Eighty-three percent of new infections in black/African American women and in Hispanic/Latina women occurred through heterosexual contact, in contrast to 70% of new infections in white women. Please note data are presented on this slide for blacks/African Americans, Hispanics/Latinos and whites only.  Asians/Pacific Islanders and American Indians/Alaska Natives made up a combined total of 2.6% of the national estimate of new infections, and as a result, additional stratification in those populations was not possible.  Data have been adjusted for reporting delay and cases without risk factor information were proportionately re-distributed.
Slide 12
Estimated Percentage of New HIV Infections by Race/Ethnicity, Sex, and Transmission Category—United States, 2006 N = 54,230
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Slide 13: Estimated Percentage of New HIV Infections among Adult and Adolescent Men Who Have Sex with Men, by Race/Ethnicity— United States, 2006 Based on a stratified extrapolation approach, using a biological marker of recent HIV infection, CDC estimated the incidence of HIV infections in 2006 as 56,300 new infections, with a 95% confidence interval of 48,200 to 64,500. Nearly three-quarters (72%) of new HIV infections in men occur among men who have sex with men (or MSM). Among MSM, 46% of new cases occurred in whites, 35% in blacks/African Americans and 19% in Hispanics/Latinos. Please note data are presented on this slide for blacks/African Americans, Hispanics/Latinos and whites only.  Asians/Pacific Islanders and American Indians/Alaska Natives made up a combined total of 2.6% of the national estimate of new infections, and as a result, additional stratification in those populations was not possible.  Data have been adjusted for reporting delay and cases without risk factor information were proportionately re-distributed.
Slide 13
Estimated Percentage of New HIV Infections among Adult and Adolescent Men Who Have Sex with Men, by Race/Ethnicity— United States, 2006
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Slide 14: Estimated Number of New HIV Infections among Adult and Adolescent Men Who Have Sex with Men, by Race/Ethnicity and Age Group—United States, 2006 N = 28,700 Based on a stratified extrapolation approach, using a biological marker of recent HIV infection, CDC estimated the incidence of HIV infections in 2006 as 56,300 new infections, with a 95% confidence interval of 48,200 to 64,500. Among MSM with new HIV infections, 13,200 were white, 10,130 were black/African American and 5,370 were Hispanic/Latino. Within these racial/ethnic subpopulations, there are differences in the age at infection. There was a greater number of new HIV infections among young black/African American MSM age 13-29 years than any other age-race/ethnicity group of MSM - over 5,000 new HIV infections in 2006. In MSM age 13-29 years the number of new infections in blacks/African Americans was 1.6 times the number in whites, and 2.3 times the number in Hispanics/Latinos. In Hispanic/Latino MSM the highest number of new infections was also in the youngest age group with over 2,000 new HIV infections in Hispanic/Latino MSM age 13-29 years. In contrast, among white MSM the highest number of new HIV infections (over 4,500) occurred in those age 30-39 years. Among black/African American MSM, more than half (52%) of new HIV infections were in men age 13-29 years, 25% age 30-39 years, 18% age 40-49 years and 6% age 50 years and older. Among Hispanic/Latino MSM, 43% of new HIV infections were in men age 13-29 years, 35% age 30-39 years, 18% age 40-49 years and 4% age 50 years and older. Among white MSM, 25% of new HIV infections were in men age 13-29 years, 35% age 30-39 years, 28% age 40-49 years and 11% age 50 years and older. Please note that data are presented on this slide for whites, black/African American, and Hispanic/Latinos only.  Asians/Pacific Islanders and American Indians/Alaska Natives made up a combined total of 2.6% of the national estimate of new infections, and as a result, additional stratification in those populations was not possible.  Data have been adjusted for reporting delay and cases without risk factor information were proportionately re-distributed.
Slide 14
Estimated Number of New HIV Infections among Adult and Adolescent Men Who Have Sex with Men, by Race/Ethnicity and Age Group—United States, 2006 N = 28,700
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Slide 15: Estimated Number of New HIV Cases—22 States 2006 Based on a biological marker of recent HIV infection, CDC used a stratified extrapolation approach to estimate the HIV incidence among persons age 13 years or older in 22 states in 2006. The total was extrapolated to all 50 states and the District of Columbia by applying the HIV incidence to AIDS ratio in the 22 states to the number of AIDS cases in the non-incidence areas. Based on the stratified extrapolation approach the incidence of HIV in the US for 2006 was 56,300 new infections, with a 95% confidence interval of 48,200 to 64,500. State-level HIV incidence estimates generated by CDC were based on national HIV surveillance datasets with cases reported to CDC through June 2007 in order to allow adequate time for reporting delay. The estimated number of new HIV infections by state ranged from 500 to 6,300. Multiple imputations for missing data at the state level were conducted using the national dataset stratified for estimation by sex, race/ethnicity, age at infection and transmission category. There were 67 strata in total. The incidence estimates were adjusted for risk redistribution, and rounded to the nearest 100. State-level HIV incidence estimates calculated by states are likely to differ from the estimates provided by CDC. Multiple factors contribute to the difference. National HIV surveillance datasets were developed after a national de-duplication process that may lead states to include different cases in their datasets. CDC used cases reported to the national HIV/AIDS Reporting System through June, 2007; states may choose a different cutoff date. Multiple imputations for estimates provided by CDC were conducted on combined data from the 22 incidence states. When states develop their own estimates they use only their state’s data for imputations. The number of cases for many states is small, and the proportion of missing data may differ significantly from the proportion of missing data within the national dataset. Depending on the local HIV epidemic, states will use different stratification factors when estimating local HIV incidence. Estimates provided by CDC were adjusted for reporting delay and risk redistribution. States have the option of making or not making these adjustments.
Slide 15
Estimated Number of New HIV Cases—22 States 2006
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Last Modified: April 6, 2009
Last Reviewed: April 6, 2009
Content Source:
Divisions of HIV/AIDS Prevention
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
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