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Creating an overview of the HIV epidemic in the United States
requires combining different indicators of the epidemic, such as
prevalence, incidence, transmission rates, and deaths. Therefore, this
document uses multiple measures to provide a comprehensive picture of
HIV in this country.
The number of people living with HIV infection in the United States (HIV
prevalence) is higher than ever before. CDC has estimated that
approximately 1.2 million (1,178,350) adults and adolescents were living
with HIV infection in the United States at the end of 2008, the most
recent year for which national prevalence estimates are available. This
represents an increase of approximately 7% from the previous estimate in
2006 [1]. The increase is due to a higher number of people becoming
infected with HIV than the number of people who die each year with HIV
or AIDS.
Despite increases in the total number of people living with HIV
infection, the annual number of new HIV infections (HIV incidence) has
remained relatively stable in recent years. According to the most recent
incidence estimates, approximately 48,100 persons were infected with HIV
in 2009 [2]. The estimated HIV incidence has been relatively stable
since the late 1990s despite more people living with HIV infection every
year and, thus, increased opportunities for transmission to occur.
The great majority of persons with HIV infection do not transmit HIV to
others. CDC estimates that there were 5 transmissions per 100 persons
living with HIV infection in the United States in 2006 [3]. This means
that at least 95% of those living with HIV infection did not transmit
the virus to others that year–an 89% decline in the estimated rate of
HIV transmission since the peak level of new infections in the
mid-1980s. The decline in transmission is likely due to effective
prevention efforts and the availability of improved testing and
treatments for HIV. The lower transmission rate is what has enabled HIV
incidence to remain stable despite increasing prevalence [1].
Estimates of New HIV Infections in the United States, 2009,
for the Most-Affected Subpopulations[2]
Subpopulations representing 2% or less of the overall US epidemic
are not reflected in this chart.
More people in the United States with HIV know of their HIV infection.
The estimated proportion of persons in the United States with HIV who
know they are infected increased from 75% in 2003 to 80% in 2008 [1].
This is a sign of progress for HIV prevention because research shows
that most individuals reduce behaviors that could transmit HIV when they
know they are infected [4].
Diagnoses of HIV infection reported to CDC have remained stable in
recent years. In 2010, an estimated 47,129 persons were diagnosed with
HIV infection [a] in the 46 states with long term, confidential, name-based
HIV infection reporting [5]. Diagnoses of HIV infection remained stable
in the 46 states from 2007–2010.
The HIV diagnosis rate has also remained stable in recent years. From
2007–2010, the annual estimated rate of diagnoses of HIV infection (the
number of HIV diagnoses per 100,000 persons) remained relatively stable
in the 46 states with long term, confidential, name-based HIV reporting.
In 2010 the estimated rate of HIV diagnoses was 16.1 per 100,000 persons
[5]. Estimated numbers and rates of diagnoses of HIV infection increased
in some subgroups and decreased in others. Variations in trends between
groups may be due to differences in testing behaviors, targeted HIV
testing initiatives, more streamlined surveillance practices in some
jurisdictions, and possibly changes in the numbers of new HIV infections
(HIV incidence) in some subgroups.
HIV disproportionately affects certain populations. Men who have sex
with men (MSM), blacks/African Americans, and Hispanic/Latinos are the
groups most affected by HIV infection.
Estimated New HIV Infections, 2009,
by Transmission Category
[2]
MSM represent approximately 2% of the U.S. population, but accounted for
more than 50% of all new HIV infections annually during 2006–2009
[6,b,2]. In 2010 MSM accounted for 61% of HIV diagnoses [5].
- From 2006–2009, over 25,000 MSM were newly infected with HIV annually
[2]. Among MSM aged 13-29, HIV incidence among black/African American
MSM increased significantly (48%) from 2006 through 2009 with a
statistically significant 12.2% estimated annual percentage increase
[2].
- From 2007–2010, the estimated number of HIV diagnoses among MSM
increased by approximately 9% [5]. This increase may be due differences
in testing behaviors, targeted HIV testing initiatives, more streamlined
surveillance practices in some jurisdictions, and possibly changes in
the numbers of new HIV infections (HIV incidence) in some subgroups
[7,c]. These increases may also be affected by the degree of uncertainty
inherent in statistical estimates.
Blacks/African Americans are the racial/ethnic group most affected by
HIV. Blacks/African Americans represented approximately 14% of the U.S.
population, but accounted for an estimated 44% of new HIV infections in
2009 [2].
- At some point in their life, 1 in 16 black/African American men will
receive a diagnosis of HIV, as will one in 32 black women [8].
- In 2009 the estimated rate of new HIV infection for black/African
American men was more than six times as high as that of white men,
nearly two and a half times that of Hispanic/Latino men, and more than
twice that of black/African American women [2].
- In 2009 the estimated rate of new HIV infection for black/African
American women was 15 times the rate for white women, and over three
times that of Hispanic women [2]. From 2007–2010, the estimated number
and rate of HIV diagnoses among blacks/African Americans remained
stable. In 2010, blacks/African Americans had an HIV diagnosis rate of
62.0 per 100,000 persons [5].
Hispanics/Latinos represented 16% of the population, but accounted for
an estimated 20% of new infections in 2009 [2].
- In 2009 the estimated rate of new HIV infection among Hispanic/Latino
men was two and a half times that of white men [2].
- In 2009 the estimated rate of new HIV infection among Hispanic/Latino
women was four and a half times that of white women [2].
- From 2007–2010, the estimated number of HIV diagnoses remained stable
among Hispanics/Latinos [5].
- The rate of HIV diagnoses among Hispanic/Latinos decreased by 7%, from
22.0 to 20.4 per 100,000 population, possibly reflecting the growing
population of Hispanics/Latinos in the United States [5].
Despite many prevention and treatment successes, people are still dying
from HIV disease. HIV remains a significant cause of death for some
populations. For example, in 2007, HIV was the third leading cause of
death for black males and black females aged 35-44 and the fourth
leading cause of death for Hispanic/Latino females in the same age range
[9,d]. Further, MSM are strongly affected by HIV and represent the
majority of persons with an HIV diagnosis who have died in the United
States.
Overall, nearly 619,400 persons with an AIDS diagnosis in the United
States have died since the beginning of the epidemic through 2009 (the
most recent year that death data are available) [5]. From 2007 through
2009, the annual estimated rate (per 100,000) of deaths of persons with
an AIDS diagnosis remained stable. Interpreting data regarding deaths of
persons with a diagnosis of HIV or AIDS can be difficult because many
factors can affect the data. For example:
- changes may be influenced by significant efforts that have been made
to improve death reporting by state and local HIV surveillance programs
in recent years;
- the changes may be related to the availability of more effective
treatments for persons with HIV infection or AIDS;
- the group of persons living with HIV infection is aging, which may
result in an increased number of deaths from any cause, including those
unrelated to HIV infection;
- there are uncertainties inherent in statistical estimates.
Estimated Rate of New HIV Infections, 2009,
by Gender and Race/Ethnicity [2]
Too many people are diagnosed with HIV late in the course of
infection.
Despite an increase in persons getting diagnosed with HIV earlier in the
course of their infection [7], far too many continue to be diagnosed
late. Among persons initially diagnosed with HIV infection during 2009,
one-third (32%) received an AIDS diagnosis within 12 months [5]. These
late diagnoses represent missed opportunities for treatment and
prevention.
AIDS disproportionately affects different parts of the country. HIV and
AIDS have had a severe impact on all regions of the country. It remains
mostly an urban disease, with the majority of individuals diagnosed with
AIDS in 2009 residing in areas with 500,000 or more people. Areas
hardest hit (by ranking of AIDS cases per 100,000 people) include Baton
Rouge and New Orleans, Louisiana; Miami, Florida; Jackson, Mississippi;
and Baltimore, Maryland [5].
Currently, 46 states have collected HIV diagnosis data
from name-based HIV reporting systems for a sufficient length of
time (defined as implementation of name-based reporting since at
least January 2007, and reporting to CDC since at least June
2007) to be included in CDC’s estimates of diagnoses of HIV
infection. However, CDC’s AIDS data represent all 50 states and
the District of Columbia. The 2010 HIV Surveillance report
contains tables with diagnoses of HIV infection and AIDS that
include 50 states, Washington DC, and 5 U.S. territories
(American Samoa, Guam, Northern Mariana Islands, Puerto Rico,
and the U.S. Virgin Islands). AIDS diagnoses data for Palau are
also available. National prevalence estimates (number of persons
living with HIV infection) are also for the 50 states and DC, as
are estimates for incidence (the number of new HIV infections)
and transmission rate (the number of HIV transmissions per 100
people). |
Key References that Explain the HIV Epidemic in the United States
Following are some of the key indicators of HIV disease in the United States
and the references that best explain them.
- HIV incidence in the United States (including subpopulation estimates):
Prejean J, Song R, Hernandez A, Ziebell R, Green T, et al. (2011) Estimated
HIV Incidence in the United States, 2006-2009. PLoS ONE 6(8): e17502.
doi:10.1371/journal.pone.0017502.
- HIV incidence estimation method: Karon JM, Song R, Brookmeyer R,
et al. Estimating HIV incidence in the United States from HIV/AIDS
surveillance data and biomarker HIV test results. Statistics in Medicine.
2008;27(23): 4617–4633.
- HIV prevalence in the United States: CDC. HIV surveillance—
United States, 1981-2008. MMWR. 2011;60:689-693.
- Estimate of undiagnosed persons with HIV in the United States:
CDC. HIV surveillance—United States, 1981–2008. MMWR.
2011;60:689-693.
- HIV transmission rates: Holtgrave DR, Hall HI, Rhodes PH, et al.
Updated annual HIV transmission rates in the United States, 1977-2006. J
Acquir Immune Defic Syndr 2009;50(2):236-238.
- Lifetime risk of HIV infection: CDC. Estimated lifetime risk for
diagnosis of HIV infection among Hispanics/Latinos—37 states and Puerto
Rico, 2007. MMWR. 2010;59(40):1297-1301.
- Deaths from HIV: CDC. WISQARS Leading Causes of Death Reports,
1999–2007. NCHS. Deaths: Final data for 2006. Statistics Reports
2009;57(14).
- Estimate of number of MSM in the United States and MSM’s rates of HIV
and syphilis: Purcell DW, Johnson C, Lansky A, et al. Calculating HIV
and syphilis rates for risk groups: Estimating the national population size
of men who have sex with men. Presented at 2010 National STD Prevention
Conference; Atlanta, GA. abstract #22896.
The following indicators can be found in the CDC’s HIV Surveillance
Report (CDC. HIV Surveillance Report, 2010; vol 22.)
- Diagnoses of HIV infection in the United States (46 states and 5
U.S. dependent areas)
- Persons living with a diagnosis of HIV infection (46 states and
5 U.S. dependent areas)
- AIDS diagnoses in the United States and 6 U.S. dependent areas
- Persons living with an AIDS diagnosis in the United States and 6
U.S. dependent areas
- Deaths of persons with a diagnosis of HIV infection or AIDS
- Time to AIDS diagnosis after a diagnosis of HIV infection (late
HIV diagnoses)
- Survival time after diagnosis of HIV infection or AIDS
- Geographic (United States) distribution of diagnoses of HIV
infection or AIDS
References
- CDC. HIV surveillance—United States, 1981-2008. MMWR.
2011;60: 689-693.
- Prejean J, Song R, Hernandez A, Ziebell R, Green T,
et al. (2011) Estimated HIV Incidence in the United States, 2006-2009.
PLoS ONE 6(8): e17502. doi:10.1371/journal.pone.0017502.
- Holtgrave DR, Hall HI, Rhodes PH, et al. Updated
annual HIV transmission rates in the United States, 1977-2006. J Acquir
Immune Defic Syndr 2009;50(2):236-238.
- Marks G, Crepaz N, Senterfitt JW, Janssen RS.
Meta-analysis of high-risk sexual behavior in persons aware and unaware they
are infected with HIV in the United States: implications for HIV prevention
programs. J Acquir Immune Defic Syndr 2005;39:446-453.
- New diagnoses are not the same as
new infections (incidence). A person can be infected with HIV for years
before being diagnosed.
- CDC. HIV Surveillance Report, 2010, Vol 22. Available
at: cdc.gov/hiv/surveillance/resources/reports/2010report.
Accessed March 13, 2012.
- Purcell DW, Johnson C, Lansky A, et al. Calculating
HIV and syphilis rates for risk groups: Estimating the national population
size of men who have sex with men. Presented at 2010 National STD Prevention
Conference; Atlanta, GA. abstract #22896. Available at
cdc.gov/hiv/topics/msm/resources/research/msm.htm.
Accessed March 9, 2012.
- The MSM rates were calculated using the
methodology described in reference #6, which is different than the
methodology used to calculate the other rates in this fact sheet, which are
based on population estimates from the US Census Bureau.
- CDC. Late HIV testing—34 states, 1996–2005. MMWR.
2009;58:661-665.
- MSM accounts for a higher proportion of
testing for acute (newly acquired) infection relative to other risk groups.
- CDC. Estimated lifetime risk for diagnosis of HIV
infection among Hispanics/Latinos —37 states and Puerto Rico, 2007. MMWR.
2010;59(40):1297-1301.
- WISQARS Leading Causes of Death Report, 1999-2007.
Available at: http://webappa.cdc.gov/sasweb/ncipc/leadcaus10.html. Accessed
March 7, 2012.
- Deaths of persons with a
diagnosis of HIV or AIDS may be due to any cause, not necessarily HIV
disease.
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