HIV Facts and Statistics: What You Need to Know

The very first cases of a disease that would later become known as AIDS (acquired immune deficiency syndrome) were first reported in the United States in 1981. Two years later, the virus that would be called human immunodeficiency virus (HIV) was discovered.

Since the beginning of what would eventually become a global pandemic, HIV has claimed the lives of over 675,000 people in the United States. Despite major advances in treatment and prevention, infections and deaths continue, particularly among vulnerable populations.

This article takes an in-depth look at current HIV statistics in the United States, including the groups disproportionately affected by the disease and the various factors that contribute to the prevalence.

HIV Overview

HIV is a virus that targets and infects immune cells known as CD4 T cells. It causes disease by "hijacking" the genetic machinery of infected cells, turning them into HIV-producing factories, and eventually killing them.

As more and more of these immune cells are destroyed, the body becomes less and less able to defend itself against opportunistic infections (infections that occur more frequently in people with a weakened immune system). When the body no longer has enough CD4 T cells to mount an immune defense, a person is said to be immunocompromised.

AIDS is a stage of the disease when either your CD4 count (the number of CD4 T cells in a cubic millimeter of blood) falls below 200, or you get one of 22 AIDS-defining conditions (illnesses that rarely occur outside of the context of HIV).

HIV is treated with antiretroviral drugs. The drugs work by blocking the virus's ability to make copies of itself. By suppressing the virus, the immune system has the chance to rebuild itself and better fight infection.

How Common Is HIV?

The global AIDS pandemic remains one of the greatest healthcare crises in human history. At the height of the epidemic in the United States in 1985, around 130,000 new infections were reported. By 2010, that number dropped to approximately 50,000 due largely to advances in HIV therapy.

While there continues to be a decline in the annual HIV infection rate, it is not as steep as some might have imagined. The causes of this are many.

According to updated statistics from the Department of Health and Human Services (HHS):

• Around 1.2 million people in the United States are currently living with HIV.
  
• In 2020, an estimated 30,635 new HIV infections occurred.
• Men who have sex with men (MSM) account for 7 of every 10 of these infections.
• People who inject drugs (PWIDs) account for 1 of every 15 new infections.
  
• Only around 70% of people living with HIV are on antiretroviral therapy, while less than 60% are able to achieve an undetectable viral load.
• Only about 1 of every 8 people living with HIV in the United States is undiagnosed.
  

HIV by Race/Ethnicity

HIV does not affect all groups equally. People of color remain disproportionately affected, not only in terms of HIV infections but also HIV-related deaths. Black and Latinx communities have the highest incidence rates overall.

According to 2019 surveillance from the Centers for Disease Control and Prevention (CDC):

• Black people account for 40% of new HIV infections, despite representing only 13% of the U.S. population. In 2019, a total of 15,340 new infections occurred in Black people.
• Latinx people account for 30% of new HIV infections, despite representing only 18% of the U.S. population. In 2019, a total of 10,502 new infections occurred in Latinx people.
• White people account for 25% of new HIV infections, despite representing the lion's share (60%) of the U.S. population. In 2019, a total of 9,018 new infections were among White people.

Race/ethnicity also factors into HIV infection rates among men who have sex with men (MSM). The disparity is even more striking given that MSM account for less than 4% of the U.S. population.

According to 2019 surveillance from the CDC:

• Black MSM accounted for 9,123 new infections (or roughly 30% of new infections).
• Latinx MSM accounted for 7,810 new infections (or roughly 20% of new infections).
• White MSM accounted for 5,805 new infections (or roughly 15% of new infections).

HIV by Age and Gender

Because HIV is mainly transmitted through sex, the disease is more prevalent in younger populations that tend to be more sexually active than older populations.

According to statistics from the CDC, 70% of new infections occur in people between the ages of 13 and 44. The majority is seen in adults 25–34, among whom 13,712 new infections were reported in 2019.

But, age alone doesn't clearly reflect the dynamics of HIV in the United States. A person's biological sex also plays a role in determining who is at greater or lesser risk of infection.

Although the rate of HIV in males is 5 times greater than that of females, most of those infections (86%) were in MSM.

According to 2019 statistics from the CDC:

• Women overall are more than twice as likely to get HIV through heterosexual sex than their male counterparts.
• Black women experienced nearly twice as many new HIV infections in 2019 as their Black male counterparts (3.473 vs. 1,646 respectively).
• Latinx women experienced twice as many new HIV infections in 2019 as their Latinx male counterparts (1,074 vs. 544 respectively).
• White women experienced more than twice as many new HIV infections in 2019 as their White male counterparts (954 vs. 407 respectively).
  

Causes of HIV and Risk Factors

HIV can be passed from one person to the next through semen, blood, vaginal or rectal secretions, and breast milk. The virus is most often transmitted during sex but can also be passed through shared needles and other drug paraphernalia.

Certain behavioral risk factors can increase the likelihood of infection, including:

• Engaging in condomless anal or vaginal sex, particularly if you are the receptive ("bottom") partner
• Having multiple sex partners
• Having a sexually transmitted infection (STI) like chlamydia, gonorrhea, syphilis, or genital herpes, which can make HIV easier to pass along
• Having a detectable HIV viral load
• Using alcohol or drugs before sex
• Using spermicides like nonoxynol-9 that can compromise vaginal or rectal tissues

There are also social, cultural, and psychological factors that can increase the risk of HIV.

Chief among these is poverty, which can limit a person's access to insurance and preventive health care. Similarly, HIV stigma and homophobia can increase the chances of isolation, depression, substance use disorder, and having sex in ways that increase transmission.

What Are the Mortality Rates for HIV?

Before the introduction of highly active antiretroviral therapy in 1996, the average life expectancy of someone newly infected with HIV was 10 years. Today, with early diagnosis and treatment, the same individual can enjoy a life expectancy similar to that of the general population.

Even so, otherwise avoidable deaths still occur among people with HIV in the United States. People of color are disproportionately affected.

According to current mortality statistics:

• An estimated 15,810 deaths by any cause were reported among people with HIV in 2019.
• Of these, roughly 5,000 are thought to be due to HIV-related complications.
• In 2019, Black people with HIV accounted for more than 40% of deaths.
• Today, the mortality rate among Black men with HIV is more than 5 times greater than that of White men with HIV.
• The mortality rate among Black women with HIV is more than 11 times greater than that of White women with HIV.

Screening and Early Detection

Due to the benefits of antiretroviral therapy, there is no longer a reason to delay the testing and diagnosis of HIV. This is especially true given that many people with HIV have no symptoms in the early stages and may not be aware that they've been infected.

To ensure the timely delivery of treatment, the CDC currently recommends once-off HIV testing for people ages 13 to 64 as part of a routine healthcare appointment.

Groups with a higher incidence of acquiring the infection—including sexually active MSM and people who inject drugs with others—may be advised to get tested once yearly or more.

The benefits of early diagnosis and treatment extend well beyond a longer life span. Studies have shown that early treatment can reduce your risk of serious HIV-related and non-HIV-related diseases (like cancer) by 53%.

In addition, by starting treatment and maintaining an undetectable viral load, your chance of infecting a sexual partner is reduced to zero.

Summary

Advances in HIV detection and treatment have translated to major reductions in deaths and the annual infection rate in the United States. Even so, HIV remains a major public health concern with over 30,000 new cases reported each year.

MSM and people of color remain disproportionately affected. There are also major gaps in the diagnosis and treatment of people with HIV, with only 60% being able to achieve an undetectable viral load.

In an effort to reduce deaths, illness, and the further spread of HIV, the CDC recommends one-off testing for people ages 13 to 64 in the United States.