AVERT - AVERTing HIV and AIDS

Introduction

It is estimated that more than one million people are living with HIV in the USA and that more than half a million have died after developing AIDS.

HIV statistics reported in the USA are currently only available for 37 states and 5 U.S. dependent areas with confidential name-based HIV infection reporting. AIDS statistics include all 50 states, the District of Columbia and five U.S. dependent areas. For more explanation, see the 'Interpreting HIV and AIDS statistics for the USA' section towards the end of this page.

HIV statistics

The U.S. Centers for Disease Control and Prevention (CDC) estimates that at the end of 2007, there were 599,819 people living with a diagnosis of HIV infection in the 37 states and five U.S. dependent areas. However, the total number of people living with an HIV infection in the U.S. is thought to be around 1.1 million.1 The discrepancy between these figures is due to several factors, including:

  • confidential name-based reporting of HIV diagnoses has not yet been implemented in all states;
  • anonymous tests, including home tests, are excluded from case reports;
  • and one in every five people living with HIV has not even had their infection diagnosed, let alone reported.2

During 2008, there were an estimated 42,439 new diagnoses of HIV infection in the 37 states and five dependent areas. Adult or adolescent males accounted for nearly three-quarters of new HIV diagnoses, more than two-thirds of whom were infected through male-to-male sexual contact. Heterosexual contact accounted for 15% of new infections among men and 84% among women. Injecting drug use was the transmission route in 9% of male and 15% of female diagnoses in 2008. In 2008 blacks/African Americans made up an estimated 50% of new diagnoses, whites 28%, and Hispanics/Latinos 19%. HIV was diagnosed in an estimated 182 children (<13 years at diagnosis) in 2008, all but 41 became infected through mother-to-child transmission.

AIDS statistics

The CDC estimates that by the end of 2007 there were 470,902 people living with an AIDS diagnoses in the United States, around 20,000 more than 2006. Since 2000 the annual numbers of new AIDS diagnoses have been relatively constant, with an estimated 37,991 in 2008. In total, an estimated 1,077,972 people have been diagnosed with AIDS in America since the beginning of the epidemic.

Just over 75% of adults and adolescents living with an AIDS diagnosis are men.

Race/ethnicity of those living with an AIDS diagnosis in the U.S. in 2007

As the pie chart below shows, blacks/African Americans accounted for the largest proportion of people living with an AIDS diagnosis in 2007.

Graph of ethnicity living with AIDS in the USA

Transmission category of those living with an AIDS diagnosis in the U.S. in 2007

Almost two-thirds of adults and adolescents living with AIDS in 2007 became infected with HIV through male-to-male sexual contact.

Graph of Men/Women living with AIDS in the USA

AIDS diagnoses among children

An estimated 3,992 children (<13 years at diagnosis) were living with an AIDS diagnosis in 2007. The vast majority of these children acquired HIV through mother-to-child transmission. During 2008 there were an estimated 41 AIDS diagnoses among children, compared to 195 in 1999 and 896 in 1992. The decline in paediatric AIDS incidence is associated with a significant increase in HIV testing among pregnant women and the use of antiretroviral drugs to prevent mother-to-child transmission.

Deaths among people diagnosed with AIDS

In 1981, the first cases of what is now known as AIDS were reported in the U.S. During the 1980s there was a rapid increase in the number of reported AIDS cases and AIDS deaths. Cases peaked with the 1993 expansion of the case definition,3 and then declined. The most dramatic drops in both cases and deaths began in 1996, with the widespread use of combination antiretroviral therapy.

People with AIDS are now surviving longer and are contributing to a steady increase in the overall number of people living with AIDS. This trend will continue as long as the number of new diagnoses exceeds the number of people dying each year.

The number of deaths of persons with an AIDS diagnosis has stabilised in recent years at around 17,000-18,000 per year. (Deaths of persons with an AIDS diagnosis may be due to any cause).

Since the beginning of the epidemic, an estimated 597,499 people with AIDS have died in the U.S.

Interpreting HIV & AIDS statistics for the USA

In order to monitor the spread of the American HIV and AIDS epidemic and to assess the need for services and resources, there is a need for accurate surveillance. In the USA, statistics on both HIV and AIDS are collected by the Centers for Disease Control and Prevention (CDC) and published in an annual report. The latest statistics on HIV and AIDS in the USA were published in June 2010.

The CDC surveillance report includes data on the number of people diagnosed with AIDS, the number living with AIDS and the number of people with AIDS who have died or survived. Such AIDS statistics include not only the 50 states and the District of Columbia but also dependent areas - Puerto Rico, American Samoa, Guam, Northern Mariana Islands and the U.S. Virgin Islands. HIV statistics are based on data from these five U.S. dependent areas and only 37 states with confidential name-based HIV infection reporting. States and areas that use confidential name-based HIV infection reporting take personal details after diagnosis of HIV infection. When this data is submitted to the CDC all personal identifying information is removed. These states comprise Alabama, Alaska, Arizona, Arkansas, Colorado, Connecticut, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Michigan, Minnesota, Mississippi, Missouri, Nebraska, New Hampshire, New Jersey, New Mexico, New York, Nevada, North Carolina, North Dakota, Ohio, Oklahoma, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, Wisconsin and Wyoming.

In recent years the use of antiretroviral therapy has slowed the progression of HIV in many infected persons and hence contributed to a decline in AIDS incidence. This means that AIDS surveillance data are less able to represent trends in the incidence of HIV infection or the impact of the epidemic on the healthcare system. In response, all 50 states have now implemented confidential name-based HIV infection reporting. However, only 37 states have been doing so long enough for the CDC to apply statistical adjustments. The HIV Surveillance Report for 2012 (published in 2014) will be the first time HIV data from all 50 states will be included.

In order to make better use of the data collected, the CDC has made a number of changes from previous reports, including replacing the older definition 'HIV/AIDS' with 'diagnosis of HIV infection'. 'Summary of Changes to the National HIV Surveillance Report' contains more information. The term 'living with AIDS' includes every living person who has ever received an AIDS diagnosis, regardless of their current state of health. The term 'living with a diagnosis of HIV infection' includes every living person with a diagnosis of HIV infection regardless of stage of disease at diagnosis.

There is often a delay between the time of diagnosis of HIV or AIDS, or the time of death, and the time at which the event is reported. For this reason the CDC estimates the number of people living with HIV or AIDS by adjusting for reporting delays. No adjustment is made for incomplete reporting.

'Adults and adolescents' are defined as persons aged 13 years or more. The term 'transmission route' refers to the most probable route of transmission of HIV infection. The term 'male-to-male sexual contact' includes gay men, bisexual men and some men who consider themselves to be neither gay nor bisexual. The 'heterosexual contact' category comprises persons who report specific heterosexual contact with a person with, or at high risk for, HIV infection (e.g., an injecting drug user). This does not include adults and adolescents born in, or who had sex with someone born in, a country where heterosexual transmission was believed to be the main mode of HIV transmission, unless they meet the criteria stated in the previous sentence.

Sources

References

  1. CDC 'HIV Prevalence Estimates -- United States, 2006' MMWR 57(39), 3 October 2008
  2. CDC 'HIV Prevalence Estimates -- United States, 2006' MMWR 57(39), 3 October 2008
  3. The CDC case definition lists medical conditions that determine an AIDS diagnosis. The most significant feature of the 1993 expansion of the definition was the inclusion of CD4 criteria. For the first time, an HIV-positive person could be diagnosed with AIDS on the basis of an extremely low CD4 cell count. The majority of such people would have gone on to develop one of the other AIDS-defining conditions, so would eventually have been included in the figures anyway. However, the expansion resulted in many people being diagnosed sooner than they would otherwise have been. This caused only a temporary distortion of the figures, which by 1996 had ceased to have a significant effect on trends.

Last updated July 14, 2010