June 1, 2023

CDC Releases New HIV Surveillance Data

Last week, the Centers for Disease Control and Prevention (CDC) published three new HIV surveillance reports that include data from 2021. Each of these reports can be found here:

• Estimated HIV Incidence and Prevalence in the United States, 2017‒2021;
• Monitoring Selected National HIV Prevention and Care Objectives by Using HIV Surveillance Data, United States and 6 Dependent Areas, 2021; and
• Diagnoses of HIV Infection in the United States and Dependent Areas, 2021.

Please note, while the 2020 surveillance report was incomplete because of the impact of COVID-19 on prevention, treatment, and overall data collection, these latest data provide us with more reliable information about trends in HIV incidence and prevalence. However, HIV estimates for both years should be interpreted with caution because of changes made to the CD4-based depletion model to account for the impact of COVID-19 on HIV testing and diagnosis in the U.S.

Overall, there is some progress in HIV prevention, testing, and treatment but disparities and inequities persist. Some key findings:

Prevention: Among key HIV prevention indicators, the greatest improvement was in the number of people taking PrEP to prevent HIV. Data on PrEP coverage show that in 2021 30 percent of the 1.2 million persons eligible for PrEP were prescribed it compared to 13 percent in 2017. PrEP coverage was lowest among Black/African American persons (11%), women (12%), and persons aged 16‒24 years (20%). However, there are still tremendous disparities between White people who get the largest number of PrEP prescriptions than that of Black/African American persons and Latinos.

Prevalence: In 2021, the percentage of HIV diagnoses in the U.S. was highest among gay, bisexual, and other men who have sex with men (67%), and HIV diagnosis rates were highest among Black/African American persons (34.8), persons aged 25‒34 years (28.8), and people in the South (14.7). White persons accounted for nearly half of all HIV diagnoses attributed to injection drug use. HIV diagnoses increased by 25 percent among transgender women, decreased 17 percent among persons aged 13‒24 years, and decreased 10 percent among Black/African American persons. Over half (52%) of all HIV diagnoses in the U.S. occurred in the South.

Incidence: In 2021, the number of HIV infections decreased by 12 percent as compared to 2017 – the greatest decrease being among gay, bisexual, and other men who have sex with men (MSM) aged 13 to 24. In this same age group, there was greater testing, PrEP uptake, and treatment, indicating those interventions were responsible for this decline. However, the really good news is that there were no increases in HIV incidence for any population as compared to 2017 data.

Overall, 66 percent of new infections were attributed to male-to-male sexual contact (MMSC), with 39 percent occurring in the 25 to 34 age group. Among women, Black women accounted for more than half (52%) of new infections. Slightly more people with HIV were aware of their status in 2021 than in 2017, and knowledge of status increased among persons aged 13 to24 years, Asian persons, Black/African American persons, Latinos, persons in the South, and among persons with infections attributed to MMSC. Estimates for people living with diagnosed and undiagnosed HIV is still estimated at 1.2 million people—a number much too high to reach our goals of ending the HIV epidemic by 2030.

Linkage to Care / Viral Suppression: In 48 U.S. jurisdictions (with complete reporting of laboratory results), 82 percent of people diagnosed with HIV diagnosed in 2021 were linked to care within one month of diagnosis. Asian persons had the highest rate of linkage to care within one month, and the lowest rates include Native Hawaiian/other Pacific Islander (NHPI) persons (80%), Black/African American persons (80%), women who inject drugs (77%), and men who inject drugs (74%). No demographic group or group by transmission category met the 95 percent Ending the HIV Epidemic target for linkage to care within one month.

The lowest percentages of viral suppression were among men who inject drugs (53%), Black/African American persons (62%), persons aged 25‒34 years (64%), persons aged 35‒44 years (64%), and women (64%).