The CDC estimates the total number of Americans living with HIV as of 2016, the last year with good public health statistics, at 1,008,929.5 Of those, 156,300 (12.8%) are unaware of their infection.6
Latest Statistics 5,6,7
|United States 2016|
HIV annual new cases
Total estimated living with HIV/AIDS
Annual AIDS deaths
CDC reports indicate that during recent years, the estimated incidence of new HIV infections has stabilized at about 39,000 per year.5 The fact that the number of new cases discovered annually has achieved relative stability still results in a progressive annual increase in the total number of HIV infections. Theories behind this center around HIV sufferers living longer due to the advent of new treatments, resulting in an ever-expanding number of active HIV cases both in the United States and worldwide.4
Gay, bisexual and other men who have sex with men (MSM)* of all races and ethnicities, particularly young to middle-aged Black/African American MSM, remain the population most profoundly affected by HIV.5 In 2017, the estimated number of new HIV infections among MSM was 25,748, a number identified as relatively stable from 2012 through 2017.5
*For assessing disease risk, the term MSM (men who have sex with men) is often used instead of gay, homosexual or bisexual because it refers to a risk behavior, rather than an identity that may or may not be tied to the behavior.
Other behaviors warranting following by public health include2,5,6:
- Injection drug use in all sex and age groups, which show around 2,389 known new HIV diagnosis during the year 2017.
- MSM sexual activities simultaneous with injection drug use show a large enough presentation of new HIV diagnoses to be categorized by the CDC separately, at 1,252 cases in 2017.
- Heterosexual contact of all ages in 2017 revealed a 9,170 new HIV diagnosis rate.
Black/African Americans continue to experience the most severe burden of HIV compared with other races and ethnicities. Black/African Americans represent approximately 13% of the United States population but accounted for an estimated 43% of new HIV infections in 2017. They also accounted for 42% of individuals living with HIV infection.9
New HIV Diagnoses in the US and Dependent Areas for the Most-Affected Subpopulations, 20175
Hispanics/Latinos represent approximately 18% of the United States population and accounted for 26% of new HIV infections in 2016. Among Latino and Hispanic MSM, new infections rose by around 30%, from 6,400 to 8,300 in 2016. The greatest rise was among 25 to 34-year-olds, where new infections increased by 68%.10
White men having sex with men runs in third place of new HIV diagnosis, with around 6,982 reported new cases in 2017.5
Heterosexual African American/black women, young people and transgender women of all ethnicities are also disproportionately affected.10
HIV infection, both worldwide and in the United States, is most often spread through anal or vaginal sexual activities, followed by exposure to infectious blood, most commonly from sharing equipment used taking illicit drugs. Male to male sexual contact, “men who have sex with men” (MSM), have 28 times the rate of infection than dedicated heterosexuals.2
New Cases of MSM HIV Diagnosis in 201712
MSM Accounts for:
- 57 percent of all new cases of HIV in North America, Central Europe, and Western Europe
- 41 percent of all new cases of HIV in Latin America
- 25 percent of all new cases of HIV in Asia, the Pacific, and the Caribbean
- 20 percent of all new cases of HIV in eastern Europe, central Asia, the Middle East, and North Africa
- 12 percent of all new cases of HIV in Western and Central Africa
The transmission of HIV is significantly affected by the type of sexual exposure. Receptive anal intercourse has a much greater risk of viral transmission as compared to receptive vaginal intercourse. The use of condoms does not preclude transmission due to many factors affecting condoms such as holes, tears, improper fitting, etc. However, condom use does lower the chance of transmission as compared to intercourse without protection. The presence of other sexually transmitted diseases, such as the ulcerations of genital herpes, can increase the risk of transmission as much as four times. Circumcision has been shown to decrease the chance of HIV acquisition by the circumcised male, as well as decreasing the probability of transmitting HIV from the one circumcised to their partner in several randomized trials, although it is important to wait for a new circumcision to heal completely before engaging in intercourse.13
Pre-exposure prophylaxis (PrEP) is a way for individuals who do not have HIV but who are at substantial risk of contracting it to prevent HIV infection by taking a pill every day. One PrEP option currently recommended is TDF-FTC (tenofovir disoproxil fumarate- emtricitabine), component drugs that are used in combination with other medicines to treat existing HIV. When an individual is exposed to HIV through sex and/or injection drug use, these medicines can help to keep the virus from establishing a permanent infection. PrEP is much less effective if it is not taken consistently. PrEP is only for individuals who are at substantial ongoing risk of HIV infection2:
- Anyone who is in an ongoing relationship with an HIV-positive partner
- Anyone who is not in a mutually monogamous relationship (i.e., an individual and their partner only have sex with each other and do not have sex outside of the relationship) who recently tested HIV-negative
- A gay or bisexual man who has had anal sex without a condom or been diagnosed with an STD in the past 6 months
- A heterosexual man or woman who does not regularly use condoms during sex with partners of unknown HIV status and are at substantial risk of HIV infection (e.g., individuals who inject drugs or have bisexual male partners).
PrEP is a powerful HIV prevention tool and can be combined with condoms and other prevention methods to provide even greater protection than when used alone. In all PrEP Clinical Trials, HIV transmission risk was lowest for participants who took the pill consistently. At times it reduced the risk of getting HIV from sexual intercourse by as much as 90%.14 Among those who inject drugs, PrEP showed a reduction of approximately 74% of contracting AIDS when taken daily.15
Clients receiving PrEP should have regular appointments with a medical provider. The recommendation is a follow-up one to three months after initiating PrEP treatment, with a visit every three months thereafter.14 Checkups are encouraged whenever exposure to, or symptoms from a sexually transmitted infection (STI) occurs, or if signs of kidney function issues appear. Should kidney markers appear during the three-month visits, (e.g., elevated creatinine, glycosuria, new proteinuria) consider halting the PrEP.14
For individuals who need to prevent HIV after a single high-risk event of potential HIV exposure such as unprotected sex, needle-sharing injection drug use or sexual assault, there is another option called post-exposure prophylaxis (PEP). It involves taking antiretroviral medications as soon as possible, but no more than 72 hours (3 days) after exposure to HIV to try to reduce the chance of becoming HIV positive. These medications keep HIV from making copies of itself and spreading throughout the body. Two to three medications are usually prescribed and must be taken for 28 days. PEP is not always effective. It does not guarantee that an individual exposed to HIV will not become infected with HIV.
Starting PEP as soon as possible after a potential HIV exposure is important. Research has shown that PEP has little or no effect in preventing HIV infection if it is started more than 72 hours after HIV exposure. It takes about three days for HIV to make copies of itself once it enters the body and for it to spread throughout the body. When HIV is only in a few cells where it entered the body, it can sometimes be halted by PEP, but when it is in many cells in many places of the body, PEP will not work.
PEP should only be used right after an uncommon situation with potential HIV exposure. If the individual is often exposed to HIV, for example, because the individual often has sex without a condom with a partner who is HIV-positive, repeated uses of PEP are not the right choice. When medications are given only after exposure, more medications requiring higher dosages are needed to block infection than when they are started before the exposure and continued for a time thereafter. In this situation, pre-exposure prophylaxis (PrEP) is indicated.