HIV Statistics You Should Know

Since the first cases of human immunodeficiency virus (HIV) were reported back in 1981, an estimated 76 million people have been infected worldwide, resulting in over 22 million deaths and 13 million AIDS orphans.

Today, around 38 million people are living with HIV, and, despite advances in treatment and the widespread distribution of antiretroviral drugs, infection and death rates remain alarmingly high. In 2019 alone, an estimated 1.7 million people were infected with HIV—roughly 5,000 per day— while over 690,000 died of HIV-related complications.

Despite these grim statistics, there have been gains. Since the height of the pandemic in 2004, HIV-related deaths and have dropped by no less than 60%, while the rate of mother-to-child transmission has been cut in half.

Still, there are enormous gaps in the global response and challenges yet to be faced in the United States, where the poor, people of color, and gay and bisexual men are disproportionately affected.

HIV in the United States

Currently, in the United States, over 1.1 million Americans are living with HIV. After years of stagnation in the annual infection rate, which hovered at around 50,000 new infections per year, the rate has begun to steadily drop in recent years due to newer preventive strategies like PrEP (pre-exposure prophylaxis) and HIV treatment as prevention, the latter of which can reduce the risk of HIV transmission to zero.

Despite these gains, around 15,800 people with HIV died in the United States in 2019, and as many as 14% of those infected (roughly 161,000) remain unaware of their status. Of those who have been diagnosed, only 63% are linked to medical care, and only 51% are unable to achieve an undetectable viral load needed to ensure a normal to near-normal life expectancy.

HIV stigma and a lack of access to medical care, particularly among the poor and communities of color, are among the driving factors for these failures.

HIV Infections by State

In the United States, where you live plays a large part in how likely you are to get HIV. While it is clear that dense urban populations with high prevalence rates contribute to the risk, there are other unique factors that account for a growing disparity between U.S. states.

A prime example is the rate of infection in states that have either adopted or refused Medicaid expansion, intended to expand healthcare to economically disadvantaged people.

Poverty remains a driving force for HIV infections, particularly in the South where the rates of poverty are highest. Moreover, nearly half of all Americans without health insurance live in the South.

With that being said, the Northeast has a higher prevalence rate overall, centered mainly in dense urban populations like New York City, Baltimore, and Washington, D.C.

These dynamics are reflected in the 10 U.S. states with the highest HIV prevalence rates, according to the CDC.

By Age

In the United States, the primary mode of HIV transmission is sex. It can come as no surprise, therefore, that the rates of new infection are highest among younger populations that are not only more sexually active but also more likely to have STDs, multiple sex partners, and other risk factors.

According to the CDC, the rate of new infections is highest among people 13 to 29, declining steadily thereafter.

Youth also accounts for the highest rate of undiagnosed infections. Today, nearly half of all HIV-positive youth between the ages of 13 and 24 are unaware of their status and, as a result, are more likely to infect others. The picture is little improved among adults 25 to 34, where one in three remains undiagnosed.

By Sexual Orientation

Gay and bisexual men account for the lion's share of HIV infections in the U.S. This not only includes men who identify as gay or bisexual but the nearly one in 10 men who have sex with men (MSM) who identify as straight.

While MSM accounts for only 2% of the U.S. population, they represent 69% of all new infections and 55% of Americans living with HIV. In their 2018 surveillance, the CDC highlighted key disparities affecting MSM:

• There are more than twice as many MSM living with HIV in the United States than heterosexuals (678,900 versus 304,800).
• The number of new infections among MSM was nearly four times that of heterosexuals (24,933 versus 4,350).
• While the HIV infection rate is declining among heterosexuals in general, the rate of new infections among MSM 24 to 35 is climbing.
• MSM represented more than half of all deaths among people with HIV.

There are many reasons for these disparities, including stigma (especially high in many communities of color), biological vulnerabilities (including an increased risk of transmission via anal sex), and illicit drug use (especially among young MSM).

By contrast, women who exclusively have sex with women are considered to be at low risk of infection.

By Race

HIV and race are integrally linked, with people of color disproportionately affected. There are many reasons for this, not least of which are the economic disparities and lack of access to quality healthcare in many ethnic and racial communities. This is especially true among Blacks in the United States whose new infection rate outpaces that of Whites by 34%.

Currently, there are around 447,000 Black Americans living with HIV compared to 323,000 White Americans. And this, despite the fact that Blacks account for 13.4% of the U.S. population compared to Whites, who represent 60.1%.

The statistics are not much better for Hispanics and Latinos, of whom 242,500 currently live with HIV. Although the new infection rate among Hispanics and Latinos is more or less the same as Whites, they account for only 18.5% of the population.

Poverty, again, is a driving factor. According to the U.S. Census Bureau, the rate of poverty among Blacks and Hispanic/Latinos is more than double that of Whites and Asians (18.8% and 15.7% versus 7.3% and 7.3% respectively).

Race also plays an integral role in the risk of HIV among MSM. The vulnerabilities experienced by all gay and bisexual men are further exacerbated by high rates of stigma in many ethnic and racial communities. There is likely no better illustration of this than among Black MSM, who alone account for 26% of all new HIV infections.

By Sex

Although men account for the majority of HIV infections in the U.S.—75% of whom are MSM—there are around 258,000 women living with HIV, the majority of whom were infected through heterosexual sex.

As the receptive partner in a heterosexual couple, women are twice as likely to get HIV as their male partners. This is reflected by data published by the CDC in 2018, wherein 5,900 women were infected as a result of heterosexual sex compared to only 2,900 men.

The risk is especially high among Black women due to socioeconomic and gender inequalities. As a result, a Black woman is 13 times more likely to get HIV than a White woman of the same age. (By contrast, White women are more than twice as likely to get infected as a result of injecting drug use compared to Black women).

None of this should suggest that heterosexual men have less to worry about. In fact, the low perception of risk among heterosexual men has translated to the highest rate of undiagnosed infections of all risk groups (17.1%). This not only increases the risk of a late diagnosis but also the chance that a man will unknowingly pass the virus to others.

Mortality Rates

HIV causes the depletion of immune cells (called CD4 T-cells) that, over time, reduces a person's ability to fight otherwise harmless infections. When the immune defenses have been fully compromised, these infections can become life-threatening. It is these so-called opportunistic infections that are among the main causes of death in people living with HIV.

In the early days of the AIDS pandemic, most people died within two years of their diagnosis. With the introduction of combination antiretroviral therapy (CART) in 1996, the number of HIV-related death plummeted by an astonishing 47% in just one year.

And, although this is only an eighth of the number of deaths reported back in 1996, the numbers remain unacceptably high given the efficacy of CART. Most occurred in the South and Northeast, accounting to the CDC.

Global HIV Statistics

As with the United States, there have been impressive declines in global HIV infections and deaths since 2004, when over 1.7 million deaths were reported. Today, the annual number of HIV-related deaths hover around 690,000—a reduction of roughly 60%.

At the same time, there has been a leveling off of many of the early gains and an increase in infection rates in certain hotspots around the world. Stagnating economic contributions from developed countries are only part of the reason why.

The vast majority of people living with HIV are in low- to medium-income countries. Of the 38 million living with HIV today, more than half are in Africa where adults infection rates often exceed 10%, 20%, and even 25% in some countries. These are described in the latest surveillance report from the United Nations Programme on HIV/AIDS (UNAIDS).

Prevalence Rates

The rate of global HIV infections has generally been on the decline since the height of the pandemic in 2004. Much of the success has been attributed to the United Nations-led 90-90-90 campaign, a global effort to have 90% of the world's HIV population diagnosed, 90% of those placed on HIV therapy, and 90% of those to achieve undetectable viral loads by 2020.

Although there remain questions as to how sustainable the goals truly are—considering that rich countries like the United States have yet to meet them—they have helped reduce the prevalence rate in hard-hit countries like South Africa, where infections have fallen by some 40% since 2010.

By contrast, there has been a steep rise in infections in places like Russia and Central Asia, where more than a third of all new infections is due, directly or indirectly, to injecting drug use. Government inaction and discrimination against gay men and other high-risk groups also help fuel the infection rates.

By Age and Sex

Unlike the United States, heterosexual sex remains the predominant mode of transmission in high-prevalent regions, such as sub-Saharan Africa. Within this context, younger, sexually active youth between the ages of 15 and 24 account for over a third of all new infections, while those aged 15 to 45 represent 60%.

Women are often disproportionately affected. In addition to biological vulnerabilities, gender inequality, unfair access to services, and sexual violence has led to higher rates of infection, often at a far earlier age compared to men.

Due to the increased access to antiretroviral therapy, people with HIV are now living longer than ever, even in high-prevalence regions. Where only 8% of people with HIV lived beyond the age of 50 in 2010, now over 20% are in their 50s and older. That number is expected to increase as the 90-90-90 targets are met.

Antiretroviral Coverage

The impressive gains in the global fight against HIV could have not been achieved without the manufacture of low-cost generic antiretrovirals.

Around 80% of these are produced in India where the Indian Patents Act, implemented in the 1970s, allowed for the breaking of international patent laws on the grounds that HIV was a global health emergency. Because of this, HIV drugs like Odefsey (emtricitabine, rilpivirine, and tenofovir) that retail for $3,000 per month in the United States cost as little as $75 per year in Africa.

Globally, there are an estimated 25.4 million people on antiretroviral therapy, or roughly 67% of the world's HIV population. Data from UNAIDS suggests that, of these, 59% achieved an undetectable viral load (more or less in line with U.S. rates).

Mother-to-Child Transmission

One of the success stories of the global fight against HIV has been the use of antiretroviral drugs to prevent mother-to-child transmission (MTCT). When used appropriately, the preventive strategy can reduce the risk of MTCT by 98% or more. Without treatment, the risk of transmission runs anywhere from 15% to 45%.

Even so, the rate of MTCT remains unacceptably high, with some countries reporting as many as one in four transmissions during pregnancy or as the result of breastfeeding.

In 2016, Armenia, Belarus, Thailand, and, the Republic of Moldova were the first four developing countries to report the elimination of MTCT from within their borders.

Mortality Rates

HIV remains a leading cause of death worldwide and the leading cause of death globally of women of reproductive age. However, HIV-related deaths have dropped dramatically in recent years, from 1.1. million in 2010 to 690,000 in 2019. All told, the mortality rate is 59% less than it was at the height of the pandemic in 2004.

Not every country is following this trend. Russia, a country often cited for its failure to address infection rates within its borders, accounted for more than 80% of new infections in the Eastern European and Central Asian regions from 2010 to 2015. A recent commitment to increase antiretroviral access to 75% of Russians living with HIV will hopefully reverse this trend.