CDC Publishes New HIV Surveillance Reports

Cross-Posted from: CDC and HIV.gov:

Today, the Centers for Disease Control and Prevention (CDC) published three new HIV surveillance reports:

• Estimated HIV Incidence and Prevalence in the United States, 2018-2022;
• Monitoring Selected National HIV Prevention and Care Objectives by Using HIV Surveillance Data, United States and 6 Territories and Freely Associated States, 2022; and
• Diagnoses, Deaths, and Prevalence of HIV in the United States and 6 Territories and Freely Associated States, 2022.

All data are also available on NCHHSTP AtlasPlus. These data can assist HIV prevention partners in focusing prevention efforts, allocating resources, monitoring trends, and determining gaps and successes in HIV prevention.

Estimated HIV Incidence and Prevalence^*: Key Findings

The new HIV incidence estimates show that national prevention efforts are continuing to move in the right direction overall, although substantial disparities exist. The estimated number of new HIV infections in 2022 (31,800) decreased 12% compared with 2018 (36,200), driven by a 30% decrease among young people aged 13–24 years. Increases in preexposure prophylaxis prescriptions, viral suppression and HIV testing likely contributed to the decline. Data also show significant declines geographically, with estimated new HIV infections decreasing 16% in the South in 2022 compared with 2018. In 2022, HIV incidence in Ending the HIV Epidemic (EHE) (phase I) jurisdictions decreased 21% among persons aged ≥ 13 years, compared with the 2017 EHE baseline year. There were no increases in HIV incidence for any populations in 2022 compared with 2018.

Although data demonstrate continued progress in HIV prevention, longstanding social and economic factors continue to contribute to health inequities—particularly among Black/African American (hereafter referred to as Black) persons and Hispanic/Latino persons. Among women overall, in 2022, 47% (2,800) of estimated new HIV infections were among Black women. New HIV infections attributed to male-to-male sexual contact (MMSC) accounted for 67% (21,400) of estimated new infections. New HIV infections among gay, bisexual, and other men who have sex with men (MSM) were about 16% lower among Black men in 2022 (7,400) compared with 2018 (8,800) and 20% lower among White men in 2022 (4,400) compared with 2018 (5,500). Although the number of new HIV infections remained about the same among Hispanic/Latino MSM (8,200 in 2018 and 8,300 in 2022), due to the declines among other groups, Hispanic/Latino men accounted for 39% of estimated new HIV infections among gay, bisexual, and other MSM in 2022.

It is estimated that 1.2 million persons in the United States were living with diagnosed and undiagnosed HIV at the end of 2022. More people with HIV were aware of their status in 2022 than in 2018, with a slight increase from 86% to 87%. Knowledge of HIV status increased among persons aged 13–24 years, Asian persons, Black persons, Hispanic/Latino persons, persons in the South, and among males with infections attributed to MMSC. Knowledge of HIV status decreased among persons aged 35-44 years (84% in 2022 compared with 86% in 2018).

Monitoring Report: PrEP Coverage

This CDC Monitoring Report does not include data on PrEP coverage. CDC has paused PrEP coverage reporting for one year to address a formula error that affects a subset of race/ethnicity data, update overall PrEP coverage estimates using newly available data sets, and determine the best way to present PrEP coverage. CDC believes this update will yield greater precision and a more complete picture of the PrEP coverage landscape in the United States.

Earlier this year a formula error was found in the calculation used to determine the number of people with indications for PrEP by race/ethnicity. This only affects the PrEP coverage estimates for two groups – White persons and persons of other races/ethnicities – and does not affect the overall PrEP coverage estimate or estimates by sex or by age group. It does, however, affect all years of PrEP coverage data (2017-2022). CDC does not expect general trends in disparities to change, but magnitudes of certain disparities are expected to shift (i.e., current PrEP coverage estimates for White persons are likely an overestimate).

Furthermore, in March 2024, data were made available to CDC that can improve the representativeness of the number of persons prescribed PrEP in the United States. In the coming months, CDC also expects to have updates to the data sets used to estimate the number of persons with indications for PrEP. Pausing PrEP coverage reporting for the next year will allow CDC to update all PrEP coverage estimates (2017-2022) using newly available data sets, rather than simply correcting the formula error using current data sources.

CDC plans to resume PrEP coverage reporting in the next Monitoring Report, currently scheduled for publication in June 2025. Until updated estimates are published, CDC advises against citing specific PrEP coverage data points and instead recommends referencing general trends and disparities.

Monitoring Report: Key Findings

Among persons who received diagnoses of HIV infection during 2022, 82% were linked to care within one month of diagnosis. Asian persons had the highest percentage of linkage to care within one month (88%), and Native Hawaiian/other Pacific Islander persons (74%), American Indian/Alaska Native persons (78%), Black persons (78%), and women (80%) had the lowest percentages. Among persons with diagnosed HIV and alive at year-end 2022, 65% were virally suppressed at the most recent viral load test. The lowest percentages of viral suppression were among Black persons (61%) and women overall (64%). Despite overall progress in eliminating perinatally acquired HIV, in 2022, the rate of perinatally acquired HIV among Black persons was 5 times the overall annual rate of 1.1 per 100,000 live births. To meet national HIV goals and ensure that all persons with diagnosed HIV receive high quality care and treatment, prevention efforts must address the drivers of social inequities and other barriers to care that cause and exacerbate health disparities.

HIV Diagnoses^**: Key Findings

In 2022, in the United States and 6 territories and freely associated states, there were 38,043 HIV diagnoses, more than half of which (52%) occurred among people living in the South. Compared to 2018, in 2022, the number of HIV diagnoses among gay, bisexual, and other MSM overall (67%) and the number of HIV diagnoses among Black gay, bisexual, and other MSM (35% of MSM) remained stable. White persons accounted for almost half (47%) of all HIV diagnoses attributed to injection drug use. Notably, compared with 2018, in 2022, HIV diagnoses increased among transgender women (25% increase), Hispanic/Latino gay, bisexual, and other MSM (22% increase), Hispanic/Latino persons overall (17% increase), and males who inject drugs (7% increase). HIV diagnoses decreased among persons aged 13–24 years (14% decrease) and Black women (10% decrease). Although Black women accounted for only 9% of HIV diagnoses overall in 2022, among cisgender women, Black women accounted for 50% of HIV diagnoses and, among transgender women, Black women accounted for 41% of HIV diagnoses. Finally, HIV diagnosis data show that the rate of HIV-related deaths declined 25%, highlighting the effectiveness of early diagnosis and linking people with diagnosed HIV to quality care and treatment.

Overall, data from these reports demonstrate that expanding the reach of HIV testing, PrEP, and treatment have been effective – but our reach must extend even further, and progress must be faster, to achieve our national goal of ending new HIV infections in the United States. This requires sharpening our collective focus on efforts that address inequities and their drivers, including racism and other social and structural determinants of health, and ensuring that whole person approaches to HIV prevention, care, and treatment are brought to scale and equitably reach all people who need them to stay healthy.

Thank you for your continued support for HIV prevention in the United States.

Sincerely,

/Robyn Fanfair/

Robyn Neblett Fanfair, MD, MPH
Captain, USPHS
Director
Division of HIV Prevention
National Center for HIV, Viral Hepatitis, STD, and TB Prevention
Centers for Disease Control and Prevention
www.cdc.gov/hiv

/Jonathan Mermin/

Jonathan Mermin, MD, MPH
Rear Admiral, USPHS (retired)
Director
National Center for HIV, Viral Hepatitis, STD, and TB Prevention
Centers for Disease Control and Prevention
Stay connected @DrMerminCDC and Connections

* HIV estimates for years 2020, 2021, and 2022 should be interpreted with caution due to adjustments made to the CD4-based depletion model to account for the impact of COVID-19 on HIV testing and diagnosis in the United States. Please see the Technical Notes section of this report for additional information.

** In 2022, reporting of HIV diagnoses was 5% higher than in 2021. Based on pre-pandemic data, an increase in diagnoses of 2-3% is expected each year. As the COVID-19 pandemic lasted beyond 2020, readers should consider the potential influence of these pandemic effects on U.S. public health systems when interpreting data HIV data for years 2021–2022.