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Introduction

HIV and AIDS have been around in the United States for more than 20 years. The epidemic has now spread to every part of the USA and to all sectors of society.

It is thought that as many as a million people are living with HIV in the USA and that more than half a million have died after developing AIDS. Unfortunately, American HIV surveillance is far from comprehensive so many statistics must be based on reports of AIDS diagnoses. In interpreting such AIDS statistics, it is important to remember that they do not correspond to new HIV infections.

AIDS statistics

People living with AIDS

At the end of 2003, the CDC estimates that 405,926 persons were living with AIDS in the USA.

Of these,

• 36% were white
• 42% were black
• 20% were Hispanic
• 2% were of other race/ethnicity.

Of the adults and adolescents¹ with AIDS, 77% were men. Of these men,

• 58% were men who had sex with men (MSM)
• 22% were injection drug users (IDU)
• 11% were exposed through heterosexual contact
• 8% were both MSM and IDU.

Of the 88,815 adult and adolescent women with AIDS,

• 63% were exposed through heterosexual contact
• 35% were exposed through injection drug use.

An estimated 1,998 children were living with AIDS at the end of 2003.

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

AIDS diagnoses and deaths

In June 1981, the first cases of what is now known as AIDS were reported in the USA. In the 1980s, there were rapid increases in the number of AIDS cases and deaths of people with AIDS. Cases peaked with the 1993 expansion of the case definition², and then declined. The most dramatic drops in both cases and deaths began in 1996, with the widespread use of antiretroviral therapy.

The rate of decrease in AIDS diagnoses slowed in the late 1990s. After reaching a plateau, the number of diagnoses increased slightly each year from 2001 to 2003. There were an estimated 43,171 diagnoses in 2003. In total, an estimated 929,985 people have been diagnosed with AIDS.

The number of deaths among people with AIDS remained relatively stable in the period 1999-2003. In the latter year, there were an estimated 18,017 deaths. Since the beginning of the epidemic, an estimated 524,060 people with AIDS have died in the USA.

Who is affected by AIDS?

During the 1990s, the epidemic shifted steadily toward a growing proportion of AIDS cases among black people and Hispanics and in women, and toward a decreasing proportion in MSM, although this group remains the largest single exposure group. Black people and Hispanics have been disproportionately affected since the early years of the epidemic. In absolute numbers, blacks have outnumbered whites in new AIDS diagnoses and deaths since 1996, and in the number of people living with AIDS since 1998.

From 1999 to 2003, the estimated number of AIDS cases decreased slightly among white people and increased slightly among black people. Meanwhile the number of Hispanics diagnosed with AIDS rose by an estimated 8%, and diagnoses in Asians/Pacific Islanders and American Indians/Alaska Natives also increased.

In the period 1999-2003, the estimated number of females diagnosed with AIDS increased by 15%, while male diagnoses grew by just 1%. The estimated annual number of AIDS diagnoses in people infected through heterosexual sex has risen each year since 1999, and MSM cases have been increasing since 2001. Meanwhile, IDU cases have been declining in number.

During 2003 there were an estimated 59 paediatric AIDS diagnoses; this is less than a third of the estimated number in 1999. The decline in paediatric AIDS incidence is associated with the implementation of Public Health Service guidelines. These guidelines include universal counselling and voluntary HIV testing of pregnant women and the use of zidovudine by HIV-infected pregnant women and their newborn infants.

The age group 35-44 years represented 41% of all AIDS cases diagnosed in 2003. Nearly three-quarters of all people who have died with AIDS did not live to the age of 45.

HIV statistics

At the end of 2003, the CDC estimates that there were 351,614 persons living with HIV/AIDS in the 33 areas which have a history of confidential name-based HIV reporting³. However, the true number of persons in the USA with HIV/AIDS is likely to be closer to one million^4,5. The discrepancy between these figures is due to several factors including

• reporting of persons diagnosed with HIV has not yet been implemented in all areas⁶
• anonymous tests, including home tests, are excluded from case reports
• many people are unaware of their HIV status⁷.

During 2003, an estimated 32,048 new diagnoses of HIV infection were reported from the 33 areas with a history of confidential name-based reporting. Of these, 72% were among adult or adolescent males, 27% were among adult or adolescent females, and less than 1% were among children under 13 years of age. Recent HIV reports represent a mixture of people with recent infection and others who may have been infected in the past but are only now being diagnosed.

Guidelines for the surveillance of HIV and AIDS, published in the USA in December 1999, recommend integrated HIV and AIDS surveillance. In addition, both the adult and paediatric HIV case definitions were updated to reflect current diagnostic methods and clinical practice.⁸

Interpreting HIV & AIDS statistics for the USA

In order to monitor the spread of the American 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 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. Such AIDS statistics include not only the 50 states and the District of Columbia but also Puerto Rico, Guam, the US Pacific Islands and the US Virgin Islands. However, around 97.5% of the total number of people living with AIDS reside within the 50 states or the District of Columbia.

Historically, many states have only reported AIDS cases. 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 health-care system. In response, more states are now implementing HIV reporting. This enables state and local areas to estimate the size of the population living with HIV/AIDS and to predict the services and resources needed.

The CDC reports HIV diagnoses and the number of people living with HIV, using only data collected through confidential name-based reporting. As of the end of 2003, confidential name-based HIV reporting has been implemented by just 36 states plus Puerto Rico, Guam, American Samoa, the Northern Mariana Islands and the US Virgin Islands. Of these 41 areas, only 33 have been reporting for at least 5 years. The resulting lack of comprehensive national HIV data is a serious problem. It is therefore hoped that all states will soon be reporting HIV cases to the CDC.

Estimates and reporting delays

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. Moreover, this delay may differ among different categories of people. For this reason the CDC estimates the number of diagnoses, deaths and people living with HIV or AIDS by adjusting for reporting delays, taking into account the differences between categories. The CDC also redistributes cases into exposure categories if none was initially reported. No adjustment is made for incomplete reporting. On this page, all numbers are CDC estimates unless stated otherwise.

AVERT.org has a collection of USA statistics pages which look at different aspects of the American epidemic.

Footnotes and references

¹ Adults and adolescents are defined as persons 13 years of age or older.

² The case definition is the conditions that need to be satisfied if a person is to be considered as having AIDS. The CDC explains: "The case definition for adults and adolescents was modified again in 1993. The revisions incorporated a broader range of AIDS-indicator diseases and conditions and used HIV diagnostic tests to improve the sensitivity and specifity of the definition." The result was that more people were categorised as having AIDS.

³ Since 1999, the following 33 areas have had laws or regulations requiring confidential name-based HIV infection reporting: Alabama, Alaska, Arizona, Arkansas, Colorado, Florida, Idaho, Indiana, Iowa, Kansas, Louisiana, Michigan, Minnesota, Mississippi, Missouri, Nebraska, Nevada, New Jersey, New Mexico, North Carolina, North Dakota, Ohio, Oklahoma, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, Wisconsin, Wyoming, and the US Virgin Islands. Since July 1997, Florida has had confidential name-based HIV infection reporting only for new diagnoses.

⁴ The much-referenced article "HIV Prevalence in the United States, 2000" (PL Fleming, PA Sweeney, D Daniels, et al) contains an estimate of between 850,000 and 950,000 people living with HIV/AIDS at the end of 2000.

⁵ The UNAIDS/WHO 2004 Report on the Global AIDS Epidemic estimates that 950,000 people were living with HIV/AIDS in the USA at the end of 2003. The low estimate is 470,000 and the high estimate is 1.6 million.

⁶ According to the number of AIDS cases reported to the CDC, the 33 areas with confidential name-based reporting of HIV infection represent approximately 43% of the US epidemic.

⁷ According to "HIV Prevalence in the United States, 2000", one quarter of people living with HIV/AIDS at the end of 2000 did not know they were infected.

⁸ The 1999 CDC report contains their revised case definition for HIV infection in adults and children.

Last updated December 23, 2004