About 1.2 million people in the United States have HIV. In 2018, nearly 38,000 people received an HIV diagnosis in the United States and dependent areas. Though the number of new HIV diagnoses has declined over the last few years, the number of people who have HIV has been increasing because people with HIV are now living longer.

In 2018, 81% of new diagnoses in the United States and dependent areas were among adult and adolescent men and 19% were among adult and adolescent women. Most new HIV diagnoses among women were from heterosexual contact (85%), and another 15% were from injection drug use. By age, 21% of new HIV diagnoses in 2018 were among young people aged 13 to 24, 36% were among people aged 25 to 34, 19% were among people aged 35 to 44, 14% were among people aged 45 to 54, and 10% were among people aged 55 and older.

When you live in a community where many people have HIV infection, the chances of having sex with someone who has HIV are higher. This interactive atlas allows you to see the rates of HIV infection (“prevalence ”) in different US communities. Within any community, the prevalence of HIV can vary among different populations.

HIV is transmitted when engaging in risky behaviors, like (1) having anal or vaginal sex without a condom or without taking medicine to prevent or treat HIV  and (2) sharing needles, syringes or other injection equipment (for example, cookers).  Certain cultural and societal factors can also play a part in HIV risk. These factors include poverty, lack of educational opportunities, lack of access to health care, homophobia , stigma, and racial/ethnic or gender discrimination.

Overall, data show

• Gay, bisexual, and other men who have sex with men (MSM) have the largest number of new HIV diagnoses in the United States and dependent areas.
  More information: About 4% of the US male population is gay or bisexual, but gay and bisexual men accounted for 86% of all new HIV diagnoses among men and 69% of all diagnoses in 2018. The number of new HIV diagnoses among gay and bisexual men was highest in men aged 25 to 34. Young black/African American gay and bisexual men (aged 13 to 24) accounted for 51% of new diagnoses among all young gay and bisexual men and 34% of new diagnoses among all black/African American gay and bisexual men.
  

  More information:Many factors may increase HIV risk for some gay, bisexual, or other men who have sex with men (MSM). For example,

  • Homophobia, stigma, and discrimination may place gay and bisexual men at risk for multiple physical and mental health problems and may affect whether they seek and are able to obtain high-quality health services.
  • Most gay and bisexual men get HIV from having anal sex without using condoms or taking medicines to prevent or treat HIV. Anal sex is the riskiest type of sex for getting or transmitting HIV. Receptive anal sex is 13 times as risky for getting HIV as insertive anal sex.
  • Socioeconomic factors, such as having limited access to quality health care, lower income and educational levels, and higher rates of unemployment and incarceration, may place some gay and bisexual men at higher risk for HIV.
• Blacks/African Americans and Hispanics/Latinos are disproportionally affected by HIV than other racial and ethnic groups.
  More information: About 13% of the US population is black/African American, but they accounted for 42% of new HIV diagnoses in 2018. Similarly, although about 18% of the total US population is Hispanic/Latino, they accounted for 27% of new HIV diagnoses in 2018.
  

  More information: Many cultural, socioeconomic, and health-related factors may increase HIV risk for some African Americans and Hispanics/Latinos. For example,

  • Stigma, fear, discrimination, and homophobia may place many African Americans and Hispanics/Latinos at higher risk for HIV.
  • The poverty rate is high among African Americans. The socioeconomic issues associated with poverty—including limited access to high-quality health care, housing, and HIV prevention education—directly and indirectly increase the risk for getting HIV and affect the health of people with and at risk for HIV.
  • Similarly, poverty, migration patterns, lower educational level, and language barriers may make it harder for some Hispanics/Latinos to get HIV testing and care. Undocumented Hispanics/Latinos may be less likely to use HIV prevention services, get an HIV test, or get treatment for HIV because of concerns about being arrested and deported.
• Transgender women who have sex with men are among the groups at highest risk for HIV infection. 
  More information: Because we don’t have complete data for this population, we don’t know how many transgender women in the United States have HIV. However, data collected by local health departments and scientists studying these communities show high levels of HIV infection, with a recent study reporting that an estimated 14% of transgender women have HIV.
  

  More information: Many cultural, socioeconomic, and health-related factors may increase HIV risk for some transgender people. For example,

  • Discrimination and social stigma can reduce access to education, jobs, health care, and housing.
  • Commercial sex work, mental health issues, incarceration, homelessness, unemployment, and high levels of substance misuse compared to the general population, as well as violence and lack of family support, may put transgender people at risk for HIV.
  • Health care providers may be insensitive to transgender identity or sexuality, which can make it harder for transgender people who have HIV to seek health care. Research shows that even if transgender women seek care, they are less likely to take antiretroviral therapy (ART) than nontransgender (cis-gender) people with HIV, though transgender women are just as likely to have health insurance coverage. The lower rates of taking ART could be because of provider decisions or because transgender people are concerned about potential interactions between ART and hormones.
• People who inject drugs remain at significant risk for getting HIV.
  

  More information: In 2018, 7% of new HIV diagnoses in the United States and dependent areas were attributed to injection drug use and another 3% to male-to-male sexual contact and injection drug use (men who reported both risk factors). Of the HIV diagnoses attributed to injection drug use, 58% were among men and 42% were among women.

  

  More information: Many factors may increase HIV risk for some people who inject drugs (PWID). For example,

  • The high-risk practices of sharing needles, syringes, and other injection equipment (for example, cookers) are common among PWID.
  • PWID may also engage in risky sexual behaviors, such as having sex without a condom or without medicines to prevent or treat HIV, having sex with multiple partners, or trading sex for money or drugs.
  • The prescription opioid and heroin epidemic has led to increased numbers of PWID, placing new populations at increased risk for HIV. The epidemic has disproportionately affected nonurban areas, where HIV prevalence rates have historically been low. These areas have limited services for HIV prevention and treatment and substance use disorder treatment.
  • Social and economic factors limit access to HIV prevention and treatment services among PWID.
  • PWID may face stigma and discrimination. Often, injection drug use is viewed as a criminal activity rather than a medical issue that requires counseling and rehabilitation. Stigma and mistrust of the health care system may prevent PWID from seeking HIV testing, care, and treatment.