Volume 26, Number 1 Estimated HIV Incidence and Prevalence in the United States, 2015–2019 This issue of the HIV Surveillance Supplemental Report is published by the Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention (CDC), U.S. Department of Health and Human Services, Atlanta, Georgia. Estimates are presented for the incidence and prevalence of HIV infection among adults and adolescents (aged 13 years and older) based on data reported to CDC through December 2020. The HIV Surveillance Supplemental Report is not copyrighted and may be used and reproduced without permission. Citation of the source is, however, appreciated. Suggested citation Centers for Disease Control and Prevention. Estimated HIV incidence and prevalence in the United States, 2015–2019. HIV Surveillance Supplemental Report 2021;26(No. 1). http://www.cdc.gov/ hiv/library/reports/hiv-surveillance.html. Published May 2021. Accessed [date]. On the Web: http://www.cdc.gov/hiv/library/reports/hiv-surveillance.html Confidential information, referrals, and educational material on HIV infection CDC-INFO 1-800-232-4636 (in English, en Español) 1-888-232-6348 (TTY) http://wwwn.cdc.gov/dcs/ContactUs/Form Acknowledgments Publication of this report was made possible by the contributions of the state and territorial health departments and the HIV surveillance programs that provided surveillance data to CDC. This report was prepared by the following staff and contractors of the Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC: Laurie Linley, Anna Satcher Johnson, Ruiguang Song, Sherry Hu, Baohua Wu, H. Irene Hall, Angela Hernandez, and Michael Friend and the Web and Consumer Services Team of the Prevention Communications Branch (editing and desktop publishing). HIV Surveillance Supplemental Report 2 Vol. 26, No. 1 Contents Contents Commentary 4 Suggested Readings 10 Technical Notes 11 References 16 Tables Section 1 Estimated Incidence of HIV Infection among Persons Aged ≥13 Years 1 Estimated HIV incidence among persons aged ≥ 13 years, by year of infection and selected characteristics, 17 2015–2019—United States 2 Estimated HIV incidence among Black/African American persons aged ≥ 13 years, by year of infection, sex at 20 birth, and selected characteristics, 2015–2019—United States 3 Estimated HIV incidence among Hispanic/Latino persons aged ≥ 13 years, by year of infection, sex at birth, 23 and selected characteristics, 2015–2019—United States 4 Estimated HIV incidence among White persons aged ≥ 13 years, by year of infection, sex at birth, and selected 26 characteristics, 2015–2019—United States 5 Estimated HIV incidence among men who have sex with men, by year of infection, race/ethnicity, and age at 29 infection, 2015–2019—United States 6 Estimated HIV incidence among persons aged ≥ 13 years, by year of infection and area of residence at 34 diagnosis, 2015–2019—United States and Puerto Rico Section 2 Estimated Prevalence of HIV Infection among Persons Aged ≥13 Years 7 Estimated HIV prevalence and undiagnosed infection among persons aged ≥ 13 years, by selected 39 characteristics, 2019—United States 8 Estimated HIV prevalence among persons aged ≥ 13 years, by year and selected characteristics, 2015–2019— 40 United States 9 Estimated HIV prevalence among Black/African American persons aged ≥ 13 years, by year, sex at birth, and 45 selected characteristics, 2015–2019—United States 10 Estimated HIV prevalence among Hispanic/Latino persons aged ≥ 13 years, by year, sex at birth, and selected 50 characteristics, 2015–2019—United States 11 Estimated HIV prevalence among White persons aged ≥ 13 years, by year, sex at birth, and selected 55 characteristics, 2015–2019—United States 12 Estimated HIV prevalence among men who have sex with men, by year, race/ethnicity, and age, 2015–2019— 60 United States 13 Estimated HIV prevalence among persons aged ≥ 13 years, by year and area of residence, 2015–2019— 65 United States and Puerto Rico Appendix: Estimates of Incidence and Prevalence for Ending the HIV Epidemic Initiative Phase I Jurisdictions A1 Estimated HIV incidence among persons aged ≥ 13 years, by year of infection and area of residence at 70 diagnosis, 2017–2019—Ending the HIV Epidemic Initiative Phase I jurisdictions A2 Estimated HIV prevalence among persons aged ≥ 13 years, by year and area of residence, 2017–2018—Ending 76 the HIV Epidemic Initiative Phase I jurisdictions HIV Surveillance Supplemental Report 3 Vol. 26, No. 1 Commentary The primary goal of the initiative, Ending the HIV the time since infection at the date of CD4 test. We Epidemic: A Plan for America (EHE), is to reduce the applied the CD4 model to NHSS data, estimated the annual number of new HIV infections by 75% in 5 distribution of delay from infection to diagnosis, and years and by at least 90% in 10 years [1]. A key objec- then produced national and jurisdiction-level esti- tive to reaching this goal is to increase the percentage mates of HIV incidence and prevalence among adults of persons with HIV who are aware of their infection and adolescents. Reporting of the first CD4 test result [2]. Persons who are aware of their HIV infection can after diagnosis of HIV infection is a required data ele- be linked to care and receive treatment to reduce mor- ment on the HIV case report form. By December bidity and viral load levels, making them less likely to 2020, a CD4 test result had been reported to NHSS for transmit the virus to others [3]. Estimates of (1) HIV 90.6% of persons with HIV diagnosed during 2015– incidence, (2) prevalence (persons living with diag- 2019. Completeness of reporting varied among states nosed or undiagnosed HIV infection), and (3) percent- and local jurisdictions. age of diagnosed infections among persons living with HIV (percentage of persons living with HIV who are REPORT CHANGES aware of their infection) are essential to determining CDC has updated the methods for producing inci- whether prevention program efforts are reducing the dence and prevalence estimates (see Technical Notes annual number of new HIV infections (incidence) and for additional information). This report is based on achieving prevention outcomes. data reported to NHSS through December 31, 2020 to Incidence measures the number of infections allow for a 12-month reporting delay. Prevalence esti- during a specified time (e.g., year). These estimates mates for the year 2019 are preliminary and based on can be used to assess changes in characteristics of death data received by CDC as of December 2020. persons with newly acquired HIV infection. Diagno- Prevalence trends through 2019 should be interpreted ses refer to persons who may have been infected with caution. The following jurisdictions had incom- years before diagnosis. plete reporting of deaths for the year 2019 and associ- Prevalence refers to the number of persons living ated prevalence estimates should be interpreted with with HIV disease at a given time regardless of the caution: Kansas, Massachusetts, Mississippi, Nevada, time of infection or whether the person has received a North Dakota, and Vermont. diagnosis. Prevalence and the percentage of diag- nosed infections among persons living with HIV REPORT FORMAT reflect the number of persons in need of care and treatment services for HIV infection. All numbers and percentages in this surveillance To produce the HIV incidence and prevalence esti- supplemental report (except numbers of diagnosed mates in this report, we used the result of the first cases) were estimated by using the CD4 model. Not CD4+ T-lymphocyte (CD4) test after HIV diagnosis all percentages mentioned in the text are displayed and an estimation method based on a CD4 depletion in the tables. model (referred to hereafter as the “CD4 model”) [4– The tables are organized into 3 sections: 7]. The first CD4 test results after HIV diagnosis are 1. Estimated incidence of HIV infection among routinely collected by all jurisdictions as part of the adults and adolescents (Tables 1–6) National HIV Surveillance System (NHSS). 2. Estimated prevalence of HIV infection among adults and adolescents (Tables 7–13) CD4 MODEL 3. Appendix: Estimated incidence and prevalence CD4 cells, a type of white blood cell, aid in fighting of HIV infection among adults and adolescents infections. HIV targets CD4 cells: without treatment, for EHE Phase 1 jurisdictions (Tables A1 HIV reduces the number of CD4 cells in a person’s and A2) body. A person’s CD4 cell count is used to determine Relative standard errors (RSEs; see Technical Notes stage of disease. Assuming that no treatment has been for additional information) were calculated for esti- received, the CD4 cell count can be used to estimate HIV Surveillance Supplemental Report 4 Vol. 26, No. 1 mated numbers and percentages and are presented in In this report, residence of persons living with diag- the tables. The standard of reliability for estimates pre- nosed HIV infection is based on the most recent known sented in this report is RSE < 30%. Estimates with address at the end of each year during 2015–2019. RSEs of 30%–50% are designated by an asterisk (*) and should be interpreted with caution. Estimates with HIGHLIGHTS OF ANALYSES RSEs of > 50% are statistically unreliable and thus are All highlights are based on reliable estimates (i.e., not shown. Additional stratifications for small race/ RSEs of < 30%). All rates are per 100,000 population. ethnicity groups, and stratifications by race/ethnicity Differences in estimated numbers of HIV infections and age for transmission categories other than male-to- (Tables 1–6) and estimated percentages of diagnosed male sexual contact, are not provided because high infections among persons living with HIV (Tables 8– RSEs resulted from small numbers. To reflect model 13) for 2019, compared with 2015, were assessed by uncertainty, incidence and prevalence estimates are the z test.