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Review
. 2021 Mar 20;397(10279):1095-1106.
doi: 10.1016/S0140-6736(21)00395-0. Epub 2021 Feb 19.

Epidemiology of HIV in the USA: epidemic burden, inequities, contexts, and responses

Patrick S Sullivan  1 , Anna Satcher Johnson  2 , Elizabeth S Pembleton  3 , Rob Stephenson  4 , Amy C Justice  5 , Keri N Althoff  6 , Heather Bradley  7 , Amanda D Castel  8 , Alexandra M Oster  2 , Eli S Rosenberg  9 , Kenneth H Mayer  10 , Chris Beyrer  6
Affiliations
Review

Epidemiology of HIV in the USA: epidemic burden, inequities, contexts, and responses

Patrick S Sullivan et al. Lancet. .

Abstract

The HIV epidemic in the USA began as a bicoastal epidemic focused in large cities but, over nearly four decades, the epidemiology of HIV has changed. Public health surveillance data can inform an understanding of the evolution of the HIV epidemic in terms of the populations and geographical areas most affected. We analysed publicly available HIV surveillance data and census data to describe: current HIV prevalence and new HIV diagnoses by region, race or ethnicity, and age; trends in HIV diagnoses over time by HIV acquisition risk and age; and the distribution of HIV prevalence by geographical area. We reviewed published literature to explore the reasons for the current distribution of HIV cases and important disparities in HIV prevalence. We identified opportunities to improve public health surveillance systems and uses of data for planning and monitoring public health responses. The current US HIV epidemic is marked by geographical concentration in the US South and profound disparities between regions and by race or ethnicity. Rural areas vary in HIV prevalence; rural areas in the South are more likely to have a high HIV prevalence than rural areas in other US Census regions. Ongoing disparities in HIV in the South are probably driven by the restricted expansion of Medicaid, health-care provider shortages, low health literacy, and HIV stigma. HIV diagnoses overall declined in 2009-18, but HIV diagnoses among individuals aged 25-34 years increased during the same period. HIV diagnoses decreased for all risk groups in 2009-18; among men who have sex with men (MSM), new diagnoses decreased overall and for White MSM, remained stable for Black MSM, and increased for Hispanic or Latino MSM. Surveillance data indicate profound and ongoing disparities in HIV cases, with disproportionate impact among people in the South, racial or ethnic minorities, and MSM.

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Conflict of interest statement

Declaration of interests

PSS reports grants from the US National Institutes of Health (NIH), the CDC, Gilead Sciences, ViiV, the National Science Foundation, and personal fees from NIH, CDC, Gilead Sciences, Merck, the Ontario HIV Research Network, and Elsevier, outside the submitted work. KNA reports grants from NIH, during the conduct of the study, and personal fees from the All of Us Research Program and TrioHealth, outside the submitted work. All other authors declare no competing interests. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the CDC.

Figures

Figure 1:
Figure 1:. Number of new HIV diagnoses by US county, 2018
Figure 2:
Figure 2:. Diagnosed HIV prevalence by US county, 2018
Figure 3:
Figure 3:. Scatterplot of HIV prevalence by US county population stratified by US Census region, 2018
For counties with populations of less than 50 000, Southern counties (blue dots) are more likely to have high HIV prevalence than the west (red), northeast (green), and midwest (purple).
Figure 4:
Figure 4:. HIV diagnoses overall and by age in the USA, 2009–18
Figure 5:
Figure 5:. HIV diagnoses overall and by risk group in the USA, 2009–18
IDU=injection drug user. MSM=men who have sex with men.
Figure 6:
Figure 6:. HIV diagnoses among men who have sex with men overall and by race or ethnicity in the USA, 2009–18
Figure 7:
Figure 7:. Disparities in HIV prevalence in the USA by race or ethnicity, sex, sex or race subgroup, risk group, and geographical region, 2017
The size of the bubble is proportionate to the size of the population in the group. For example, the population of IDU (light green circle) is smaller than the population of Black women (dark blue circle), but the IDU-HET disparity (22·9%) is larger than the Black women-White women disparity (17·6%). HET=heterosexual people. MSM=men who have sex with men. IDU=injection drug users. TM=transgender men. TW=transgender women.
Figure 8:
Figure 8:. Poverty and HIV care in the USA, 2018
(A) HIV prevalence by US county. (B) Percent of population living in poverty by US county. (C) Income inequality, expressed through the Gini coefficient, by US county. (D) Proportion of population without health insurance by US county.
See this image and copyright information in PMC

References

    1. US Centers for Disease Control and Prevention. Today’s HIV/AIDS epidemic. August, 2016. https://www.cdc.gov/nchhstp/newsroom/docs/factsheets/todaysepidemic-508.pdf (accessed Jan 29, 2020).
    1. Curran JW, Jaffe HW, Hardy AM, Morgan WM, Selik RM, Dondero TJ. Epidemiology of HIV infection and AIDS in the United States. Science 1988; 239: 610–16. - PubMed
    1. Fauci AS, Redfield RR, Sigounas G, Weahkee MD, Giroir BP. Ending the HIV epidemic: a plan for the United States. JAMA 2019; 321: 844–45. - PubMed
    1. US Centers for Disease Control and Prevention. HIV Surveillance Report, 2018 (updated), volume 31. May, 2020. http://www.cdc.gov/hiv/library/reports/hiv-surveillance.html (accessed Jan 10, 2021).
    1. Sullivan PS, Purcell DW, Grey JA, et al. Patterns of racial/ethnic disparities and prevalence in HIV and syphilis diagnoses among men who have sex with men, 2016: a novel data visualization. Am J Public Health 2018; 108: S266–73. - PMC - PubMed

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