The Impact of HIV and AIDS in the United States

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This year’s HIV outbreak in Scott County, Indiana, refocused public attention on HIV and AIDS as an ongoing public health issue. Time magazine featured the Indiana story on its June 15, 2015, cover. 

Indiana Gov. Mike Pence declared a public health emergency after 79 new cases of HIV were diagnosed by March1—setting the stage for the Indiana legislature to approve a bill allowing needle exchange programs in counties with HIV emergencies related to drug abuse.2 Since then the numbers have continued to climb.

However, the primary group at risk for HIV remains gay, bisexual and other men who have sex with men.3 In 2013, gay and bisexual men accounted for 65 percent of estimated new HIV infections in the U.S. and 81 percent of infections among all newly infected men, according to the Centers for Disease Control and Prevention, or CDC.4 Injection drug users represented just 8 percent of new infections that same year.5

About 1.2 million people in the U.S. currently live with HIV, and one in eight (12 percent) of those do not know that they have the virus.6 Each year 50,000 new cases are diagnosed, a number that has remained steady since the late 1990s, despite significant educational efforts at federal, state and community levels.7

The History of HIV and AIDS
HIV is a virus that weakens the immune system by destroying immune cells called CD4 that fight disease and infection. The final stage for this virus is called Acquired Immune Deficiency Syndrome, or AIDS, in which the CD4 cells fall below a certain threshold.8 Without treatment, the average life expectancy for someone with AIDS is three years. New treatment regimens are available that don’t eradicate or eliminate the HIV virus but can help patients live a longer, healthier life and reduce the risk of HIV transmission.9 HIV can be transmitted by contact with certain body fluids from an HIV-infected person through sexual contact, sharing needles used to inject drugs, pregnancy, childbirth, breastfeeding, blood transfusion or organ transplant.10

The first reported cases of AIDS in the early 1980s drew national attention to the rapidly growing HIV epidemic in the U.S. Since 1981, more than 1.8 million people in the U.S. have been infected with the virus and approximately 650,000 people have died from it.11 Men have a higher risk of contracting HIV and dying from AIDS than women. In 2013, men accounted for 80 percent of those newly diagnosed with HIV.12 

New HIV infections among men who have sex with men, often referred to as MSM by health professionals, and young people ages 13–35 have increased annually, while the number of new infections among women has declined over time since the beginning of the epidemic.13 

Women are more likely to acquire the HIV virus through heterosexual contact than other risk factors.14 

Primary Transmission of HIV is Among Men Who Have Sex with Men

Men who have sex with men are estimated to be about 2 percent of the total U.S. population, yet in 2013 this group represented 65 percent of new HIV infections among adolescents and adults.15 Since 2008, the number of new HIV infections among men ages 13–24 who have sex with men has increased about 22 percent. 

  • Among men who have had same-sex contact and were newly diagnosed with HIV, 36 percent were black and 38 percent were white. Another 22 percent were Hispanic or Latino gay or bisexual men.16 In 2013, of the estimated 14,500 gay and bisexual men diagnosed with AIDS, 40 percent were blacks/African- Americans; 32 percent were whites; and 23 percent were Hispanics/Latinos.17
  • Testing conducted in 20 cities by the CDC in 2011 found that nearly one in five (18 percent) gay and bisexual men tested positive for HIV and that HIV prevalence increased with increasing age.18 
  • The CDC recommends that all gay or bisexual men get tested for HIV at least once a year and sexually active men who have sex with men get tested for HIV once every three to six months.19 

Blacks and Hispanics Disproportionately Infected by HIV

  • Blacks and Hispanics suffer the largest burden of HIV and AIDS among population groups compared to their size in the total U.S. population. Blacks made up 12 percent of the U.S. population in 2010, but represented 44 percent of all new HIV infections that year according to CDC data.20 Latinos’ rates of HIV diagnosis in 2010 are almost double their proportion in the U.S. population: 21 percent of HIV infections compared to 12 percent of the population. Among black women, the disproportionate impact of HIV is even more stark than among men: of all new infections among women in 2010, 64 percent were to black women. Black men made up 39 percent of all new infections to men in 2010.21
  • Blacks are more likely to develop AIDS and die from HIV as compared to all other racial ethnic groups, and the survival rates among blacks after an AIDS diagnosis are significantly lower. Since the early 1990s, blacks infected with HIV die faster and at a younger age on average than HIV positive individuals from other racial and ethnic groups.22
  • In states, the same disproportionality exists. According to CSG calculations, the rate of new HIV reports in 2013 were 10 times, or more, greater in 21 states for blacks than whites. Only in Hawaii was the rate for blacks less than two times as great as for whites.(See state table included in this brief.)
  • In all states except Hawaii, Idaho and Oklahoma, the rate of new HIV reports in 2013 among Hispanics was at least twice that of whites, according to CSG calculations. In 11 states, the rate for Hispanics was five times, or more, greater than for whites.

HIV and AIDS Hit the South Hard 

Across the U.S., HIV and AIDS are concentrated in metropolitan areas such as Los Angeles and Miami.23 Consequently states with large urban populations report the highest rates of HIV, including five of the 10 states with the highest rates of new infection— Florida, Illinois, New Jersey, New York and Texas. States in the South are disproportionally affected by HIV.24 Six of the states with the top 10 new infection rates of HIV in 2013 are Southern.

  • New HIV infections were concentrated in large U.S. metropolitan areas. In 2011, 81 percent of all new diagnoses were in large cities, with New York, Los Angeles and Miami leading the list.25
  • The District of Columbia’s rate of new HIV infection in 2010 was 109.2 per 100,000, more than twice the rate of Maryland (43.7) with the next highest rate. The South accounted for 45 percent of new AIDS cases in the U.S. in 2010, followed by the Northeast (24 percent), the West (19 percent) and the Midwest (13 percent).26

National Response for Prevention and Funding

  • In 2014, the federal government spent $29.5 billion toward HIV and AIDS. Of total funding, 55 percent was appropriated for routine care, 10 percent for housing and social support assistance, 9 percent for research and 22 percent for the global assistance to address the epidemic.27
  • Several federal programs exist to provide health insurance coverage, routine care, access to medications, care coordination and social supports for people with HIV, including such general social services programs as Medicare and Medicaid, as well as specific grant programs targeting HIV and AIDS such as the Ryan White HIV/AIDS Program, Housing Opportunities for Persons with AIDS program, and the CDC HIV Prevention grant programs.
  • The largest federally funded grant program is the Ryan White HIV/AIDS Program, which awarded more than $1.9 billion dollars in 2014. The Ryan White HIV/AIDS Program is a last resort payer for comprehensive HIV care and treatment and was the U.S. government’s first response to the HIV and AIDS epidemic. First enacted in 1990, the program provides funding to cities, states and other public or private nonprofit entities to develop, organize, coordinate and operate systems for the delivery of health care and support services to medically underserved individuals and families affected by HIV.28 
  • In 2011, the most recent data available, more than $11.6 billion in Medicaid funding went to enrollees with HIV or AIDS. Medicaid is the single largest source of coverage for more than 230,000 enrollees with HIV.29 New York spent the most, $2.4 billion in the 2011 fiscal year. The next highest spending states were California, with nearly $700 million, and Florida at $550 million. (See state table included in this brief.)
  • Enactment of the 2010 Affordable Care Act increased the opportunity for more people living with or at risk for HIV to receive health care access, prevention, routine care and treatment in states that decide to increase program eligibility.
  • The CDC offers best practices and policy options to identify HIV and AIDS infections and reduce transmission in the United States, including the adoption of routine opt-out screening and testing by providers in health care settings for adolescents and adults ages 13–64, minors, at-risk populations, pregnant women and infants.
  • The National HIV/AIDS Strategy 2020 is the U.S. government’s strategic plan to reduce the burden of HIV and improve the lives of those living with HIV and AIDS. This action plan, released in July 2015, aims to eliminate new HIV infections, improve the HIV continuum of care and reduce HIV-related health disparities among population groups.30 The updated strategy focuses on four key areas: widespread testing and linkage to care, additional supports for people living with HIV to remain in routine care, universal HIV viral load suppression and full access to medications that prevent HIV transmission.

The Impact of HIV and AIDS in the United States

RESOURCES
1 Matthew Dolan, “Drug Related HIV Outbreak Sparks Emergency in Indiana, The Wall Street
Journal
,
March 26, 2015. .
2 Lesley Weidenbener, “Pence signs law to facilitate needle exchange programs,” IndyStar, May
5, 2015.
3 CDC, “HIV Among Gay and Bisexual Men,” accessed August 25, 2015.
4 Ibid.
5 AIDS.gov, “HIV in the United States: At A Glance,” accessed August 25, 2015.
6 Ibid.
7 CDC, Estimates of New HIV Infections in the United States,” accessed August 25, 2015..
8 AIDS.gov, “CD4 Count,” accessed August 25, 2015.
9 Ibid.
10 CDC, “HIV Transmission,” accessed August 25, 2015. .
11 CDC, “HIV/AIDS: Basic Statistics,” accessed August 25, 2015.
12 CDC, “HIV Among Women,” accessed August 25, 2015.
13 Ibid.
14 Ibid.
15 CDC, “HIV Among Gay and Bisexual Men.”
16 Ibid.
17 Ibid.
18 Ibid.
19 CDC, “HIV Among African American Gay and Bisexual Men,” accessed August 25, 2015.
20 Kaiser Family Foundation, “Black Americans and HIV/AIDS,” April 25, 2014. .
21 Kaiser Family Foundation, “New HIV Infections by Race/Ethnicity and Sex, United States,2010,” accessed August 26, 2015. 
22 Kaiser Family Foundation, Black Americans and HIV/AIDS.”
23 CDC, “HIV and AIDS in the United States by Geographic Distribution,” accessed August 26,2015. 
24 Kaiser Family Foundation, “HIV Case Rates (per 100,000), Adults and Adolescents, by Race/Ethnicity,” 2013.
25 Kaiser Family Foundation, “The HIV/AIDS Epidemic in the United States,” April 7, 2014. 
26 CDC, “HIV and AIDS in the United States by Geographic Distribution.”
27 The White House, “National HIV/AIDS Strategy for the United States,” July 2015. 
28 Ibid.
29 Kaiser Family Foundation, “Medicaid and HIV/AIDS,” March 5, 2013.
30 The White House, “National HIV/AIDS Strategy for the United States.”