Diagnoses of HIV Infection in the United States and Dependent Areas 2021: Commentary

Overview

The Centers for Disease Control and Prevention (CDC) collects, analyzes, and disseminates surveillance data on HIV infection; these data are one of the nation’s primary sources of information on HIV in the United States. The annual surveillance report, published by CDC, summarizes information about diagnosed HIV infection in the United States and dependent areas. HIV surveillance data are used by CDC and their public health partners in other federal agencies, health departments, nonprofit organizations, academic institutions, and the public to help focus prevention efforts; plan services; allocate resources; develop policy; detect, monitor, and intervene in HIV clusters; and monitor trends in HIV infection. Data in this report may be used to accelerate action to reach disproportionately affected populations and achieve national goals outlined in Healthy People 2030 [1], the National HIV/AIDS Strategy (NHAS) (2022‒2025) [2], and the Ending the HIV Epidemic in the U.S. (EHE) initiative [3].

Impact of COVID-19 Pandemic

Data for the year 2020 should be interpreted with caution due to the impact of the COVID-19 pandemic on access to HIV testing, care-related services, and case surveillance activities in state/local jurisdictions. The overall number of HIV diagnoses in the United States in 2020 (30,335) was 17% lower than in 2019 (Figure A). The decline in 2020 was larger than the average yearly decline (2%–3%) observed during 2017–2019. The underdiagnosis of HIV in 2020 was due to disruptions in clinical care services, patient hesitancy in accessing clinical services, and shortages in HIV testing reagents/materials [4–8]. To emphasize the need for caution, tables presenting data for the year 2020 include “COVID-19 pandemic” in the title, and the 2020 column is highlighted in tables that provide multiple years of data.

During 2021, the overall number of HIV diagnoses in the United States (35,769) partially rebounded and was 18% higher than in 2020 (Figure A). The partial rebound in the number of HIV diagnoses may be due to the identification and reporting of HIV diagnoses missed in 2020. The ongoing impact of the pandemic on HIV testing, diagnoses, and treatment has varied by jurisdiction, with some recovering more slowly than others. In 2021, some jurisdiction’s levels of HIV testing, diagnoses, and treatment remained below pre-COVID-19 levels [9]. Increasing testing efforts and innovative strategies to reach persons with undiagnosed HIV infection are needed to offset this diagnosis gap. Death data for years 2020 and 2021 should be interpreted with caution due to excess deaths in the United States population attributed to the COVID-19 pandemic. For additional information, see http://www.cy118119.com/nchs/nvss/vsrr/covid19/excess_deaths.htm. Assessments of trends in HIV diagnoses, deaths, and prevalence that include data for the year 2020 should be interpreted with caution. See COVID-19 Suggested Readings for additional information on COVID-19 and HIV.

Numbers, percentages, and rates of diagnoses of HIV infection during 2021 are based on data from all 50 states, the District of Columbia, and 6 U.S. dependent areas (American Samoa, Guam, the Northern Mariana Islands, Puerto Rico, the Republic of Palau, and the U.S. Virgin Islands). Data for 2021 and additional data stratifications and years are available via NCHHSTP AtlasPlus. NCHHSTP AtlasPlus is an interactive tool that gives users the ability to create customized tables, maps, and charts using CDC’s surveillance data on HIV, viral hepatitis, sexually transmitted diseases, and tuberculosis. AtlasPlus also provides access to indicators on social determinants of health (SDOH). Data on stage 3 (AIDS) classifications can be found in the Stage 3 (AIDS) classification slide set (for cumulative data through the most recent year) and in AtlasPlus.

Report Changes

• Terminology for transmission category was updated.
• Relative percent change analyses (i.e., comparing 2017 and 2021) have been included, as editions published prior to 2020 (COVID-19 pandemic).
• Special Focus Profile section now includes “Persons residing in the Southern Region of the United States.” Trends for changes in absolute and relative disparities have been added to this section.
• Technical Notes section now includes “Limitations of Data and Findings.”
• Tables that present data by using the transmission category classification, based on a person’s assigned sex at birth, include the definition for male-to-male sexual contact (MMSC) and an updated definition for injection drug use (IDU) and MMSC/IDU.