aids in usa
AIDS was first identified in the USA in 1981. The epidemic has now spread to every part of the USA and to all sectors of society.
It is thought that more than one million people are living with HIV in the USA and that more than half a million have died after developing AIDS.
American HIV surveillance data are not comprehensive so many statistics must be based on reports of AIDS diagnoses. In interpreting such AIDS statistics, it is important to remember that they do not correspond to new HIV infections. Most people live with HIV for several years before developing AIDS.
People living with AIDS
At the end of 2007, the CDC estimates that 468,578 people were living with , around 20,000 more than 2006. This number includes all people who have ever been diagnosed with an AIDS-defining condition and are believed to be alive, including many people who have recovered their health by taking antiretroviral therapy. The chart below shows the ethnicities of these people, revealing that black Americans have been disproportionately affected.
The charts below show how adults and adolescents (aged 13 and over) living with AIDS most likely became infected with HIV. Just over 75% of adults and adolescents living with AIDS are men.
An estimated 3,792 children aged under 13 were living with AIDS at the end of 2007. The vast majority of these children acquired HIV from their mothers during pregnancy, labour, delivery or breastfeeding.
People with AIDS are surviving longer and are contributing to a steady increase in the number of people living with AIDS. This trend will continue as long as the number of new diagnoses exceeds the number of people dying each year.
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AIDS diagnoses and deaths
In June 1981, the first cases of what is now known as AIDS were reported in the USA. During the 1980s, there were rapid increases in the number of AIDS cases and deaths of people with AIDS. Cases peaked with the 1993 expansion of the case definition1, and then declined. The most dramatic drops in both cases and deaths began in 1996, with the widespread use of combination .
Since 2000 the annual numbers of AIDS diagnoses have been relatively constant, with an estimated 37,041 in 2006. In total, an estimated 1,051,875 people have been diagnosed with AIDS in America.
The death rate among people with AIDS has also remained relatively stable in recent years; there were an estimated 14,561 deaths in 2007. Since the beginning of the epidemic, an estimated 583,298 people with AIDS have died in the USA.
Who is affected by AIDS?
During the 1990s, the epidemic shifted steadily toward a growing proportion of AIDS cases among black people and Hispanics and in women, and toward a decreasing proportion in MSM, although this group remains the largest single exposure group. Black people and Hispanics have been disproportionately affected since the early years of the epidemic. In absolute numbers, blacks have outnumbered whites in new AIDS diagnoses and deaths since 1996, and in the number of people living with AIDS since 1998.
During 2006 there were an estimated 28 paediatric AIDS diagnoses, compared to 195 in 1999 and 896 in 1992. The decline in paediatric AIDS incidence is associated with more HIV testing of pregnant women and the use of such as zidovudine (AZT) by HIV-infected pregnant women and their newborn infants.
The age group 35-49 years accounted for around half of all AIDS cases diagnosed in 2007. Around two-thirds of all people who have died with AIDS did not live to the age of 45.
At the end of 2007, the CDC estimates that there were 571,378 people living with HIV/AIDS in the 39 states and dependent areas that have a history of confidential name-based HIV reporting, based on reported diagnoses and deaths2. However, the total number of people living in the USA with HIV/AIDS is thought to be around 1.1 million3. The discrepancy between these figures is due to several factors including:
- confidential name-based reporting of HIV diagnoses has not yet been implemented in all states4
- anonymous tests, including home tests, are excluded from case reports
- one in every five people living with HIV has not even had their infection diagnosed, let alone reported.5
During 2007, there were an estimated 44,084 new diagnoses of HIV infection in the 39 areas with a history of confidential name-based reporting. This is around a 15% increase on 2006 though an actual increase in the number of infections is just one possible reason given by the CDC. Other possible factors include changes to state reporting, an increase in testing, and instability in the data.
In the 34 states with a history of confidential name-based reporting, adult or adolescent males accounted for nearly three-quarters of new HIV diagnoses, more than two-thirds of whom were infected by male-to-male sexual contact. Heterosexual contact accounted for 83% of diagnoses among women and 14% among women. was the transmission route in 10% of male and 16% of female diagnoses in 2007. HIV was diagnosed in 159 children in 2007, all but 20 who became infected by mother-to-child transmission. Recent HIV reports represent a mixture of people with recent infection and others who may have been infected in the past but are only now being diagnosed.
Using a different statistics model it is estimated that around 56,300 Americans became newly infected with HIV in 2006 in the 50 US states and the District of Columbia. African Americans made up an estimated 45% of new infections, whites 35%, and Hispanic/Latinos 17%. Male-to-male sexual contact caused 53% of infections in 2006, with heterosexual contact and injection drug use being the other principal transmission routes causing 31% and 12% of new infections in 2006 respectively. The number of new infections peaked in 1984-85 at around 130,000 per year, fell to a low of around 49,000 in the early 1990s, peaked again at around 58,000 in the late 1990s, and then declined slightly to its current level. This overall pattern masks variation between exposure groups. Among men who have sex with men, there has been a steady rise in new infections since the early 1990s.
Interpreting HIV & AIDS statistics for the USA
In order to monitor the spread of the American epidemic and to assess the need for services and resources, there is a need for accurate surveillance. In the USA, statistics on both HIV and AIDS are collected by the Centers for Disease Control and Prevention (CDC) and published in an annual report. The latest report was published in February 2009, and contains data up to the end of 2007.
The CDC surveillance report includes data on the number of people diagnosed with AIDS, the number living with AIDS and the number of people with AIDS who have died. Such AIDS statistics include not only the 50 states and the District of Columbia but also Puerto Rico, Guam, the US Pacific Islands and the US Virgin Islands. However, around 97.5% of the total number of people living with AIDS reside within the 50 states or the District of Columbia.
In recent years, the use of antiretroviral therapy has slowed the progression of HIV in many infected persons and hence contributed to a decline in AIDS incidence. This means that AIDS surveillance data are less able to represent trends in the incidence of HIV infection or the impact of the epidemic on the health-care system. In response, more states are now implementing HIV case reporting. This enables state and local areas to better estimate the size of the population living with HIV/AIDS and to predict the services and resources needed.
The CDC reports HIV diagnoses and the number of people living with HIV, using only data collected through confidential name-based reporting. By the end of 2006, confidential name-based reporting of adult and child HIV cases had been implemented by 53 states and dependent areas including Puerto Rico, Guam, American Samoa, the Northern Mariana Islands and the US Virgin Islands. Of these 53 areas, only 39 have been reporting since at least 2003.
Estimates and reporting delays
There is often a delay between the time of diagnosis of HIV or AIDS, or the time of death, and the time at which the event is reported. Moreover, this delay may differ among different categories of people. For this reason the CDC estimates the number of diagnoses, deaths and people living with HIV or AIDS by adjusting for reporting delays, taking into account the differences between categories. The CDC also redistributes cases into exposure categories if none was initially reported. No adjustment is made for incomplete reporting. On this page, all numbers are CDC estimates unless stated otherwise