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The HIV/AIDS Epidemic in the United States

The first cases of what would later become known as AIDS were reported in the United States in June of 1981.1 Since then, approximately 1.9 million people in the U.S. are estimated to have been infected with HIV, including over 698,000 who have already died; today, 1.2 million people are living with HIV.2,3,4  The response to the U.S. epidemic has yielded numerous successes, but challenges remain:

  • While the number of new HIV diagnoses declined 19% between 2005 and 2014, more than 44,000 people were diagnosed in the U.S., including U.S. dependent areas, in 2014, and diagnoses increased among some populations.5,6
  • The epidemic’s impact varies across the country, and it continues to have a disproportionate impact on certain populations, particularly racial and ethnic minorities and gay and bisexual men and other men who have sex with men.7,8,9
  • HIV testing is important for both treatment and prevention efforts and rapid testing is now much more widely available. Routine HIV testing is recommended for all people ages 13-64,10 and recent policy decisions have expanded health insurance coverage of HIV testing.11 Yet, 13% of those infected with HIV are unaware they are infected.12
  • Treatment advances have substantially reduced AIDS-related morbidity and mortality and extended the lives of many. Antiretroviral therapy (ART) also reduces the risk of HIV transmission and, therefore, can help prevent the spread of HIV.13 Current U.S. HIV treatment guidelines recommend initiating antiretroviral therapy (ART) as soon as one is diagnosed with HIV,14 and new research (including the Strategic Timing of AntiRetroviral Treatment study or START) has underscored the importance of starting treatment early.15 Still, many people with HIV are not in care, on treatment, or virally suppressed.16 Additionally, nearly a quarter of people diagnosed with HIV in 2013 were classified as having AIDS at the time of their diagnosis, meaning they were tested late in their illness.17

Overview and Key Trends

  • Today, more people are living with HIV than ever before as people are living longer with the disease, new infections continue to occur, and diagnoses surpass deaths each year.18,19
Figure 1: Key Snapshot of the U.S. Epidemic Today20,21,22
  • Number of new HIV diagnoses, 2014: 44,784
  • Number of people living with HIV: 1.2 million
  • Number of AIDS deaths since beginning of epidemic: 698,219, including more than 13,000 in 2013
  • Percent of people infected with HIV who don’t know it: 13%
  • Percent of people with HIV who are virally suppressed: 30%
  • Despite advances in combating HIV, hundreds of thousands have died from the disease nationwide. Still, HIV-related mortality rates, which rose steadily through the 1980s and peaked in 1995, have declined significantly; the age-adjusted HIV death rate has dropped by more than 80% since its peak.23 This is largely due to ART but also to decreasing HIV incidence after the 1980s. While HIV is not a leading cause of death for Americans overall, it remains a leading cause of death for certain age groups – in 2014, HIV was the 8th leading cause of death for those ages 25-34, and the 9th for those ages 35-44.24
  • HIV transmission patterns have shifted over time. In 2014, most cases of HIV occurred through male-to-male sexual contact (66%).25 An additional 3% of diagnoses occurred among gay and bisexual men with a history of injection drug use.26 Diagnoses attributable to injection drug use have declined significantly over time, decreasing 63% between 2005 and 2014, and accounted for 6% of new diagnoses in 2014.27,28 Heterosexual sex now accounts for more cases than at the beginning of the epidemic – 24% of new diagnoses in 2014 – but diagnoses attributable to heterosexual sex have declined 35% between 2005 and 2014.29,30
  • Medical advances and programs aimed at prevention and care have reached many people with or at risk for HIV, but looking across the spectrum from HIV diagnosis to viral suppression reveals missed opportunities for addressing the epidemic. According to the Centers for Disease Control and Prevention (CDC), while many people with HIV are diagnosed (87%), far fewer received medical care (39%) and are prescribed ART (36%), and only one in three (30%) are virally suppressed.31 Viral suppression is greater among those who are in medical care.32
Impact Across the Country

Although HIV has been reported in all 50 states, the District of Columbia, and U.S. dependencies, the impact of the epidemic is not uniformly distributed.

  • Ten states accounted for about two-thirds (66%) of HIV diagnoses among adults and adolescents in 2014 (Figure 2).33,34,35 Regionally, the South accounted for half of HIV diagnoses in 2014.36
  • Rates of HIV diagnoses per 100,000 provide a different measure of the epidemic’s impact, since they reflect the concentration of diagnoses after accounting for differences in population size across states. The District of Columbia has the highest rate in the nation, compared to states, more than 4 times the national rate (Figure 2).37,38 Seven of the top 10 states by rate are in the South.39,40
  • New HIV diagnoses are concentrated primarily in large U.S. metropolitan areas (82% in 2014), with Baton Rouge, Miami, and New Orleans topping the list of the areas most heavily burdened.41
Figure 2: Top Ten States/Areas by Number and Rate of New HIV Diagnoses, 201442,43,44
State New HIV Diagnoses, Number (%) State/Area New HIV Diagnoses, per 100,000
California 5,533 (12.4%) District of Columbia 66.9
Florida 5,332 (12.0%) Louisiana 36.6
Texas 4,817 (10.8%) Florida 31.3
New York 3,817 (8.6%) Maryland 27.7
Georgia 2,247 (5.0%) U.S. Virgin Islands 27.4
Illinois 1,728 (3.9%) Georgia 27.0
New Jersey 1,536 (3.5%) New York 22.8
North Carolina 1,416 (3.2%) Puerto Rico 22.7
Louisiana 1,408 (3.2%) Texas 22.1
Maryland 1,388 (3.1%) Mississippi 21.0
Subtotal 29,222 (65.5%)
U.S. Total 44,608 (100%) U.S. Rate 16.6

Racial and Ethnic Minorities

Racial and ethnic minorities have been disproportionately affected by HIV/AIDS since the beginning of the epidemic, and represent the majority of new HIV diagnoses, people living with HIV disease, and deaths among people with HIV.45,46,47

Figure 3: New HIV Diagnoses & U.S. Population, by Race/Ethnicity, 2014

Figure 3: New HIV Diagnoses & U.S. Population, by Race/Ethnicity, 2014

  • Blacks and Latinos account for a disproportionate share of new HIV diagnoses, relative to their size in the U.S. population.48,49 Blacks also account for more people living with HIV than any other racial group – an estimated 496,500 of the 1.2 million people living with HIV in the U.S. are black.50
  • Blacks also have the highest rate of new HIV diagnoses, followed by Latinos – in 2014, the rate of new HIV diagnoses per 100,000 for Blacks (49.4) was about 8 times that of whites (6.1); Latinos (18.4) had a rate 3 times that of whites.51
  • Blacks accounted for close to half (45%) of deaths among people with an HIV diagnosis in 2013.52
  • Survival after an AIDS diagnosis is lower for Blacks than for most other racial/ethnic groups, and Blacks have had the highest age-adjusted death rate due to HIV disease throughout most of the epidemic.53,54 HIV ranks higher as a cause of death for Blacks and Latinos, compared with whites, particularly among those 20-54.55 Further, HIV was the 4th leading cause of death for Black women ages 35-44 in 2014.56

Impact on Women and Young People

  • More than 284,000 women are living with HIV in the U.S. today.57
  • In 2014, women accounted for 19% of new HIV diagnoses, a 40% drop since 2005.58,59
  • Women of color are particularly affected, and in 2014, Black women accounted for 6 in 10 (61%) of new HIV diagnoses among women; Latinas and white women each accounted for 18%.60 Although there is a disproportionate impact on Black women, new diagnoses among Black women decreased 42% between 2005 and 2014.61
  • Teens and young adults continue to be at risk, with those under 35 accounting for 54% of new HIV diagnoses in 2014 (those ages 13-24 accounted for 22% and those ages 25-34 accounted for 31%).62 Most young people are infected sexually.63
  • Among young people, gay and bisexual men and minorities have been particularly affected.64
  • Perinatal HIV transmission, from an HIV-infected mother to her baby, has declined significantly in the U.S., largely due to ART which can prevent mother-to-child transmission.65,66,67

Impact on Gay and Bisexual Men

  • While estimates show that gay and bisexual men comprise only about 2% of the U.S. population,68 male-to-male sexual contact accounts for most new HIV diagnoses (63% in 2014, with an additional 3% occurring in gay and bisexual men with a history of injection drug use) and most people living with HIV (55% in 2012, with an additional 5% occurring in gay and bisexual men with a history of injection drug use).69,70 Additionally, among males with HIV, the share of diagnoses attributable to male-to-male sexual contact increased between 2010 and 2014.71
  • Black accounted for the largest number of new diagnoses (11,207) among gay and bisexual men in 2014, followed by whites (9,012).72 Additionally, according to a recent study, Black gay and bisexual men were found to be at a much higher risk of being diagnosed with HIV during their lifetimes compared with Latino and white gay and bisexual men.73
  • Younger gay and bisexual men (ages 20-29) are at particular risk. In 2014, this group accounted for more than 1 in 4 (28%) of all new HIV diagnoses and 42% of new diagnoses among all gay and bisexual men.74 Among Black gay and bisexual men, this age group accounted for 54% of new diagnoses.75
  • A study in 20 major U.S. cities found that about 1 in 5 (22%) men who have sex with men is living with HIV, and, of those, 1 in 4 are unaware of their infection.76 Prevalence among Blacks was higher (36%) and awareness of infection was lower (67%), compared with men who have sex with men in the study overall.77

The U.S. Government Response

  • In FY 2016, U.S. federal funding to combat HIV totaled $33.0 billion, of which $26.4 billion (80%) was for domestic HIV efforts; of the funds dedicated to the domestic epidemic, the largest share ($19.7 billion) was for care, $3.0 for cash and housing assistance, $2.7 billion for research, and $0.9 for prevention78
  • Numerous federal departments and agencies are involved in the domestic HIV/AIDS response and key government programs that provide health insurance coverage, care, and support to people with HIV in the U.S. include Medicaid, Medicare, the Ryan White HIV/AIDS Program, and the Housing Opportunities for Persons with HIV/AIDS Program (HOPWA). Social Security’s income programs for those who are disabled (SSI and SSDI) are important sources of support. The Centers for Disease Control and Prevention (CDC) leads U.S. surveillance and prevention activities, which are carried out in conjunction with state and local health departments. In addition to government efforts, a wide range of community and other organizations provide services for people with HIV and those at risk for HIV.
  • The passage of the Affordable Care Act (ACA) in March 2010 provided new opportunities for expanding health care access, prevention, and treatment services for millions of people in the U.S., including many people with or at risk for HIV. Importantly, for people living with HIV there also new protections in the law that make access to health coverage more equitable including the expansion of Medicaid and in the private market, prohibition on rate setting tied to health status, elimination of preexisting condition exclusions, and an end to lifetime and annual caps.79,80
  • In July 2015, the U.S. government released an update to the July 2010 National HIV/AIDS Strategy, which was the first comprehensive plan for addressing the epidemic in the U.S.81,82 The update reiterates the original strategy goals: reduce new HIV infections; increase access to care and improve health outcomes; reduce HIV-related health disparities; and achieve a more coordinated national HIV/AIDS response. The update also reflects new scientific developments since the original strategy, including pre-exposure prophylaxis (PrEP) and the role of antiretrovirals as part of the national prevention strategy, and addresses the changing healthcare landscape as the ACA has been further implemented.83 Further, the update revises the key indicators that will help to monitor progress in addressing the epidemic and focuses on key communities at risk for or heavily burdened by the epidemic, such as men who have sex with men, black men and women, and youth between 13 and 24.84
Endnotes
  1. CDC. MMWR, Vol. 30, No. 21; June 1981.

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  2. CDC. HIV Surveillance Report, Diagnoses of HIV Infection in the United States and Dependent Areas, 2014, Vol. 26; November 2015. HIV diagnosis data are estimates from 50 states, the District of Columbia, and 6 U.S. dependent areas.

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  3. CDC. HIV in the United States: At a Glance; June 2016.

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  4. CDC. HIV Surveillance Supplemental Report, Monitoring Selected National HIV Prevention and Care Objectives by Using HIV Surveillance Data, Vol. 20, No. 2; July 2015.

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  5. CDC. HIV Surveillance Report, Diagnoses of HIV Infection in the United States and Dependent Areas, 2014, Vol. 26; November 2015. HIV diagnosis data are estimates from 50 states, the District of Columbia, and 6 U.S. dependent areas.

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  6. CDC. HIV in the United States: At a Glance; June 2016.

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  7. CDC. HIV Surveillance Report, Diagnoses of HIV Infection in the United States and Dependent Areas, 2014, Vol. 26; November 2015. HIV diagnosis data are estimates from 50 states, the District of Columbia, and 6 U.S. dependent areas.

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  8. CDC. HIV in the United States: At a Glance; June 2016.

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  9. CDC. HIV Surveillance Supplemental Report, Monitoring Selected National HIV Prevention and Care Objectives by Using HIV Surveillance Data, Vol. 20, No. 2; July 2015.

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  10. CDC. MMWR, Vol. 55, No. RR14; September 2006.

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  11. KFF. HIV Testing in the United States; June 2016.

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  12. CDC. HIV Surveillance Supplemental Report, Monitoring Selected National HIV Prevention and Care Objectives by Using HIV Surveillance Data, Vol. 20, No. 2; July 2015.

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  13. CDC. Prevention Benefits of HIV Treatment; updated February 2016.

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  14. DHHS. Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents; updated January 2016.

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  15. AIDSinfo, Statement by the HHS Panel on Antiretroviral Guidelines for Adults and Adolescents Regarding Results from the START and TEMPRANO Trials; July 2015.

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  16. CDC. HIV Surveillance Supplemental Report, Monitoring Selected National HIV Prevention and Care Objectives by Using HIV Surveillance Data, Vol. 20, No. 2; July 2015.

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  17. CDC. HIV Surveillance Supplemental Report, Monitoring Selected National HIV Prevention and Care Objectives by Using HIV Surveillance Data, Vol. 20, No. 2; July 2015.

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  18. CDC. HIV Surveillance Report, Diagnoses of HIV Infection in the United States and Dependent Areas, 2014, Vol. 26; November 2015. HIV diagnosis data are estimates from 50 states, the District of Columbia, and 6 U.S. dependent areas.

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  19. CDC. HIV Surveillance Supplemental Report, Monitoring Selected National HIV Prevention and Care Objectives by Using HIV Surveillance Data, Vol. 20, No. 2; July 2015.

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  20. CDC. HIV Surveillance Report, Diagnoses of HIV Infection in the United States and Dependent Areas, 2014, Vol. 26; November 2015. HIV diagnosis data are estimates from 50 states, the District of Columbia, and 6 U.S. dependent areas.

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  21. CDC. HIV in the United States: At a Glance; June 2016.

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  22. CDC. HIV Surveillance Supplemental Report, Monitoring Selected National HIV Prevention and Care Objectives by Using HIV Surveillance Data, Vol. 20, No. 2; July 2015.

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  23. CDC. NCHS. Health, United States, 2015; May 2016.

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  24. CDC. NCHS. Deaths: Leading Causes for 2014; June 2016.

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  25. CDC. HIV Surveillance Report, Diagnoses of HIV Infection in the United States and Dependent Areas, 2014, Vol. 26; November 2015. HIV diagnosis data are estimates from 50 states, the District of Columbia, and 6 U.S. dependent areas.

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  26. CDC. HIV Surveillance Report, Diagnoses of HIV Infection in the United States and Dependent Areas, 2014, Vol. 26; November 2015. HIV diagnosis data are estimates from 50 states, the District of Columbia, and 6 U.S. dependent areas.

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  27. CDC. HIV Surveillance Report, Diagnoses of HIV Infection in the United States and Dependent Areas, 2014, Vol. 26; November 2015. HIV diagnosis data are estimates from 50 states, the District of Columbia, and 6 U.S. dependent areas.

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  28. ← Return to text

  29. CDC. HIV Surveillance Report, Diagnoses of HIV Infection in the United States and Dependent Areas, 2014, Vol. 26; November 2015. HIV diagnosis data are estimates from 50 states, the District of Columbia, and 6 U.S. dependent areas.

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  30. ← Return to text

  31. CDC. HIV Surveillance Supplemental Report, Monitoring Selected National HIV Prevention and Care Objectives by Using HIV Surveillance Data, Vol. 20, No. 2; July 2015.

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  32. Bradley H et al. Increased HIV viral suppression among US adults receiving medical care, 2009-2013, Conference on Retroviruses and Opportunistic Infections (CROI), Boston, abstract 53; 2016.

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  33. CDC. HIV Surveillance Report, Diagnoses of HIV Infection in the United States and Dependent Areas, 2014, Vol. 26; November 2015. HIV diagnosis data are estimates from 50 states, the District of Columbia, and 6 U.S. dependent areas.

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  34. CDC. National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Atlas. Data are estimates from all 50 states, the District of Columbia, and 6 U.S. dependent areas.

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  35. Table includes data on HIV diagnoses among adults and adolescents and reflects data from U.S. dependent areas.

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  36. CDC. HIV Surveillance Report, Diagnoses of HIV Infection in the United States and Dependent Areas, 2014, Vol. 26; November 2015. HIV diagnosis data are estimates from 50 states, the District of Columbia, and 6 U.S. dependent areas.

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  37. CDC. HIV Surveillance Report, Diagnoses of HIV Infection in the United States and Dependent Areas, 2014, Vol. 26; November 2015. HIV diagnosis data are estimates from 50 states, the District of Columbia, and 6 U.S. dependent areas.

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  38. CDC. National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Atlas. Data are estimates from all 50 states, the District of Columbia, and 6 U.S. dependent areas.

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  39. CDC. HIV Surveillance Report, Diagnoses of HIV Infection in the United States and Dependent Areas, 2014, Vol. 26; November 2015. HIV diagnosis data are estimates from 50 states, the District of Columbia, and 6 U.S. dependent areas.

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  40. CDC. National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Atlas. Data are estimates from all 50 states, the District of Columbia, and 6 U.S. dependent areas.

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  41. CDC. HIV Surveillance Report, Diagnoses of HIV Infection in the United States and Dependent Areas, 2014, Vol. 26; November 2015. HIV diagnosis data are estimates from 50 states, the District of Columbia, and 6 U.S. dependent areas.

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  42. CDC. HIV Surveillance Report, Diagnoses of HIV Infection in the United States and Dependent Areas, 2014, Vol. 26; November 2015. HIV diagnosis data are estimates from 50 states, the District of Columbia, and 6 U.S. dependent areas.

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  43. CDC. National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Atlas. Data are estimates from all 50 states, the District of Columbia, and 6 U.S. dependent areas.

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  44. Table includes data on HIV diagnoses among adults and adolescents and reflects data from U.S. dependent areas.

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  45. CDC. HIV Surveillance Report, Diagnoses of HIV Infection in the United States and Dependent Areas, 2014, Vol. 26; November 2015. HIV diagnosis data are estimates from 50 states, the District of Columbia, and 6 U.S. dependent areas.

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  46. ← Return to text

  47. CDC. HIV Surveillance Supplemental Report, Monitoring Selected National HIV Prevention and Care Objectives by Using HIV Surveillance Data, Vol. 20, No. 2; July 2015.

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  48. CDC. HIV Surveillance Report, Diagnoses of HIV Infection in the United States and Dependent Areas, 2014, Vol. 26; November 2015. HIV diagnosis data are estimates from 50 states, the District of Columbia, and 6 U.S. dependent areas.

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  49. U.S. Census Bureau. 2014 Population Estimates.

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  50. CDC. HIV Surveillance Supplemental Report, Monitoring Selected National HIV Prevention and Care Objectives by Using HIV Surveillance Data, Vol. 20, No. 2; July 2015.

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  51. CDC. HIV Surveillance Report, Diagnoses of HIV Infection in the United States and Dependent Areas, 2014, Vol. 26; November 2015. HIV diagnosis data are estimates from 50 states, the District of Columbia, and 6 U.S. dependent areas.

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  52. CDC. HIV Surveillance Report, Diagnoses of HIV Infection in the United States and Dependent Areas, 2014, Vol. 26; November 2015. HIV diagnosis data are estimates from 50 states, the District of Columbia, and 6 U.S. dependent areas.

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  53. CDC. HIV Surveillance Report, Diagnoses of HIV Infection in the United States and Dependent Areas, 2014, Vol. 26; November 2015. HIV diagnosis data are estimates from 50 states, the District of Columbia, and 6 U.S. dependent areas.

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  54. CDC. NCHS. Health, United States, 2015; May 2016.

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  55. CDC. NCHS. Deaths: Leading Causes for 2014; June 2016.

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  56. CDC. NCHS. Deaths: Leading Causes for 2014; June 2016.

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  57. CDC. HIV Surveillance Supplemental Report, Monitoring Selected National HIV Prevention and Care Objectives by Using HIV Surveillance Data, Vol. 20, No. 2; July 2015.

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  58. CDC. HIV Surveillance Report, Diagnoses of HIV Infection in the United States and Dependent Areas, 2014, Vol. 26; November 2015. HIV diagnosis data are estimates from 50 states, the District of Columbia, and 6 U.S. dependent areas.

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  59. ← Return to text

  60. CDC. HIV Surveillance Report, Diagnoses of HIV Infection in the United States and Dependent Areas, 2014, Vol. 26; November 2015. HIV diagnosis data are estimates from 50 states, the District of Columbia, and 6 U.S. dependent areas.

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  61. ← Return to text

  62. CDC. HIV Surveillance Report, Diagnoses of HIV Infection in the United States and Dependent Areas, 2014, Vol. 26; November 2015. HIV diagnosis data are estimates from 50 states, the District of Columbia, and 6 U.S. dependent areas.

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  65. CDC. HIV Surveillance Report, Diagnoses of HIV Infection in the United States and Dependent Areas, 2014, Vol. 26; November 2015. HIV diagnosis data are estimates from 50 states, the District of Columbia, and 6 U.S. dependent areas.

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  66. Nesheim S et al. “A Framework for Elimination of Perinatal Transmission of HIV in the United States.” Pediatrics, Vol. 130, No. 4; September 2012.

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  67. Whitmore SK et al. “Correlates of Mother-to-Child Transmission of HIV in the United States and Puerto Rico.” Pediatrics, Vol. 129, No. 1; January 2012.

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  68. KFF analysis of CDC data.

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  69. CDC. HIV Surveillance Report, Diagnoses of HIV Infection in the United States and Dependent Areas, 2014, Vol. 26; November 2015. HIV diagnosis data are estimates from 50 states, the District of Columbia, and 6 U.S. dependent areas.

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  70. CDC. HIV Surveillance Supplemental Report, Monitoring Selected National HIV Prevention and Care Objectives by Using HIV Surveillance Data, Vol. 20, No. 2; July 2015.

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  71. CDC. HIV Surveillance Report, Diagnoses of HIV Infection in the United States and Dependent Areas, 2014, Vol. 26; November 2015. HIV diagnosis data are estimates from 50 states, the District of Columbia, and 6 U.S. dependent areas.

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  72. CDC. HIV Surveillance Report, Diagnoses of HIV Infection in the United States and Dependent Areas, 2014, Vol. 26; November 2015. HIV diagnosis data are estimates from 50 states, the District of Columbia, and 6 U.S. dependent areas.

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  73. CDC. Lifetime Risk of HIV Diagnosis; February 2016.

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  74. CDC. HIV Surveillance Report, Diagnoses of HIV Infection in the United States and Dependent Areas, 2014, Vol. 26; November 2015. HIV diagnosis data are estimates from 50 states, the District of Columbia, and 6 U.S. dependent areas.

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  75. CDC. HIV Surveillance Report, Diagnoses of HIV Infection in the United States and Dependent Areas, 2014, Vol. 26; November 2015. HIV diagnosis data are estimates from 50 states, the District of Columbia, and 6 U.S. dependent areas.

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  76. ← Return to text

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  81. ← Return to text

  82. The White House. National HIV/AIDS Strategy for the United States; July 2010.

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  83. ← Return to text

  84. ← Return to text

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