Texas Health and Human Services / Texas Health Steps

The HIV Epidemic in the U.S.

human crowd forming HIV text

Human immunodeficiency virus (HIV) disease remains a serious health threat in the United States. Adolescents and young adults are among the groups at highest risk for this virus that attacks the immune system. There is no cure for HIV. If not treated, HIV can lead to AIDS (acquired immunodeficiency syndrome). Without treatment, individuals with AIDS typically survive only about three years (Centers for Disease Control and Prevention [CDC], 2021).

Ending the nation’s HIV epidemic by 2030 is the goal of the U.S. Department of Health and Human Services (HHS), which announced a plan in 2019 to meet that goal, stating, “HIV has cost America too much for too long and remains a significant public health issue” (HHS, 2021). The 2019 plan, titled Ending the HIV Epidemic in the U.S., calls for:

  • 75 percent reduction in new HIV cases by 2025
  • 90 percent reduction by 2030

If those goals are met, an estimated 250,000 HIV cases would be prevented (Ibid., 2021).

New HIV cases have decreased from a peak in the mid-1980s. Yet the federal government warns of a possible HIV resurgence, citing trends in substance injection; HIV-related stigma; homophobia and transphobia; lack of access to HIV prevention, testing and treatment; and lack of awareness that HIV remains a significant public health threat (Ibid., 2021).

A key strategy of the plan to reduce new HIV cases by 90 percent is prevention, including use of PrEP (pre-exposure prophylaxis) medication. This quick course provides an introduction to PrEP and shows how pediatricians and other primary care providers in Texas can use risk reduction guidance, HIV testing and PrEP to stop HIV transmission.

HIV in the United States By the Numbers

700,000-plus individuals have died from HIV-related illness since 1981

2 million individuals ages 13 years and older have HIV

About 4 percent of all HIV cases are among individuals ages 13 through 24 years

36,800 individuals, including adolescents, were newly diagnosed in 2019 (includes U.S states and territories, such as Puerto Rico and Guam)

About 1 in 5 new HIV cases in 2018 were among individuals ages 13 through 24 years

Government agencies spend $20 billion a year on HIV prevention and care


Sources: American Academy of Pediatrics (2022), CDC (2021), HHS (2021)

Quick Quiz

Among individuals living with HIV in the U.S., what percentage are unaware they have the disease?

10 percent

15 percent

20 percent

25 percent

HIV Demographics and Disparities in the U.S and Texas

New HIV cases in the U.S. decreased by 9 percent from 2015-2019 (CDC, 2021), mostly because cases among gay and bisexual men ages 13 through 24 years dropped 33 percent. Still, nearly 37,000 individuals were diagnosed with HIV in 2019, in the following approximate categories:

  • 69 percent: Gay, bisexual or other men having sex with men
  • 23 percent: Heterosexuals
  • 7 percent: Individuals who inject substances
  • 2 percent: Transgender individuals

Racial and ethnic minorities are severely and disproportionately affected by HIV (HHS, 2021):

  • 44 percent of cases are Black individuals
  • 30 percent of cases are Hispanic individuals
  • HIV is on the rise among American Indian and Alaska Native populations

HIV disease is not distributed evenly. It is highly concentrated in certain geographical hot spots, most notably in the South—including Texas (CDC, 2019). Six Texas counties had more than 100 new HIV cases in 2019 among individuals ages 13 years and older, according to the CDC:

  1. Harris County (Houston area) — 1,195
  2. Dallas County (Dallas area) — 733
  3. Bexar County (San Antonio area) — 336
  4. Tarrant County (Fort Worth area) — 307
  5. Travis County (Austin area) — 174
  6. El Paso County (El Paso area) — 116

See the Appendix to access an interactive map of HIV cases by Texas county.

Youth at Special Risk for HIV

There is good news in the fight against the HIV epidemic: Between 2014 and 2018, new diagnoses of HIV disease decreased among individuals ages 13 through 24 years (AAP, 2022). However, most sexually active youth in the U.S. don’t believe they’re at risk for contracting HIV and have never been tested for it, according to the 2022 AAP clinical report titled Adolescents and Young Adults: The Pediatrician’s Role in HIV Testing and Pre- and Postexposure HIV Prophylaxis.

An earlier review article noted some of the common reasons for increased risk. “Expected onset of sexual activity during adolescence coupled with substance use experimentation and low rates of condom use render adolescents to be among the groups that are most vulnerable to infection with HIV and other sexually transmitted infections (STIs)” (Pediatrics, 2020).

In 2018, HIV disease was undiagnosed in an estimated 45 percent of youth ages 13 through 24 years living with HIV (AAP, 2022). Diagnosed cases of HIV among that age group in 2018 showed:

  • 88 percent male youth
  • 12 percent female youth

According to the 2022 AAP clinical report:

Youth with HIV infection are also the least likely of any age group to be linked to HIV care in a timely manner. Youth also have lower rates of viral suppression, making them less likely to stay healthy and increasing their risk of HIV transmission to others.”

In addition, youth in non-white populations are disproportionately affected by HIV disease compared with white youth (Ibid., 2022):

  • HIV occurs 11 times more often in Black/African American youth
  • HIV occurs 3.4 times more often in Hispanic/Latinx youth

Texas data from DSHS (2021) also shows HIV cases among youth are highest in non-white populations:

  • 2019 cases in Texas among ages 15 through 19 years:
    • Boys and men: 94 Black, 93 Hispanic, 23 white
    • Girls and women: 12 black, 10 Hispanic, 2 white
  • 2019 cases in Texas among ages 20 through 24 years:
    • Boys and men: 277 Hispanic, 248 Black, 95 white
    • Girls and women: 55 Black, 21 Hispanic, 10 white






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