HIV remains a public health challenge in the United States. While advancements in prevention and treatment have improved outcomes, certain populations experience disproportionately higher rates of new infections. Understanding these disparities is important for developing targeted public health interventions that reduce new transmissions and support those living with HIV.
Populations with Elevated Transmission Concerns
Gay, bisexual, and other men who have sex with men (MSM) remain the population most affected by HIV in the U.S. In 2022, this group accounted for 67% of estimated new HIV infections and 83% of estimated infections among all men. MSM also represented 67% of new diagnoses.
People who inject drugs (PWID) also represent a group with elevated concerns regarding HIV transmission. In 2022, PWID accounted for 7% of both estimated new HIV infections and new HIV diagnoses. HIV prevalence was higher among Black PWID compared to Hispanic and White PWID.
Racial and ethnic disparities are evident across various groups. Black/African American individuals accounted for 37% of estimated new HIV infections and 38% of new HIV diagnoses in 2022. Hispanic/Latino individuals accounted for 33% of estimated new HIV infections and 32% of new HIV diagnoses. Together, these communities made up over half of estimated new HIV infections in 2022.
Transgender individuals, particularly transgender women, also face elevated rates of HIV. In 2022, transgender people accounted for 2% of new HIV diagnoses, with transgender women accounting for the majority. Studies show high rates of HIV among transgender women in select U.S. cities, with higher rates among Black transgender women.
Geographic disparities further highlight areas of concern, with the Southern U.S. bearing a significant burden. In 2022, the South accounted for nearly half (49%) of the estimated new HIV infections and 52% of new HIV diagnoses.
Underlying Factors Driving Disparities
The disproportionate rates of HIV in certain populations are influenced by various social and structural factors. Socioeconomic conditions, such as poverty, housing instability, and limited educational opportunities, can increase vulnerability to HIV. For instance, people experiencing homelessness or unstable housing have higher rates of HIV and may face challenges in maintaining care routines.
Access to healthcare also presents significant barriers for many. Lack of health insurance, limited transportation options, and a shortage of culturally responsive care providers can delay HIV diagnosis and treatment, making it difficult for individuals to engage with prevention services, testing, and consistent care.
Stigma and discrimination related to sexual orientation, gender identity, race, and HIV status itself are substantial impediments. Such stigma can deter individuals from seeking testing, prevention, and treatment services, fearing judgment or negative repercussions. Systemic inequities, rooted in historical injustices, contribute to these persistent disparities.
Limited access to prevention services, including pre-exposure prophylaxis (PrEP) and syringe services programs, contributes to the problem. For example, some regions, particularly in the South, face more barriers to PrEP access, including prior authorization requirements for insurance plans. These factors collectively create environments where HIV transmission can persist and disproportionately affect specific communities.
Strategies for Prevention and Support
Public health efforts aim to mitigate HIV disparities through targeted interventions. Tailored prevention campaigns and education initiatives reach specific populations with culturally appropriate messages, addressing misconceptions and promoting safer behaviors.
Increasing access to HIV testing and ensuring prompt linkage to care upon diagnosis are foundational strategies. Early diagnosis allows individuals to begin treatment, benefiting their health and preventing further transmission. Connecting individuals to care services supports continuous engagement and viral suppression.
Expanding access to Pre-Exposure Prophylaxis (PrEP) and Post-Exposure Prophylaxis (PEP) is a significant component of prevention. PrEP, a daily medication, can reduce the risk of HIV infection by nearly 99% for men who have sex with men and by 74-84% for people who inject drugs when taken consistently. PEP is an emergency medication taken after a possible exposure to prevent HIV.
Support for harm reduction services, such as syringe services programs (SSPs), helps prevent HIV transmission among people who inject drugs. SSPs provide sterile equipment and connect individuals to substance use treatment and other supportive services. Addressing social determinants of health through policy and community programs is also important. This involves initiatives that improve economic stability, housing, and healthcare access. Reducing stigma and promoting acceptance within communities fosters an environment where individuals feel safe accessing necessary services.