Over 1.1 million people aged 13 and older are living with diagnosed HIV in the United States, and roughly 39,200 new diagnoses were made in 2023 alone. That translates to a national diagnosis rate of 13.7 per 100,000 people. While those numbers are significant, HIV is not evenly spread across the country. Where you live, your age, your race, and your sex all dramatically shape how likely you are to encounter the virus.
How Many People Are Living With HIV
As of 2023, the CDC counted 1,132,739 people aged 13 and older living with diagnosed HIV across the U.S. and its territories. That figure only includes people who have been tested and received a diagnosis. An additional portion of people are living with HIV and don’t know it, which means the true total is higher. The estimated number of new infections in 2022 was around 31,800, a figure that has remained relatively stable in recent years rather than declining sharply.
HIV-related deaths have dropped considerably compared to the peak of the epidemic in the 1990s, but they haven’t disappeared. In 2023, there were 4,496 HIV-related deaths among people with diagnosed HIV. Modern treatment can reduce the virus to undetectable levels in the blood, effectively preventing progression to AIDS and eliminating the risk of sexual transmission. The national goal is to get 95% of diagnosed individuals to that point. As of 2017, only about 63% had reached viral suppression, meaning there’s still a considerable gap between where things stand and where they need to be.
The South Carries a Disproportionate Burden
HIV in the U.S. is largely a Southern epidemic. In 2023, the South accounted for 51% of all new HIV diagnoses (20,188 cases) despite being home to about 38% of the U.S. population. The diagnosis rate in the South was 18.4 per 100,000, well above the national average of 13.7. The West came in second with about 21% of new diagnoses, followed by the Northeast and Midwest at roughly 13% each.
The concentration goes even deeper than regional lines. More than half of all HIV diagnoses in 2016 and 2017 occurred in just 48 counties plus Washington, D.C., and San Juan, Puerto Rico. That’s a remarkably small slice of the country’s geography carrying most of the epidemic’s weight. Seven additional states with high rates of rural HIV round out the areas where the federal government has focused its “Ending the HIV Epidemic” initiative.
The South also accounts for a disproportionate share of HIV-related deaths: 2,457 of the 4,496 deaths in 2023, or 56%. That’s partly driven by lower rates of insurance coverage, fewer HIV-specialized clinics, and greater stigma that can delay testing and treatment in Southern states.
Racial and Ethnic Disparities
Black and Hispanic/Latino Americans are affected by HIV at rates far out of proportion to their share of the population. Together, these two groups made up about 70% of estimated new HIV infections in 2022. Black Americans, who represent roughly 13% of the U.S. population, account for the single largest share of new diagnoses. Hispanic/Latino individuals, at about 19% of the population, represent the second-largest share.
These disparities don’t reflect differences in individual behavior. They’re driven by structural factors: poverty, limited access to healthcare and prevention tools like PrEP (a daily pill that prevents HIV infection), housing instability, and the lingering effects of systemic racism on health infrastructure in communities of color. A person’s risk has as much to do with the prevalence of HIV in their sexual network and their access to testing and treatment as it does with any personal choice.
Who Is Most Affected by Transmission Route
Male-to-male sexual contact remains the most common transmission route in the U.S. by a wide margin. In 2023, half of all diagnoses attributed to this category were among men living in the South. Heterosexual contact and injection drug use account for smaller but meaningful portions of new cases. Women are most commonly diagnosed through heterosexual contact.
The concentration among men who have sex with men has been consistent for decades and reflects both biological factors (anal sex carries a higher per-act transmission risk than vaginal sex) and network effects (when HIV prevalence is already high within a community, each sexual encounter carries more statistical risk). PrEP has been a game-changer for prevention in this group, but uptake remains uneven, particularly among Black and Latino men and those living outside major cities.
What Viral Suppression Means for the Bigger Picture
A person with HIV who takes antiretroviral therapy consistently can reduce the amount of virus in their blood to undetectable levels, a state called viral suppression. At that point, HIV cannot be transmitted sexually, and the person’s life expectancy approaches that of someone without the virus. This concept, sometimes summarized as “undetectable equals untransmittable,” has fundamentally changed what an HIV diagnosis means.
The challenge is getting everyone there. The federal target is 95% viral suppression among all diagnosed individuals. The 2017 baseline was 63.1%, meaning more than a third of people who knew they had HIV were not virally suppressed. The reasons range from inconsistent access to medication and healthcare, to mental health and substance use challenges, to the simple difficulty of taking a pill every day for life. Each person who falls out of care represents both a personal health risk and a potential link in the chain of ongoing transmission.
Putting the Numbers in Context
Compared to sub-Saharan Africa, where some countries have adult HIV prevalence above 20%, the U.S. rate is low in absolute terms. But compared to other high-income countries, the U.S. has a relatively large epidemic, driven largely by inequities in healthcare access. Countries with universal healthcare systems and aggressive prevention programs, like the U.K. and Australia, have seen steeper declines in new infections over the past decade.
For most Americans, the individual risk of contracting HIV is quite low. But that average obscures enormous variation. A young Black gay man in Atlanta faces a fundamentally different risk landscape than a white heterosexual woman in rural Vermont. Understanding HIV prevalence in the U.S. means understanding that it’s not one epidemic but many overlapping ones, shaped by geography, race, sex, and access to the tools that prevent and treat it.