HIV Declines among Young People, Drives Decrease in New Infections

May 25, 2023

New CDC data estimated annual new HIV infections were 12% lower in 2021 compared to 2017—dropping from about 36,500 infections to about 32,100. The decline was driven by a 34 percent decrease in new infections among 13- to 24-year-olds, mostly among gay and bisexual males. HIV prevention efforts must go further and progress must be faster, however, for gains to reach populations equitably and for national goals to end the HIV epidemic to be reached.

According to CDC’s latest estimates, annual HIV infections dropped from 9,300 in 2017 to 6,100 in 2021 among 13- to 24-year-olds. Declines among young gay and bisexual males (who account for roughly 80 percent of new infections in this age group) drove the trend, falling from an estimated 7,400 infections to about 4,900 during the timeframe. 

“Our nation’s HIV prevention efforts continue to move in the right direction,” said CDC Director Rochelle P. Walensky, MD, MPH. “Longstanding factors, such as systemic inequities, social and economic marginalization, and residential segregation, however, stand between highly effective HIV treatment and the prevention and people who could benefit from them. Efforts must be accelerated and strengthened for progress to reach all groups faster and equitably.” 

Data suggest that improved reach of HIV testing, treatment, and pre-exposure prophylaxis (PrEP) has contributed to progress in HIV prevention among young gay and bisexual males. 

“In prevention, patience is not a virtue,” said Jonathan Mermin, MD, MPH, Director of CDC’s National Center for HIV, Viral Hepatitis, STD, and TB Prevention. “Decreasing HIV incidence among youth, including young gay and bisexual males, shows us what is possible. But ending the HIV epidemic and achieving equity requires we expand this progress to all.” 

HIV PrEP and treatment outcomes improve, though longstanding factors limit gains among Black people and Hispanic/Latino people. 

The decline in annual HIV infections among young gay and bisexual males was not even across all racial and ethnic groups. Declines were lower among young Black/African American (subsequently, Black) and 13- to 24-year-old Hispanic/Latino gay and bisexual males than young White gay and bisexual males, suggesting that HIV prevention and treatment are not reaching everyone in this group equitably—and reflecting broader disparities that hinder HIV prevention. 

Among key HIV prevention indicators, the greatest improvement was in the number of people taking PrEP to prevent HIV. In 2021, about 30 percent of the 1.2 million people who could benefit from PrEP were prescribed it—a notable improvement compared to about 13 percent prescribed PrEP in 2017. However, although most people who could benefit from PrEP are Black or Hispanic/Latino people, estimates suggest relatively few Black people or Hispanic/Latino people were prescribed PrEP in 2021. 

There were also small increases in other key prevention measures, but not at the pace needed to reach national goals. More people with HIV were aware of their status in 2021 than 2017, with an uptick from 86 percent to 87 percent. Though data aren’t directly comparable due to reporting differences, the portion of people with diagnosed HIV who were virally suppressed due to effective treatment was slightly higher in 2021 than in 2017, up from 63 percent to 66 percent. Viral suppression was lower among Black people and Hispanic/Latino people than White people. 

Deeply entrenched social determinants of health continue to drive these disparities and their outcomes. Most new HIV infections in 2021 were among gay and bisexual men, the majority of whom were Black or Hispanic/Latino. About one-fifth of new HIV infections in 2021 were among women, and over half of those were among Black women. 

“At least three people in the U.S. get HIV every hour—at a time when we have more effective prevention and treatment options than ever before,” said Robyn Neblett Fanfair, MD, MPH, Acting Director of CDC’s Division of HIV Prevention. “These tools must reach deep into communities and be delivered faster to expand progress from some groups to all groups.” 

CDC release