As with all pandemics, some groups are hit harder than others, and, not only is the number of new cases rising but so, too, are the odds of getting HIV if you’re in that group. Understanding the risks—where HIV is more common and less common—can help you navigate the risk and reduce the odds.
Calculating HIV Risk
When epidemiologists refer to the scale of the HIV pandemic, they not only describe it by the actual number of infections but also by its incidence (number of new cases) and prevalence (proportion of people affected).
In terms of HIV risk, prevalence is arguably the more important value in that it describes how many people in a specific group have HIV at that moment in time. The higher the prevalence, the more “common” HIV is within that group, and the greater your likelihood of infection.
HIV prevalence not only describes a geographic population, such as the city of San Francisco or sub-Saharan Africa, but also groups with defined characteristics, like men who have sex with men (MSM) or people between the ages of 18 and 24.
By calculating the rate of infections within these groups, both health officials and the public have a better idea of how “common” HIV is within that population and can formulate strategies to reduce the risk of infection.
How Common Is HIV Today?
The prevalence of HIV can vary dramatically by region but is influenced by many of the same factors whether you live in a developed country like the United States or a developing country in Africa or Asia.
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HIV Prevalence in the U.S.
Currently, in the United States, an estimated 1.1 million Americans are living with HIV out of a total population of about 331 million. That translates to an HIV prevalence of roughly 0.3%.
This doesn’t mean that wherever you go in the U.S., the risk will be the same. In dense urban populations, the risk of infection is greater, whether the infection is HIV or COVID-19. But other factors weigh in as well, not least of which include poverty and access to quality healthcare.
In richer communities, access to health insurance means that you are more likely to more likely get diagnosed, treated, and maintain an undetectable viral load if you get HIV. Without the same access to care, people who are poor are less likely to be diagnosed and more likely to infect others, increasing the HIV prevalence in their communities.
These dual dynamics—population density and poverty—are reflected in prevalence rates that are not only higher in cities like New York and Washington, D.C. but also in parts of the country, like the South, where access to healthcare is poor. As a result, HIV prevalence rates are highest in the Northeast (0.534%) and the South (0.517%), where both of these concerns are endemic.
As a result, the prevalence rates seen in Eswatini (Swaziland), for example, are significantly greater than those seen in resource-rich countries like the United States.
Prior to the widespread distribution of antiretroviral drugs, it was not uncommon to see prevalence rates in some countries exceeding 26%. Although figures like these have dropped significantly since the height of the pandemic in 2004, they still remain astonishingly high, with as many as one in four people affected in some so-called high-prevalent countries.
This is especially true in sub-Saharan Africa, where an estimated 25.7 million people currently live with HIV.
What Are the Odds of Getting HIV?
If all things were equal, a 0.3% HIV prevalence might seem relatively low. But clearly, different factors influence the risk of HIV from one group to another. When multiple risk factors overlap, the HIV prevalence in that group can easily increase by two-, 10-, 20-fold, or more.
By Age
Sex is the primary mode of HIV transmission in the United States and most other parts of the world. As a result, younger people who are generally more sexually active are at greater risk. Young people are also more likely to engage in risky behaviors, such as multiple sex partners and alcohol/substance abuse, or contract STDs like chlamydia or gonorrhea, which help facilitate HIV infection.
These risks are evidenced by the 2019 annual surveillance report from the Centers for Disease Control and Prevention (CDC) in which the incidence of HIV was two to three times higher in adults 24 to 35 than any other age group.
As a result, the HIV prevalence among younger people in the United States is higher than that of the population as a whole: roughly 457 infections per 100,000, or 0.457%.
By Routes of Transmission
HIV is effectively transmitted through body fluids, including blood, semen, vaginal fluids, and breast milk. With that being said, how these fluids enter the body makes a big difference in how likely you are to get infected.
In the United States, the lion’s share of new infections are among men who have sex with men (MSM), the majority of whom acquire HIV through anal sex. MSM also represent the largest single population of people living with HIV, with numbers exceeding 678,000 in 2019.
Statistically speaking, male-to-male sexual contact increases the risk of HIV by 57-fold compared to a matched set of heterosexual men. Homophobia, stigma, high rates of substance abuse, and biological vulnerabilities (including the permeability of rectal tissues) all contribute to the increased risk of HIV.
Biological vulnerabilities also factor into the increased rates of infection among heterosexual women. As the receptive partner in vaginal sex, the risk of transmission among women is twice that of her male partner.
Although injecting drug use represents a smaller proportion of overall infections in the U.S. (roughly 189,600), the blood-to-blood transmission of HIV via shared needles is extremely effective and is believed to contribute to as many as one in 10 new infections per year.
By contrast, the mother-to-child transmission of HIV, while common in many developing countries, is nearly non-existent in the U.S. due to the routine use of prenatal antiretroviral therapy and the avoidance of breastfeeding by mothers with HIV.
Not only are the rates of poverty twice as high among Blacks and Latinos as they are with Whites (18.8% and 15.7% versus 7.3% respectively), but the resulting lack of access to qualified healthcare paired with high levels of HIV stigma continue to many away from the diagnosis and treatment they most desperately need.
As a population group, whites account for nearly a third of all new HIV infections in the United States but have a substantially lower HIV prevalence than either Blacks or Latinos.
Today, Blacks and Latinos represent only 13.4% and 18.5% of the U.S. population but respectively account for over 447,000 and 242,500 of the total infections. By contrast, Whites represent 60.1% of the U.S. population and account for only 323,000 infections.
Get tested. Knowing your status gives you powerful information to help keep you and your partner(s) safe. The U. S. Preventive Services Task Force currently recommends HIV testing for all Americans 15 to 65 as part of a routine healthcare provider’s visit. Limit your number of sex partners. Simply put, the more partners you have, the greater your risk of infection. Avoid serosorting. Serosorting, the practice of choosing partners based on their HIV status, can lead to a reduction in your perceived risk of HIV, which can lead to increased risk-taking and a greater likelihood of infection. Avoid alcohol and illicit drugs. Both can impair your judgment and lead to risk-taking behaviors. If you do use drugs, avoid sharing needles and other drug paraphernalia. Take PrEP. HIV pre-exposure prophylaxis (PrEP) is antiretroviral medication used to prevent infection in HIV-negative people. When taken as prescribed, PrEP can reduce your risk of sexual infection by 99%. Make your viral load undetectable. If you are HIV-positive, taking your HIV medications every day helps ensure your viral load remains undetectable. By getting and staying undetectable, your risk of infecting others is reduced to zero. Use condoms. Even if you are on PrEP or have an undetectable viral load, using a condom helps prevent STDs that HIV drugs can’t. By contrast, getting an STD increases your risk of HIV. Get PEP if accidentally exposed. HIV post-exposure prophylaxis (PEP) is a 28-day course of antiretrovirals used to avert infection if accidentally exposed to HIV, whether through a burst condom or unprotected sex.
In the same way that the risk of HIV is influenced by multiple factors—some of which you can control and others you can’t—HIV prevention strategies require a multifactorial approach.
This is especially true if you are in a serodiscordant relationship, in which one partner has HIV and the other hasn’t. In such cases, you need to not only reduce the infectivity of the HIV-positive partner but the susceptibility of the HIV-negative partner as well. With modern antiretroviral therapies, this is possible.
Arguably, the greater challenge is avoiding infection if you’re in a casual relationship or have multiple partners. Even if you inquire about a partner’s status (and you should), you can’t always be sure that the response is accurate or up to date.
A Word From Verywell
Although HIV is not necessarily the life-threatening disease that it once was, it still poses serious risks to a person’s health and well-being if an infection occurs. By educating yourself and formulating an effective prevention strategy, you can reduce the risk of transmission and enjoy peace of mind whether you have multiple risk factors or just one.
If you need help in formulating an HIV prevention strategy, speak with your doctor or ask for a referral to a community-based HIV organization or a local STD clinic.
Demographically, HIV contraction rates are highest for people aged 25 to 34. By race, Blacks have the highest rates of new HIV diagnoses.
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