Core Indicators for Monitoring the Ending the HIV Epidemic Initiative: National HIV Surveillance System Data Reported through December 2021; and Preexposure Prophylaxis (PrEP) Data Reported through September 2021

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HIV Surveillance Data Tables

Core Indicators for Monitoring the Ending the HIV Epidemic Initiative:
National HIV Surveillance System Data Reported through December 2021; and Preexposure Prophylaxis (PrEP) Data Reported through September 2021

This issue of HIV Surveillance Data Tables is published by the Division of HIV Prevention (DHP), National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention (CDC), U.S. Department of Health and Human Services, Atlanta, Georgia.

Data are presented for diagnoses of HIV infection reported to CDC through December 2021 and preexposure prophylaxis (PrEP) data reported through September 2021.

HIV Surveillance Data Tables is not copyrighted and may be used and copied without permission. Citation of the source is, however, appreciated.

Suggested Citation

Centers for Disease Control and Prevention. Core indicators for monitoring the Ending the HIV Epidemic initiative: National HIV Surveillance System Data Reported through December 2021; and Preexposure Prophylaxis (PrEP) Data Reported through September 2021. HIV Surveillance Data Tables 2022;3(No. 1). https://www.cdc.gov/hiv/library/reports/surveillance-data-tables/index.html. Published May 2022. Accessed [date].

Download the full report pdf icon[PDF – 1 MB].

Technical Notes

The Ending the HIV Epidemic in the U.S. (EHE) ini­tiative leverages critical scientific advances in HIV prevention, diagnosis, treatment, and outbreak response [1]. The goal of the initiative is to reduce new HIV infections by 75% by 2025 and then by at least 90% by 2030. The 6 core indicators of the EHE initiative are the following:

  • New HIV infections: the estimated number of new HIV infections in a calendar year.
  • Knowledge of HIV status: the estimated percentage of persons with HIV who have received a diagnosis.
  • HIV diagnoses: the number of HIV infections confirmed by laboratory or clinical evidence in a calendar year.
  • Linkage to HIV medical care: the percentage of persons who have received a diagnosis of HIV infection in a calendar year and were linked to HIV medical care within 1 month.
  • HIV viral suppression: the percentage of persons living with diagnosed HIV who have a suppressed viral load at the most recent test in a calendar year.
  • Preexposure prophylaxis (PrEP) coverage: the percentage of the number of persons prescribed PrEP in a calendar year relative to the estimated number of persons with indications for PrEP in a calendar year.

The Centers for Disease Control and Prevention (CDC) routinely releases HIV Surveil­lance Data Tables on the core indicators for EHE to allow for more timely monitoring of progress. This release of provisional (2017–2020) and preliminary (2021) data on EHE core indicators does not include estimates of new HIV infections (HIV incidence) and knowledge of HIV status due to the impact of the COVID-19 pandemic on HIV testing in the U.S. [2–5]. CDC currently uses surveillance data and a CD4-depletion model to estimate the number of new HIV infections in the U.S. The CD4-based model cannot be used to produce reliable estimates of new infections due to COVID-related disruptions in HIV testing [3–6]. The overall number of HIV diagnoses among adults and adolescents in the U.S. in 2020 (30,346) was 17% lower than in 2019 (36,528) (Table 1a). The steep reduction in diagnoses in 2020 causes concern regarding underdiagnosis during the COVID-19 pandemic [5]. Estimates of new HIV infections and knowledge of HIV status for the year 2020 will not be produced as more time and data are needed to accurately assess COVID-19’s impact on HIV transmission in the U.S.

The tables included in this report provide data on HIV diagnoses and linkage to HIV medical care for years 2017–2021 and viral suppression data for the year 2020 reported to CDC as of December 2021, and data on PrEP coverage for years 2017–2021 reported through September 2021. Data for the 4 indicators are provided at the national, state, and county levels (EHE Phase I jurisdictions only). See Tabulation and Presentation of Data for details on how the indicators are calculated.

Surveillance of HIV Infection

Data presented were reported (after the removal of personally identifiable information) to the CDC through December 31, 2021. Please use caution when inter­preting the following:

  • Data on diagnoses of HIV infection. HIV surveil­lance reports may not be representative of all per­sons with HIV because not all infected persons have been (1) tested or (2) tested at a time when the infection could be detected and diagnosed. Also, some states offer anonymous HIV testing; the results of anonymous tests are not reported to the confidential, name-based HIV registries of state and local health departments. Therefore, reports of confidential test results may not repre­sent all persons who tested positive for HIV infection.
  • Deaths and prevalence-based data (HIV viral suppression).
  • Numbers less than 12 and trends based on these numbers.
  • Data for the year 2020. The COVID-19 pandemic may have impacted access to HIV testing and care, and case surveillance activities in state/local jurisdictions [2–5].
  • Data for the year 2021. Data provided using a National HIV Surveillance System (NHSS) dataset produced prior to reaching a 12-month report­ing lag are considered preliminary.

Tabulation and Presentation of Data

Diagnoses of HIV Infection

Diagnoses of HIV infection are the numbers of per­sons aged ≥ 13 years with HIV diagnosed during 2017–2021 (Tables 1a–d). Data presented were reported (after the removal of personally identifiable information) to CDC.

An evaluation of surveillance data (2015–2019 diagnoses) found that, on average, approximately 75% of HIV diagnoses are reported to CDC during the year of diagnosis and approximately 95% of HIV diagnoses are reported to CDC by the end of the fol­lowing year. Data for the year 2020 should be interpreted with caution due to the impact of the COVID-19 pandemic on access to HIV testing, care-related services, and case surveillance activities in state/local jurisdictions [2–5]. Data for the year 2021 are considered preliminary until a 12-month reporting lag has been reached and should be interpreted with caution.

More information on counting diagnoses of HIV infection can be found at https://www.cdc.gov/hiv/library/reports/hiv-surveillance/vol-33/index.html (HIV Surveillance Report, 2020).

Linkage to HIV Medical Care

Linkage to HIV medical care within 1 month of HIV diagnosis is measured for persons aged ≥ 13 years whose infection was diagnosed during January 2020 through September 2021, and who resided in any of the jurisdictions (including EHE Phase I jurisdictions) with complete reporting of labo­ratory data to CDC at the time of diagnosis (Tables 2a–c). The numerator is the number of persons aged ≥ 13 years whose HIV infection was diagnosed during January 2020 through September 2021 and who had ≥ 1 CD4 T-lymphocyte (CD4) or viral load (VL) tests within 1 month of HIV diagno­sis. The denominator is the number of persons aged ≥ 13 years whose HIV infection was diagnosed during January 2020 through September 2021. Reporting of linkage to HIV medical care data requires a minimum 3-month reporting lag to account for delays in reporting of laboratory results to NHSS; therefore, data on linkage to HIV medical care in these surveillance tables are for persons with HIV diagnosed during January 2020 through September 2021 and that were reported to NHSS through December 2021. Data are not provided for states and associated jurisdictions that do not have laws requiring reporting of all CD4 and viral loads, or that have incomplete reporting of laboratory data to CDC. Areas without laws: Idaho and New Jersey. Areas with incomplete reporting: Kentucky, Pennsylvania, Puerto Rico, and Vermont.

Data for the year 2020 should be interpreted with caution due to the impact of the COVID-19 pandemic on access to HIV testing, care-related services, and case surveillance activities in state/local jurisdictions [2–5]. Data for the year 2021 are considered preliminary until a 12-month reporting lag has been reached and should be interpreted with caution.

More information on calculating linkage to care can be found at https://www.cdc.gov/hiv/library/reports/hiv-surveillance/vol-27-no-3/index.html (Monitoring selected national HIV prevention and care objectives by using HIV surveillance data—United States and 6 dependent areas, 2020).

Viral Suppression

Viral suppression at most recent test during 2020 is measured for persons aged ≥ 13 years who resided, as of their most recent known address during 2020, in any of the jurisdictions (including EHE Phase I jurisdictions) with complete reporting of laboratory data to CDC, and who were alive at the end of 2020 (Tables 3a–c). The numerator is the number of persons aged ≥ 13 years with HIV infection diagnosed by the end of 2019, and who had a VL of < 200 copies/mL at the most recent test in 2020. The denominator is the number of persons aged ≥ 13 years with HIV diagnosed by the end of 2019, and who were alive at the end of 2020. Data used to calculate prevalence are based on deaths reported to CDC as of December 2021. The following areas had incomplete reporting of deaths for the year 2020, and viral suppression data should be interpreted with caution: Kansas, North Carolina, Puerto Rico, and South Carolina. Data for Maryland should be interpreted with caution due to incomplete reporting of case information to CDC during December 2021. Data are not provided for states and associated EHE Phase I jurisdictions that do not have laws requiring reporting of all CD4 and viral loads, or that have incomplete reporting of laboratory data to CDC. Areas without laws: Idaho and New Jersey. Areas with incomplete reporting: Kentucky, Pennsylvania, Puerto Rico, and Vermont.

Data for the year 2020 should be interpreted with caution due to the impact of the COVID-19 pandemic on access to HIV testing, care-related services, and case surveillance activities in state/local jurisdictions [2–5].

More information on calculating viral suppression can be found at https://www.cdc.gov/hiv/library/reports/hiv-surveillance/vol-27-no-3/index.html (Monitoring selected national HIV prevention and care objectives by using HIV surveillance data—United States and 6 dependent areas, 2020).

Preexposure Prophylaxis Coverage

Preexposure prophylaxis (PrEP) coverage, reported as a percentage, is defined as the number of persons aged ≥ 16 years classified as having been prescribed PrEP during the specified year divided by the estimated number of persons aged ≥ 16 years who had indications for PrEP during the speci­fied year (Tables 4a–4c). PrEP coverage is an EHE indicator that is not a reportable disease or condition and is not reported to NHSS. Multiple data sources, described below, are used to calculate PrEP coverage.

Please use caution when interpreting PrEP data. Different data sources were used in the numerator and denominator to calculate PrEP coverage.

Persons prescribed PrEP
National pharmacy data from the IQVIA Real World Data—Longitudinal Prescriptions database (hereafter, IQVIA database) are used to classify persons aged ≥ 16 years who have been prescribed PrEP in the spe­cific year. The IQVIA database captures prescriptions from all payers and represents approximately 92% of all prescriptions from retail pharmacies and 60%–86% from mail-order outlets in the United States. The database does not include prescriptions from some closed health care systems that do not make their pre­scription data available to IQVIA. Therefore, these are minimum estimates of PrEP coverage. The annual number of persons classified as having been pre­scribed PrEP was based on a validated algorithm that discerns whether tenofovir disoproxil fumarate and emtricitabine (TDF/FTC) was prescribed for PrEP after excluding prescriptions for HIV treatment, hepa­titis B treatment, or HIV postexposure prophylaxis [7–9]. Tenofovir alafenamide and emtricitabine (TAF/FTC) was approved as an alternative drug for PrEP by the U.S. Food and Drug Administration (FDA) in October 2019. Starting with the 2019 data, TAF/FTC was included in the algorithm to classify the number of persons prescribed PrEP. In addition, generic TDF/FTC for PrEP became available in the United States in October 2020. Starting with the 2020 data, generic TDF/FTC was included in the algorithm to classify the number of persons prescribed PrEP.

The number of persons classified as having been prescribed PrEP is reported by sex, age group, and race/ethnicity. Transmission category data are not available in the IQVIA database, and race/ethnicity data are available for < 40% of persons with PrEP prescriptions. Please use caution when interpreting PrEP data by race/ethnicity. Race/ethnicity catego­ries available in the IQVIA database include White, Black/African American, Hispanic/Latino, and other. The number of persons prescribed PrEP for each racial/ethnic group presented in this report was extrapolated by applying the racial/ethnic distribu­tion of known records to those for which data on race/ethnicity were unknown.

Geographic Designations
In the IQVIA database, a person’s location is reported as a 3-digit ZIP code prefix (hereafter, ZIP3) assigned by the U.S. Postal Service. To estimate the number of persons prescribed PrEP at the state or county level, a probability-based approach is used to crosswalk between ZIP3s and states/counties by using data from (a) the U.S. Census Bureau’s American Community Survey (ACS) 5-year estimates by ZIP Code Tabulation Areas (ZCTAs) [10], and (b) the U.S Department of Housing and Urban Development’s ZIP Code Crosswalk Files [11]. Because of reliability concerns, subnational estimates of <40 are not included.

Persons with PrEP indications
The ACS and U.S. Census Bureau files were used to estimate the number of men who have sex with men (MSM) in a jurisdiction [12, 13]. Next, behavioral data from the National Health and Nutrition Examination Survey (NHANES) were used to estimate the proportion of HIV-negative MSM with indications for PrEP [14].

The number of HIV-negative MSM with indications for PrEP was multiplied by the ratio of percentage of diagnoses during the specified year attributed to other major transmission risk groups compared to the percentage among MSM in a given state or county. The estimated numbers of persons with indications for PrEP in the 3 major transmission risk groups (MSM, heterosexuals, persons who inject drugs) in each jurisdiction were then summed to yield a state- or county-specific estimate. State estimates were then summed for a national total of persons with indications for PrEP [12]. Jurisdictional estimates were rounded to the nearest 10.

The tables included in this report provide updated data on PrEP coverage for the years 2017 through September 2021 by using the IQVIA data reported through September 2021. IQVIA conducts data quality assurance activities. As a result, the number of persons classified as having been prescribed PrEP in a given year might change from time to time. The impact of the changes may vary by demographic category nationally and by jurisdiction. The data sources used to estimate the number of persons with indications for PrEP have different schedules of availability. Consequently, the availability of a denominator lags the availability of a numerator by approximately 1 year or more. PrEP coverage data with a lagged denominator are considered preliminary.

For this release of HIV Surveillance Data Tables, 2017 denominators were used for 2017 PrEP coverage data; 2018 denominators were used for 2018, 2019, 2020, and 2021 PrEP coverage data; consequently, 2019 through September 2021 PrEP coverage data are considered preliminary. In addition to being preliminary, data for the year 2020 through September 2021 should be interpreted with caution and with an awareness of the impact of the COVID-19 pandemic on filling PrEP prescriptions in state/local jurisdictions [15].

More information on calculating PrEP coverage can be found at
https://www.cdc.gov/hiv/library/reports/hiv-surveillance/vol-27-no-3/index.html (Monitoring selected national HIV prevention and care objectives by using HIV surveillance data—United States and 6 dependent areas, 2020).

References

  1. HHS. What is Ending the HIV Epidemic in the U.S.? https://www.hiv.gov/federal-response/ending-the-hiv-epidemic/overviewexternal icon. Updated June 2, 2021. Accessed October 25, 2021.
  2. CDC [Schuchat A, CDC COVID-19 Response Team]. Public health response to the initiation and spread of pandemic COVID-19 in the United States, February 24–April 21, 2020. MMWR 2020;69(18):551–556. doi:http://dx.doi.org/10.15585/mmwr.mm6918e2
  3. Delaney KP, Jayanthi P, Emerson B, et al. Impact of COVID-19 on commercial laboratory testing for HIV in the United Statesexternal icon. 2021 CROI, March 6-10, 2021. Abstract 739
  4. Moitra E, Tao J, Olsen J, Shearer RD, Wood BR, Busch AM, LaPlante A, Baker JV, Chan PA. Impact of the COVID-19 pandemic on HIV testing rates across four geographically diverse urban centres in the United States: An observational studyexternal icon. Lancet Reg Health Am. 2022 Mar;7:100159. doi: 10.1016/j.lana.2021.100159.
  5. Chang JJ, Chen Q, Hechter RC, Dionne-Odom J, Bruxvoort K. Change in HIV and STI testing and diagnoses during the COVID-19 pandemicexternal icon. 2022 CROI, February 12-16 and 22-24, 2022. Abstract 142.
  6. Song R, Hall HI, Green TA, Szwarcwald CL, Pantazis N. Using CD4 data to estimate HIV inci­dence, prevalence, and percent of undiagnosed infec­tions in the United Statesexternal icon. J Acquir Immune Defic Syndr 2017;74(1):3–9. doi:10.1097/QAI.0000000000001151
  7. Wu H, Mendoza MC, Huang YA, Hayes T, Smith DK, Hoover KW. Uptake of HIV preexposure prophylaxis among commercially insured persons—United States, 2010–2014external icon. Clin Infect Dis 2017; 64(2):144–149. doi:10.1093/cid/ciw701
  8. CDC [Huang YA, Zhu W, Smith DK, Harris N, Hoover KW]. HIV preexposure prophylaxis, by race and ethnicity—United States, 2014–2016. MMWR 2018;67(41):1147–1150. doi:10.15585/mmwr.mm6741a3
  9. Furukawa NW, Smith DK, Gonzalez CJ, et al. Evaluation of algorithms used for PrEP surveillance using a reference population from New York City, July 2016– June 2018external icon. Public Health Rep 2020;135(2):202–210. doi:10.1177/0033354920904085
  10. U.S. Census Bureau. American Community Survey 5- year data (2009–2019). https://www.census.gov/data/developers/data-sets/acs-5year.2019.htmlexternal icon. Published December 10, 2020. Accessed October 25, 2021.
  11. U.S. Department of Housing and Urban Development (HUD). HUD USPS ZIP code crosswalk files. https://www.huduser.gov/portal/datasets/usps_crosswalk.htmlexternal icon. Updated June 2021. Accessed October 25, 2021.
  12. Grey JA, Bernstein KT, Sullivan PS, Purcell DW, Chesson HW, Gift TL, Rosenberg ES. Estimating the population sizes of men who have sex with men in US states and counties using data from the American Community Surveyexternal icon. JMIR public health and surveillance. 2016;2(1):e14.
  13. Purcell DW, Johnson CH, Lansky A, Prejean J, Stein R, Denning P, et al. Estimating the population size of men who have sex with men in the United States to obtain HIV and syphilis ratesexternal icon. Open AIDS J 2012;6:98-107.
  14. CDC [Smith DK, Van Handel M, Wolitski RJ, et al]. Vital Signs: Estimated percentages and numbers of adults with indications for preexposure prophylaxis to prevent HIV acquisition—United States, 2015. MMWR 2015;64(46):1291–1295. doi:10.15585/mmwr.mm6446a4
  15. Huang YA, Zhu W, Wiener, et al. Impact of COVID-19 on HIV Preexposure prophylaxis prescriptions in the United States – A time series analysisexternal icon. Clin Infect Dis January 2022. doi: 10.1093/cid/ciac038

Suggested Citation

Centers for Disease Control and Prevention. Core indicators for monitoring the Ending the HIV Epidemic initiative: National HIV Surveillance System Data Reported through December 2021; and Preexposure Prophylaxis (PrEP) Data Reported through September 2021. HIV Surveillance Data Tables 2022;3(No. 1). https://www.cdc.gov/hiv/library/reports/surveillance-data-tables/index.html. Published May 2022. Accessed [date].

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Acknowledgments

This issue of HIV Surveillance Data Tables was prepared by the following staff and contractors of the Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, CDC: Anna Satcher Johnson, Zanetta Gant, Ya-lin Huang, Dawn Smith, Jianmin Li, Xiaohong Hu, Baohua Wu, Kyung Lee, Pei Hou, Weiming Zhu, Lei Yu, Ishwarya Ravichandran, Saja Khader, Norma Harris, and Michael Friend (editing and desktop publishing).

The Web and Consumer Services Team of the Prevention Communications Branch are acknowledged for their contributions to the report website.

Publication of HIV Surveillance Data Tables was made possible by the contributions of the state and territorial health departments and the HIV surveillance programs that provided surveillance data to CDC.

Table 1a. Diagnoses of HIV infection among persons aged ≥13 years, by selected characteristics, 2017–2021—United States
2017 2018 2019 2020 (COVID-19 pandemic)a 2021 (preliminary)b
No. No. No. No. No.
Gender
Male 30,414 29,690 28,918 24,242 24,863
Female 7,242 7,037 6,890 5,409 5,647
Transgender womanc 612 627 652 638 643
Transgender manc 33 48 45 40 46
Additional gender identityd 15 15 23 17 32
Age at diagnosis (yr)
13–24 8,277 7,848 7,638 6,082 5,956
25–34 13,395 13,384 13,075 11,258 11,499
35–44 7,240 7,180 7,114 5,924 6,643
45–54 5,567 5,235 4,887 3,929 3,833
≥55 3,837 3,770 3,814 3,153 3,300
Race/ethnicity
American Indian/Alaska Native 200 173 204 200 198
Asian 923 862 733 635 630
Black/African American 16,223 15,736 15,471 12,824 12,846
Hispanic/Latinoe 9,925 9,945 9,889 7,999 8,775
Native Hawaiian/other Pacific Islander 50 61 66 65 74
White 9,628 9,433 9,063 7,831 8,110
Multiracial 1,367 1,207 1,102 792 598
Transmission category (based on sex at birth)f
Male-to-male sexual contact 25,346 24,545 23,975 20,572 21,230
Injection drug use
      Male 1,292 1,407 1,381 1,178 1,273
      Female 1,086 1,105 1,154 855 944
Male-to-male sexual contact and injection drug use 1,470 1,465 1,524 1,105 1,099
Heterosexual contactg
      Male 2,902 2,877 2,669 2,012 1,895
      Female 6,131 5,928 5,730 4,536 4,696
Otherh
      Male 31 37 39 29 37
      Female 58 53 54 59 59
Region of residencei
Northeast 5,977 5,557 5,305 4,262 4,159
Midwest 5,096 4,927 4,740 4,118 4,203
South 19,662 19,364 19,149 15,661 16,740
West 7,581 7,569 7,334 6,305 6,129
Total 38,316 37,417 36,528 30,346 31,231

Abbreviation: CDC, the Centers for Disease Control and Prevention [footnotes only].
Note. Data are for cases reported to CDC through December 2021.

aData for the year 2020 should be interpreted with caution due to the impact of the COVID-19 pandemic on HIV access to HIV testing, care-related services, and case surveillance activities in state/local jurisdictions.
bData for the year 2021 are considered preliminary until a 12-month reporting delay has been reached, and should be interpreted with caution.
c“Transgender woman” includes individuals who were assigned “male” sex at birth but have ever identified as “female” gender. “Transgender man” includes individuals who were assigned “female” sex at birth but have ever identified as “male” gender.
dAdditional gender identity examples include “bigender,” “gender queer,” and “two-spirit.”
eHispanic/Latino persons can be of any race.
fTransmission category is determined based on assigned sex at birth; data have been statistically adjusted to account for missing transmission category, therefore values may not sum to column subtotals and total.
gSexual contact with a person known to have, or with a risk factor for, HIV infection.
hOther risk factors, including hemophilia, blood transfusion, and risk factor not reported or not identified.
iData are based on residence at time of diagnosis of HIV infection.

Table 1b. Diagnoses of HIV Infection among Persons Aged ≥13 Years, by Selected Characteristics, 2017–2021—United States and 6 Dependent Areas
2017 2018 2019 2020 (COVID-19 pandemic)a 2021 (preliminary)b
No. No. No. No. No.
Gender
Male 30,778 30,058 29,247 24,488 25,140
Female 7,336 7,117 6,971 5,450 5,720
Transgender womanc 614 629 654 640 643
Transgender manc 33 49 45 40 46
Additional gender identityd 15 15 23 17 32
Age at diagnosis (yr)
13–24 8,355 7,927 7,701 6,135 6,011
25–34 13,520 13,519 13,191 11,336 11,593
35–44 7,327 7,255 7,192 5,985 6,720
45–54 5,658 5,328 4,954 3,977 3,904
≥55 3,916 3,839 3,902 3,202 3,353
Race/ethnicity
American Indian/Alaska Native 200 173 204 200 198
Asian 926 866 740 635 630
Black/African American 16,227 15,744 15,476 12,827 12,849
Hispanic/Latinoe 10,371 10,377 10,280 8,285 9,117
Native Hawaiian/other Pacific Islander 51 63 70 65 74
White 9,633 9,436 9,068 7,831 8,115
Multiracial 1,368 1,209 1,102 792 598
Transmission category (based on sex at birth)f
Male-to-male sexual contact 25,580 24,810 24,204 20,758 21,436
Injection drug use
      Male 1,326 1,431 1,406 1,198 1,292
      Female 1,095 1,107 1,160 857 947
Male-to-male sexual contact and injection drug use 1,483 1,477 1,536 1,109 1,100
Heterosexual contactg
      Male 2,987 2,947 2,734 2,051 1,945
      Female 6,216 6,008 5,805 4,575 4,765
Otherh
      Male 31 37 40 29 38
      Female 58 53 55 59 59
Region of residencei
Northeast 5,977 5,557 5,305 4,262 4159
Midwest 5,096 4,927 4,740 4,118 4203
South 19,662 19,364 19,149 15,661 16740
West 7,581 7,569 7,334 6,305 6129
U.S. dependent areas 460 451 412 289 350
Total 38,776 37,868 36,940 30,635 31581

Abbreviation: CDC, the Centers for Disease Control and Prevention [footnotes only].
Note. Data are for cases reported to CDC through December 2021.

aData for the year 2020 should be interpreted with caution due to the impact of the COVID-19 pandemic on HIV access to HIV testing, care-related services, and case surveillance activities in state/local jurisdictions.
bData for the year 2021 are considered preliminary until a 12-month reporting delay has been reached, and should be interpreted with caution.
c“Transgender woman” includes individuals who were assigned “male” sex at birth but have ever identified as “female” gender. “Transgender man” includes individuals who were assigned “female” sex at birth but have ever identified as “male” gender.
dAdditional gender identity examples include “bigender,” “gender queer,” and “two-spirit.”
eHispanic/Latino persons can be of any race.
fTransmission category is determined based on assigned sex at birth; data have been statistically adjusted to account for missing transmission category, therefore values may not sum to column subtotals and total.
gSexual contact with a person known to have, or with a risk factor for, HIV infection.
hOther risk factors, including hemophilia, blood transfusion, and risk factor not reported or not identified.
iData are based on residence at time of diagnosis of HIV infection.

Table 1c. Diagnoses of HIV infection among persons aged ≥13 years, by area of residence, 2017–2021—United States and 6 dependent areas
2017 2018 2019 2020 (COVID-19 pandemic)a 2021 (preliminary)b
Area of residence No. No. No. No. No.
Alabama 647 604 635 585 386
Alaska 30 23 27 29 22
Arizona 720 752 747 662 723
Arkansas 287 286 289 242 337
California 4,839 4,749 4,454 3,924 3,535
Colorado 434 403 465 324 356
Connecticut 274 259 212 171 199
Delaware 125 91 94 93 81
District of Columbia 316 280 250 197 97
Florida 4,558 4,515 4,361 3,408 4,437
Georgia 2,606 2,486 2,407 1,977 1,689
Hawaii 76 72 64 51 58
Idaho 45 37 33 32 36
Illinois 1,372 1,369 1,257 1,096 842
Indiana 515 511 486 433 484
Iowa 125 114 100 100 120
Kansas 120 157 132 138 155
Kentucky 367 378 328 300 351
Louisiana 989 957 880 722 956
Maine 29 31 30 16 30
Maryland 1,020 990 915 706 634
Massachusetts 602 648 538 434 269
Michigan 773 719 674 519 628
Minnesota 278 286 273 229 286
Mississippi 429 475 471 402 390
Missouri 505 450 487 359 507
Montana 31 24 25 14 21
Nebraska 87 77 81 73 85
Nevada 497 497 518 392 450
NewHampshire 32 38 31 33 30
NewJersey 1,105 1,020 1,083 805 902
New Mexico 148 155 174 131 143
New York 2,736 2,449 2,336 1,963 1,844
North Carolina 1,291 1,180 1,365 1,079 1,297
North Dakota 38 36 40 36 21
Ohio 982 973 965 888 821
Oklahoma 300 278 336 333 260
Oregon 203 229 199 180 193
Pennsylvania 1,093 1,018 993 775 828
RhodeIsland 86 76 71 53 51
South Carolina 708 725 722 655 525
South Dakota 41 29 33 34 24
Tennessee 721 742 773 647 782
Texas 4,356 4,425 4,342 3,548 3,623
Utah 113 120 135 131 119
Vermont 20 18 11 12 6
Virginia 865 866 833 628 764
Washington 435 496 480 421 467
West Virginia 77 86 148 139 131
Wisconsin 260 206 212 213 230
Wyoming 10 12 13 14 6
Subtotal 38,316 37,417 36,528 30,346 31,231
Guam 4 7 11 0 1
Northern Mariana Islands 1 1 2 0 0
Puerto Rico 447 431 391 286 346
Republic of Palau 0 0 0 0 0
U.S. Virgin Islands 8 12 8 3 3
Subtotal 460 451 412 289 350
Total 38,776 37,868 36,940 30,635 31,581

Abbreviation: CDC, the Centers for Disease Control and Prevention [footnotes only].
Note. Data are based on residence at the time of diagnosis of HIV infection. Data are for cases reported to CDC through December 2021.

aData for the year 2020 should be interpreted with caution due to the impact of the COVID-19 pandemic on HIV access to HIV testing, care-related services, and case surveillance activities in state/local jurisdictions.
bData for the year 2021 are considered preliminary until a 12-month reporting delay has been reached, and should be interpreted with caution.

Table 1d. Diagnoses of HIV infection among persons aged ≥13 years, by area of residence, 2017–2021—Ending the HIV Epidemic Phase I jurisdictions
2017 2018 2019 2020 (COVID-19 pandemic)a 2021 (preliminary)b
Area of residence No. No. No. No. No.
Arizona
Maricopa County 493 528 505 477 489
California
Alameda County 202 199 217 157 175
Los Angeles County 1,743 1,703 1,537 1,382 1,229
Orange County 314 288 247 264 250
Riverside County 275 263 266 239 207
Sacramento County 180 169 147 153 97
San Bernardino County 255 263 295 263 250
San Diego County 414 383 383 296 175
San Francisco County 244 239 208 153 178
District of Columbia 316 280 250 197 97
Florida
Broward County 671 617 597 460 664
Duval County 297 275 279 229 281
Hillsborough County 300 297 265 247 333
Miami-Dade County 1,142 1,163 1,134 781 1,161
Orange County 465 454 464 369 443
Palm Beach County 287 281 236 213 168
Pinellas County 163 175 182 152 140
Georgia
Cobb County 159 153 178 135 105
DeKalb County 366 356 343 269 240
Fulton County 619 596 532 477 456
Gwinnett County 180 148 211 149 104
Illinois
Cook County 985 979 882 774 627
Indiana
Marion County 226 205 205 167 199
Louisiana
East Baton Rouge Parish 163 177 155 124 148
Orleans Parish 180 177 158 105 156
Maryland
Baltimore City 237 231 197 175 120
Montgomery County 165 126 131   80 79
Prince George’s County 303 304 278 214 194
Massachusetts
Suffolk County 163 148 133 135 95
Michigan
Wayne County 322 300 289 227 251
Nevada
Clark County 449 443 451 343 403
New Jersey
Essex County 310 259 233 199 220
Hudson County 161 162 150 123 121
New York
Bronx County 503 458 502 338 353
Kings County 629 544 474 444 368
New York County 398 375 333 296 305
Queens County 433 414 354 316 291
North Carolina
Mecklenburg County 269 237 267 209 268
Ohio
Cuyahoga County 148 151 159 185 152
Franklin County 222 192 215 204 160
Hamilton County 187 182 172 132 114
Pennsylvania
Philadelphia County 510 438 445 331 304
Puerto Rico
San Juan Municipio 112 103   88   71 77
Tennessee
Shelby County 259 291 261 235 273
Texas
Bexar County 349 323 331 282 306
Dallas County 818 794 748 658 710
Harris County 1,100 1,203 1,218 921 1,001
Tarrant County 304 282 312 292 280
Travis County 212 188 177 162 213
Washington
King County 213 289 242 198 232

Abbreviation: CDC, the Centers for Disease Control and Prevention [footnotes only].
Note. Data are based on residence at the time of diagnosis of HIV infection. Data are for cases reported to CDC through December 2021.

aData for the year 2020 should be interpreted with caution due to the impact of the COVID-19 pandemic on HIV access to HIV testing, care-related services, and case surveillance activities in state/local jurisdictions.
bData for the year 2021 are considered preliminary until a 12-month reporting delay has been reached, and should be interpreted with caution.

Table 2a. Linkage to HIV medical care within 1 month of HIV diagnosis among persons aged ≥13 years, by selected characteristics, January 2020–September 2021—45 states and the District of Columbia
2020 (COVID-19 pandemic)a 2021 (January–September, preliminary)h
Total diagnoses ≥1 CD4 or VL tests No CD4 or VL test Total diagnoses ≥1 CD4 or VL tests No CD4 or VL test
No. No. % No. % No. No. % No. %
Gender
Male 22,727 18,739 82.5 3,988 17.5 19,466 16,242 83.4 3,224 16.6
Female   5,042  4,146 82.2 896 17.8 4,281   3,547 82.9 734 17.1
Transgender womanb   599  484 80.8 115 19.2   517   433 83.8   84 16.2
Transgender manb 38 35 92.1  3 7.9  41 38 92.7 3 7.3
Additional gender identityc 16 15 93.8  1 6.3  24 20 83.3 4 16.7
Age at diagnosis (yr)
13–24   5,728  4,585 80.0 1,143 20.0 4,719   3,823 81.0 896 19.0
25–34 10,570  8,701 82.3 1,869 17.7 8,999   7,496 83.3 1,503 16.7
35–44   5,545  4,573 82.5 972 17.5 5,135   4,301 83.8 834 16.2
45–54   3,644  3,081 84.5 563 15.5 2,962   2,516 84.9 446 15.1
≥55   2,935  2,479 84.5 456 15.5 2,514   2,144 85.3 370 14.7
Race/ethnicity
American Indian/Alaska Native   195  156 80.0 39 20.0   168   142 84.5   26 15.5
Asian   612  538 87.9 74 12.1   482   432 89.6   50 10.4
Black/African American 12,069  9,615 79.7 2,454 20.3 10,010   8,131 81.2 1,879 18.8
Hispanic/Latinod   7,498  6,380 85.1 1,118 14.9 6,912   5,954 86.1 958 13.9
Native Hawaiian/other Pacific Islander 63 54 85.7  9 14.3  51 41 80.4   10 19.6
White   7,256  6,066 83.6 1,190 16.4 6,228   5,177 83.1 1,051 16.9
Multiracial   729  610 83.7 119 16.3   478   403 84.3   75 15.7
Transmission category (based on sex at birth)e
Male-to-male sexual contact 19,414 16,097 82.9 3,317 17.1 16,726 14,033 83.9 2,692 16.1
Injection drug use   1,846  1,439 77.9 407 22.1 1,650   1,271 77.0 379 23.0
Male   1,052  819 77.8 234 22.2   949   720 75.9 229 24.1
Female   794  620 78.1 174 21.9   701   550 78.6 150 21.4
Male-to-male sexual contact and injection drug use   1,023  821 80.3 202 19.7   870   706 81.1 164 18.9
Heterosexual contactf   6,058  4,994 82.4 1,064 17.6 5,015   4,212 84.0 803 16.0
Male   1,826  1,479 81.0 347 19.0 1,432   1,211 84.6 220 15.4
Female   4,231  3,515 83.1 717 16.9 3,583   3,001 83.8 582 16.2
Totalg 28,422 23,419 82.4 5,003 17.6 24,329 20,280 83.4 4,049 16.6

Note. Data are based on residence at diagnosis of HIV infection. Data are for cases reported to CDC through December 2021. Linkage to HIV medical care was measured by documentation of ≥1 CD4 or VL tests ≤1 month after HIV diagnosis. Data not provided for states and associated counties that do not have laws requiring reporting of all CD4 and viral loads, or that have incomplete reporting of laboratory data to CDC. Areas without laws: Idaho and New Jersey. Areas with incomplete reporting: Kentucky, Pennsylvania (excluding Philadelphia), and Vermont.

aData for the year 2020 should be interpreted with caution due to the impact of the COVID-19 pandemic on HIV access to HIV testing, care-related services, and case surveillance activities in state/local jurisdictions.
b“Transgender woman” includes individuals who were assigned “male” sex at birth but have ever identified as “female” gender. “Transgender man” includes individuals who were assigned “female” sex at birth but have ever identified as “male” gender.
cAdditional gender identity examples include “bigender,” “gender queer,” and “two-spirit.”
dHispanic/Latino persons can be of any race.
eTransmission category is determined based on assigned sex at birth; data have been statistically adjusted to account for missing transmission category, therefore values may not sum to column subtotals and total.
fSexual contact with a person known to have, or with a risk factor for, HIV infection.
gOther risk factors including hemophilia, blood transfusion, and risk factor not reported or not identified. Data not displayed because the numbers were too small to be meaningful.
hData for the year 2021 are considered preliminary until a 12-month reporting delay has been reached, and should be interpreted with caution.

Table 2b. Linkage to HIV medical care within 1 month of HIV diagnosis among persons aged ≥13 years, by area of residence, January 2020–September 2021—45 states and the District of Columbia
2020 (COVID-19 pandemic)a 2021 (January–September, preliminary)b
Total diagnoses ≥1 CD4 or VL tests No CD4 or VL test Total diagnoses ≥1 CD4 or VL tests No CD4 or VL test
Area of residence No. No. % No. % No. No. % No. %
Alabama 585 466 79.7 119 20.3 350 273 78.0  77 22.0
Alaska 29 28 96.6   1 3.4  17 17 100 0 0.0
Arizona 662 561 84.7 101 15.3 663 568 85.7  95 14.3
Arkansas 242 193 79.8 49 20.2 274 216 78.8  58 21.2
California 3,924 3,269 83.3 655 16.7  3,028 2,552 84.3   476 15.7
Colorado 324 284 87.7 40 12.3 301 264 87.7  37 12.3
Connecticut 171 143 83.6 28 16.4 171 149 87.1  22 12.9
Delaware 93 75 80.6 18 19.4  60 50 83.3  10 16.7
District of Columbia 197 172 87.3 25 12.7  90 75 83.3  15 16.7
Florida 3,408 2,863 84.0 545 16.0  3,496 2,991 85.6   505 14.4
Georgia 1,977 1,605 81.2 372 18.8  1,495 1,285 86.0   210 14.0
Hawaii 51 44 86.3   7 13.7  50 43 86.0 7 14.0
Illinois 1,096 921 84.0 175 16.0 745 649 87.1  96 12.9
Indiana 433 323 74.6 110 25.4 390 301 77.2  89 22.8
Iowa 100 90 90.0 10 10.0  94 82 87.2  12 12.8
Kansas 138 118 85.5 20 14.5 120 108 90.0  12 10.0
Louisiana 722 549 76.0 173 24.0 720 582 80.8   138 19.2
Maine 16 15 93.8   1 6.3  25 22 88.0 3 12.0
Maryland 706 617 87.4 89 12.6 570 507 88.9  63 11.1
Massachusetts 434 382 88.0 52 12.0 251 233 92.8  18 7.2
Michigan 519 438 84.4 81 15.6 498 438 88.0  60 12.0
Minnesota 229 206 90.0 23 10.0 220 182 82.7  38 17.3
Mississippi 402 294 73.1 108 26.9 324 227 70.1  97 29.9
Missouri 359 285 79.4 74 20.6 407 315 77.4  92 22.6
Montana 14 13 92.9   1 7.1  14 13 92.9 1 7.1
Nebraska 73 65 89.0   8 11.0  78 67 85.9  11 14.1
Nevada 392 338 86.2 54 13.8 392 350 89.3  42 10.7
New Hampshire 33 26 78.8   7 21.2  27 27 100 0 0.0
New Mexico 131 111 84.7 20 15.3 107 94 87.9  13 12.1
New York 1,963 1,685 85.8 278 14.2  1,568 1,350 86.1   218 13.9
North Carolina 1,079 887 82.2 192 17.8  1,046 851 81.4   195 18.6
North Dakota 36 31 86.1   5 13.9  21 18 85.7 3 14.3
Ohio 888 761 85.7 127 14.3 710 606 85.4   104 14.6
Oklahoma 333 253 76.0 80 24.0 223 163 73.1  60 26.9
Oregon 180 150 83.3 30 16.7 148 112 75.7  36 24.3
Rhode Island 53 48 90.6   5 9.4  50 24 48.0  26 52.0
South Carolina 655 576 87.9 79 12.1 500 446 89.2  54 10.8
South Dakota 34 29 85.3   5 14.7  23 20 87.0 3 13.0
Tennessee 647 481 74.3 166 25.7 624 428 68.6   196 31.4
Texas 3,548 2,731 77.0 817 23.0  3,061 2,426 79.3   635 20.7
Utah 131 111 84.7 20 15.3  99 84 84.8  15 15.2
Virginia 628 512 81.5 116 18.5 618 502 81.2   116 18.8
Washington 421 373 88.6 48 11.4 364 323 88.7  41 11.3
West Virginia 139 99 71.2 40 28.8 107 79 73.8  28 26.2
Wisconsin 213 185 86.9 28 13.1 187 165 88.2  22 11.8
Wyoming 14 13 92.9   1 7.1    3   3 100 0 0.0

Abbreviations: CD4, CD4+ T-lymphocyte count (cells/µL) or percentage; VL, viral load (copies/mL); CDC, the Centers for Disease Control and Prevention [footnotes only].
Note. Data are based on residence at diagnosis of HIV infection. Data are for cases reported to CDC through December 2021. Linkage to HIV medical care was measured by documentation of ≥1 CD4 or VL tests ≤1 month after HIV diagnosis. Data not provided for states and associated counties that do not have laws requiring reporting of all CD4 and viral loads, or that have incomplete reporting of laboratory data to CDC. Areas without laws: Idaho and New Jersey. Areas with incomplete reporting: Kentucky, Pennsylvania, Puerto Rico, and Vermont.

aData for the year 2020 should be interpreted with caution due to the impact of the COVID-19 pandemic on HIV access to HIV testing, care-related services, and case surveillance activities in state/local jurisdictions.
bData for the year 2021 are considered preliminary until a 12-month reporting delay has been reached, and should be interpreted with caution.

Table 2c. Linkage to HIV medical care within 1 month of HIV diagnosis among persons aged ≥13 years, by area of residence, January 2020–September 2021—Ending the HIV Epidemic Phase I jurisdictions
2020 (COVID-19 pandemic)a 2021 (January–September, preliminary)b
Total diagnoses ≥1 CD4 or VL tests No CD4 or VL test Total diagnoses ≥1 CD4 or VL tests No CD4 or VL test
Area of residence No. No. % No. % No. No. % No. %
Arizona
Maricopa County 477 408 85.5 69 14.5 439 382 87.0 57 13.0
California
Alameda County 157 132 84.1 25 15.9 138 125 90.6 13 9.4
Los Angeles County 1,382 1,128 81.6 254 18.4 1,052 881 83.7 171 16.3
Orange County 264 237 89.8 27 10.2 211 185 87.7 26 12.3
Riverside County 239 196 82.0 43 18.0 185 141 76.2 44 23.8
Sacramento County 153 135 88.2 18 11.8 91 81 89.0 10 11.0
San Bernardino County 263 186 70.7 77 29.3 225 169 75.1 56 24.9
San Diego County 296 256 86.5 40 13.5 162 143 88.3 19 11.7
San Francisco County 153 144 94.1 9 5.9 144 137 95.1 7 4.9
District of Columbia 197 172 87.3 25 12.7 90 75 83.3 15 16.7
Florida
Broward County 460 402 87.4 58 12.6 506 437 86.4 69 13.6
Duval County 229 184 80.3 45 19.7 226 184 81.4 42 18.6
Hillsborough County 247 209 84.6 38 15.4 248 213 85.9 35 14.1
Miami-Dade County 781 660 84.5 121 15.5 905 785 86.7 120 13.3
Orange County 369 318 86.2 51 13.8 385 322 83.6 63 16.4
Palm Beach County 213 170 79.8 43 20.2 164 135 82.3 29 17.7
Pinellas County 152 128 84.2 24 15.8 109 89 81.7 20 18.3
Georgia
Cobb County 135 110 81.5 25 18.5 94 85 90.4 9 9.6
DeKalb County 269 224 83.3 45 16.7 216 193 89.4 23 10.6
Fulton County 477 401 84.1 76 15.9 401 348 86.8 53 13.2
Gwinnett County 149 111 74.5 38 25.5 87 78 89.7 9 10.3
Illinois
Cook County 774 662 85.5 112 14.5 556 485 87.2 71 12.8
Indiana
Marion County 167 128 76.6 39 23.4 171 134 78.4 37 21.6
Louisiana
East Baton Rouge Parish 124 99 79.8 25 20.2 117 91 77.8 26 22.2
Orleans Parish 105 84 80.0 21 20.0 106 96 90.6 10 9.4
Maryland
Baltimore City 175 150 85.7 25 14.3 108 99 91.7 9 8.3
Montgomery County 80 70 87.5 10 12.5 73 67 91.8 6 8.2
Prince George’s County 214 193 90.2 21 9.8 176 149 84.7 27 15.3
Massachusetts
Suffolk County 135 121 89.6 14 10.4 88 84 95.5 4 4.5
Michigan
Wayne County 227 186 81.9 41 18.1 198 172 86.9 26 13.1
Nevada
Clark County 343 295 86.0 48 14.0 349 311 89.1 38 10.9
New York
Bronx County 338 289 85.5 49 14.5 301 268 89.0 33 11.0
Kings County 444 376 84.7 68 15.3 317 272 85.8 45 14.2
New York County 296 250 84.5 46 15.5 258 210 81.4 48 18.6
Queens County 316 279 88.3 37 11.7 246 211 85.8 35 14.2
North Carolina
Mecklenburg County 209 173 82.8 36 17.2 222 186 83.8 36 16.2
Ohio
Cuyahoga County 185 164 88.6 21 11.4 123 110 89.4 13 10.6
Franklin County 204 180 88.2 24 11.8 144 128 88.9 16 11.1
Hamilton County 132 115 87.1 17 12.9 100 92 92.0 8 8.0
Pennsylvania
Philadelphia County 331 286 86.4 45 13.6 258 212 82.2 46 17.8
Tennessee
Shelby County 235 158 67.2 77 32.8 215 120 55.8 95 44.2
Texas
Bexar County 282 202 71.6 80 28.4 256 202 78.9 54 21.1
Dallas County 658 502 76.3 156 23.7 573 448 78.2 125 21.8
Harris County 921 698 75.8 223 24.2 845 651 77.0 194 23.0
Tarrant County 292 211 72.3 81 27.7 252 199 79.0 53 21.0
Travis County 162 130 80.2 32 19.8 162 136 84.0 26 16.0
Washington
King County 198 177 89.4 21 10.6 178 157 88.2 21 11.8

Abbreviations: CD4, CD4+ T-lymphocyte count (cells/µL) or percentage; VL, viral load (copies/mL). CDC, the Centers for Disease Control and Prevention [footnotes only].
Note. Data are based on residence at diagnosis of HIV infection. Data are for cases reported to CDC through December 2021. Linkage to HIV medical care was measured by documentation of ≥1 CD4 or VL tests ≤1 month after HIV diagnosis. Data not provided for states and associated counties that do not have laws requiring reporting of all CD4 and viral loads, or that have incomplete reporting of laboratory data to CDC. Areas without laws: Idaho and New Jersey. Areas with incomplete reporting: Kentucky, Pennsylvania (excluding Philadelphia), Puerto Rico, and Vermont.

aData for the year 2020 should be interpreted with caution due to the impact of the COVID-19 pandemic on HIV access to HIV testing, care-related services, and case surveillance activities in state/local jurisdictions.
bData for the year 2021 are considered preliminary until a 12-month reporting delay has been reached, and should be interpreted with caution.

Table 3a. HIV viral suppression during 2020 (COVID-19 pandemic) among persons aged ≥13 years with HIV infection diagnosed by year-end 2019 and alive at year-end 2020, by selected characteristics—45 states and the District of Columbia
Persons alive at year-end 2020 VL < 200 copies/mL
No. No. %
Gender
Male 717,879 466,295 65.0
Female 215,092 135,941 63.2
Transgender womana   10,625 6,967 65.6
Transgender mana 444 303 68.2
Additional gender identityb 207 148 71.5
Age at year-end 2019 (yr)
13–24 28,697 18,236 63.5
25–34 150,764    93,549 62.0
35–44 178,445 111,292 62.4
45–54 243,064 159,138 65.5
≥55 343,277 227,439 66.3
Race/ethnicity
American Indian/Alaska Native 2,988 1,844 61.7
Asianc   14,655 9,987 68.1
Black/African American 382,521 230,853 60.4
Hispanic/Latinod 220,065 139,001 63.2
Native Hawaiian/other Pacific Islander    845     545 64.5
White 275,950 193,780 70.2
Multiracial   46,546    33,597 72.2
Transmission category (based on sex at birth)e
Male-to-male sexual contact 544,758 366,068 67.2
Injection drug use 97,081 53,638 55.3
Male 55,700 28,955 52.0
Female Injection drug use 41,380    24,683 59.6
Male-to-malesexual contact and injection drug use   51,989    33,360 64.2
Heterosexualcontactf 236,672 148,910 62.9
Male   69,303    41,204 59.5
Female 167,368 107,706 64.4
Otherg 13,748 7,677 55.8
Male 6,932 3,803 54.9
Female 6,817 3,874 56.8
Totalh 944,247 609,654 64.6

Abbreviations: VL, viral load (copies/mL); CD4, CD4+ T-lymphocyte count (cells/µL) or percentage. CDC, the Centers for Disease Control and Prevention [footnotes only].
Note. Data for the year 2020 should be interpreted with caution due to the impact of the COVID-19 pandemic on HIV access to HIV testing, care-related services, and case surveillance activities in state/local jurisdictions. Data are based on address of residence as of December 31, 2020 (i.e., most recent known address). A VL test result of <200 copies/mL indicates HIV viral suppression. VL test results are from the most recent test during 2020. Data not provided for states and associated counties that do not have laws requiring reporting of all CD4 and viral loads, or that have incomplete reporting of laboratory data to CDC. Areas without laws: Idaho and New Jersey. Areas with incomplete reporting: Kentucky, Pennsylvania (excluding Philadelphia), Puerto Rico, and Vermont.

a“Transgender woman” includes individuals who were assigned “male” sex at birth but have ever identified as “female” gender. “Transgender man” includes individuals who were assigned “female” sex at birth but have ever identified as “male” gender.
bAdditional gender identity examples include “bigender,” “gender queer,” and “two-spirit.”
cIncludes legacy cases among Asian/Pacific Islander persons.
dHispanic/Latino persons can be of any race.
eTransmission category is determined based on assigned sex at birth; data have been statistically adjusted to account for missing transmission category, therefore values may not sum to column subtotals and total.
fSexual contact with a person known to have, or with a risk factor for, HIV infection.
gOther risk factors, including hemophilia, blood transfusion, and risk factor not reported or not identified.
hIncludes 677 persons of unknown race/ethnicity.

Table 3b. HIV viral suppression during 2020 (COVID-19 Pandemic) among persons aged ≥13 years with HIV infection diagnosed by year-end 2019 and alive at year-end 2020, by area of residence—45 states and the District of Columbia
Persons alive at year-end 2020 VL < 200 copies/mL
Area of residence No. No. %
Alabama 13,579 8,875 65.4
Alaska 701 550 78.5
Arizona 17,060 11,242 65.9
Arkansas 5,821 2,885 49.6
California 130,455 85,115 65.2
Colorado 12,928 7,512 58.1
Connecticut 10,402 7,418 71.3
Delaware 3,349 2,405 71.8
District of Columbia 13,596 7,444 54.8
Florida 111,231 74,884 67.3
Georgia 55,634 33,659 60.5
Hawaii 2,330 1,776 76.2
Illinois 34,712 22,449 64.7
Indiana 11,440 7,493 65.5
Iowa 2,836 2,248 79.3
Kansasa 3,213 2,324 72.3
Louisiana 20,676 13,895 67.2
Maine 1,635 1,266 77.4
Marylandb 32,715 20,335 62.2
Massachusetts 20,602 13,685 66.4
Michigan 16,352 11,342 69.4
Minnesota 8,771 5,858 66.8
Mississippi 9,326 5,156 55.3
Missouri 12,511 8,108 64.8
Montana 671 517 77.0
Nebraska 2,248 1,357 60.4
Nevada 10,656 6,818 64.0
New Hampshire 1,296 951 73.4
New Mexico 3,811 2,176 57.1
New York 123,315 77,805 63.1
North Carolinaa 32,498 21,291 65.5
North Dakota 490 330 67.3
Ohio 22,818 14,775 64.8
Oklahoma 6,281 3,696 58.8
Oregon 7,164 5,597 78.1
Rhode Island 2,615 1,812 69.3
South Carolinaa 17,283 12,434 71.9
South Dakota 660 313 47.4
Tennessee 17,572 11,841 67.4
Texas 93,839 56,378 60.1
Utah 3,132 2,142 68.4
Virginia 23,425 14,683 62.7
Washington 13,877 10,697 77.1
West Virginia 1,951 1,175 60.2
Wisconsin 6,428 4,718 73.4
Wyoming 342 224 65.5

Abbreviations: CD4, CD4+ T-lymphocyte count (cells/µL) or percentage; VL, viral load (copies/mL); CDC, the Centers for Disease Control and Prevention [footnotes only].
Note. Data for the year 2020 should be interpreted with caution due to the impact of the COVID-19 pandemic on HIV access to HIV testing, care-related services, and case surveillance activities in state/local jurisdictions. Data are based on address of residence as of December 31, 2020 (i.e., most recent known address). A VL test result of <200 copies/mL indicates HIV viral suppression. VL test results are from the most recent test during 2020. Data not provided for states and associated counties that do not have laws requiring reporting of all CD4 and viral loads, or that have incomplete reporting of laboratory data to CDC. Areas without laws: Idaho and New Jersey. Areas with incomplete reporting: Kentucky, Pennsylvania, Puerto Rico, and Vermont.

aData should be interpreted with caution due to incomplete ascertainment of deaths that occurred during the year 2020.
bData should be interpreted with caution due to incomplete reporting of case information to CDC during December 2021.

Table 3c. HIV viral suppression during 2020 (COVID-19 Pandemic) among persons aged ≥13 years with HIV infection diagnosed by year-end 2019 and alive at year-end 2020, by area of residence — Ending the HIV Epidemic Phase I jurisdictions
Persons alive at year-end 2020 VL < 200 copies/mL
Area of residence No. No. %
Arizona
Maricopa County 11,643 7,851 67.4
California
Alameda County 5,883 4,117 70.0
Los Angeles County 48,881 30,955 63.3
Orange County 6,835 4,269 62.5
Riverside County 9,530 7,298 76.6
Sacramento County 4,364 2,993 68.6
San Bernardino County 4,596 2,773 60.3
San Diego County 13,026 7,687 59.0
SanFrancisco County 11,650 8,424 72.3
District of Columbia 13,596 7,444 54.8
Florida
Broward County 19,525 13,410 68.7
Duval County 6,111 3,953 64.7
Hillsborough County 6,988 5,106 73.1
Miami-Dade County 25,779 15,256 59.2
Orange County 8,617 6,118 71.0
Palm Beach County 7,830 5,034 64.3
Pinellas County 4,678 3,582 76.6
Georgia
Cobb County 3,347 2,153 64.3
DeKalb County 8,728 5,417 62.1
Fulton County 15,528 9,375 60.4
Gwinnett County 3,039 1,989 65.4
Illinois
Cook County 25,183 16,001 63.5
Indiana
Marion County 4,625 3,128 67.6
Louisiana
East Baton Rouge Parish 3,977 2,967 74.6
Orleans Parish 4,845 3,233 66.7
Marylanda
Baltimore City 9,762 5,786 59.3
Montgomery County 3,776 2,089 55.3
Prince George’s County 7,867 4,993 63.5
Massachusetts
Suffolk County 5,571 3,673 65.9
Michigan
Wayne County 6,779 4,371 64.5
Nevada
Clark County 9,049 5,797 64.1
New York
Bronx County 27,306 17,310 63.4
Kings County 25,770 15,749 61.1
New York County 26,113 15,448 59.2
Queens County 15,731 9,653 61.4
North Carolinab
Mecklenburg County 5,993 3,891 64.9
Ohio
Cuyahoga County 4,737 3,118 65.8
Franklin County 5,003 3,309 66.1
Hamilton County 2,987 1,862 62.3
Pennsylvania
Philadelphia County 16,678 9,762 58.5
Tennessee
Shelby County 6,072 3,939 64.9
Texas
Bexar County 6,480 4,097 63.2
Dallas County 18,383 10,482 57.0
Harris County 26,174 16,371 62.5
Tarrant County 5,942 3,582 60.3
Travis County 5,006 3,403 68.0
Washington
King County 6,919 5,516 79.7

Abbreviations: VL, viral load (copies/mL); CD4, CD4+ T-lymphocyte count (cells/µL) or percentage; CDC, the Centers for Disease Control and Prevention [footnotes only].
Note. Data for the year 2020 should be interpreted with caution due to the impact of the COVID-19 pandemic on HIV access to HIV testing, care-related services, and case surveillance activities in state/local jurisdictions. Data are based on address of residence as of December 31, 2020 (i.e., most recent known address). A VL test result of <200 copies/mL indicates HIV viral suppression. VL test results are from the most recent test during 2020. Data not provided for states and associated counties that do not have laws requiring reporting of all CD4 and viral loads, or that have incomplete reporting of laboratory data to CDC. Areas without laws: Idaho and New Jersey. Areas with incomplete reporting: Kentucky, Pennsylvania (excluding Philadelphia), Puerto Rico, and Vermont.

aData should be interpreted with caution due to incomplete reporting of case information to CDC during December 2021.
bData should be interpreted with caution due to incomplete ascertainment of deaths that occurred during the year 2020.

Table 4a. Number of persons prescribed PrEP, number of persons with PrEP indications, and PrEP coverage during January 2017 through September 2021, among persons aged ≥16 years, by selected characteristics—United States
2017 2018 2019
Persons Prescribed PrEPa Persons with PrEP Indicationsb PrEP Coveragec Persons Prescribed PrEPa Persons with PrEP Indicationsb PrEP Coveragec Persons Prescribed PrEPa Persons with PrEP Indicationsb PrEP Coveragec
No. No. % No. No. % No. No. %
Sex at birth
Male 144,108 993,840 14.5 204,722 989,200 20.7 252,180 989,200 25.5
Female 11,261 227,240 5.0 15,872 227,010 7.0 20,998 227,010 9.2
Age (yr)
16–24 19,682 259,130 7.6 29,821 246,290 12.1 36,867 246,290 15.0
25–34 62,820 425,690 14.8 90,097 434,680 20.7 112,015 434,680 25.8
35–44 36,442 233,560 15.6 51,111 238,470 21.4 63,290 238,470 26.5
45–54 24,167 180,870 13.4 31,556 173,420 18.2 36,906 173,420 21.3
≥55 12,300 121,830 10.1 18,047 123,350 14.6 24,157 123,350 19.6
Race/ethnicityd
Black/African American 19,647 475,100 4.1 29,103 468,540 6.2 37,084 468,540 7.9
Hispanic/Latinoe 22,623 299,580 7.6 33,973 312,820 10.9 43,334 312,820 13.9
Other 6,847 132,040 5.2 9,635 131,180 7.3 11,649 131,180 8.9
White 106,351 311,250 34.2 148,002 300,650 49.2 181,255 300,650 60.3
Total 155,468 1,221,080 12.7 220,713 1,216,210 18.1 273,321 1,216,210 22.5
Table 4a. Number of persons prescribed PrEP, number of persons with PrEP indications, and PrEP coverage during January 2017 through September 2021, among persons aged ≥16 years, by selected characteristics—United States
2020 (COVID-19 pandemic) 2021 (January – September)
Persons Prescribed PrEPa Persons with PrEP Indicationsb PrEP Coveragec Persons Prescribed PrEPa Persons with PrEP Indicationsb PrEP Coveragec
No. No. % No. No. %
Sex at birth
Male 276,810 989,200 28.0 293,764 989,200 29.7
Female 23,667 227,010 10.4 22,994 227,010 10.1
Age (yr)
16–24 38,420 246,290 15.6 38,462 246,290 15.6
25–34 119,125 434,680 27.4 126,174 434,680 29.0
35–44 72,044 238,470 30.2 78,257 238,470 32.8
45–54 40,603 173,420 23.4 41,124 173,420 23.7
≥55 30,313 123,350 24.6 32,927 123,350 26.7
Race/ethnicityd
Black/African American 42,568 468,540 9.1 44,351 468,540 9.5
Hispanic/Latinoe 49,306 312,820 15.8 52,750 312,820 16.9
Other 12,254 131,180 9.3 12,825 131,180 9.8
White 196,478 300,650 65.4 207,180 300,650 68.9
Total 300,606 1,216,210 24.7 317,106 1,216,210 26.1

Abbreviations: PrEP, preexposure propphylaxis; FDA, Food and Drug Administration [footnotes only].
Note. Data for years 2020 and 2021 should be interpreted with caution due to the impact of the COVID-19 pandemic on filling PrEP prescriptions in state/local jurisdictions.

aEstimated by using data from IQVIA pharmacy database reported through September 2021 based on an algorithm that included FDA-approved drugs for PrEP. Data for which values are unknown were not reported thus values may not sum to column total.
bEstimated by using 2017 and 2018 data from National HIV Surveilance System, National Health and Nutrition Examination Survey, and U.S. Census Bureau’s American Community Survey. Data are rounded to the nearest 10. Data for which values are unknown were not reported; thus, values may not sum to column total. The data sources used to estimate the number of persons with indications for PrEP have different schedules of data availability. Consequently, the availability of a denominator may lag the availability of a numerator. In this table, 2017 denominators were used for 2017 PrEP coverage data; 2018 denominators were used for 2018 – 2021 PrEP coverage data.
cPrEP coverage, reported as a percentage, was calculated as the number who have been prescribed PrEP divided by the estimated number of persons who had indications for PrEP.
dRace/ethnicity data were only available for <40% of persons prescribed PrEP each year. Number prescribed PrEP and PrEP coverage for race/ethnicity reported in the table were adjusted applying the distribution of records with known race/ethnicity to records with missing race/ethnicity.
eHispanic/Latino can be of any race.

Table 4b. Number of persons prescribed PrEP, number of persons with PrEP indications, and PrEP coverage during January 2017 through September 2021, among persons aged ≥16 years, by area of residence—United States and Puerto Rico
2017 2018 2019
Persons Prescribed PrEPa Persons with PrEP Indicationsb PrEP Coveragec Persons Prescribed PrEPa Persons with PrEP Indicationsb PrEP Coveragec Persons Prescribed PrEPa Persons with PrEP Indicationsb PrEP Coveragec
Area of residence No. No. % No. No. % No. No. %
Alabama 1,017 11,390 8.9 1,543 11,020 14.0 1,834 11,020 16.6
Alaska 126 2,370 5.3 198 1,780 11.1 229 1,780 12.9
Arizona 2,252 26,820 8.4 3,510 25,780 13.6 4,550 25,780 17.6
Arkansas 418 4,840 8.6 590 5,130 11.5 732 5,130 14.3
California 26,160 166,150 15.7 36,033 165,030 21.8 41,473 165,030 25.1
Colorado 2,392 25,510 9.4 3,434 25,120 13.7 4,336 25,120 17.3
Connecticut 1,578 10,970 14.4 2,265 9,560 23.7 2,656 9,560 27.8
Delaware 281 4,860 5.8 423 4,400 9.6 473 4,400 10.8
District of Columbia 3,807 13,710 27.8 5,017 12,950 38.7 5,817 12,950 44.9
Florida 8,449 125,160 6.8 14,711 125,330 11.7 21,670 125,330 17.3
Georgia 4,483 40,680 11.0 6,332 39,030 16.2 8,584 39,030 22.0
Hawaii 442 5,440 8.1 679 4,360 15.6 812 4,360 18.6
Idaho 265 3,860 6.9 364 4,790 7.6 471 4,790 9.8
Illinois 10,157 54,620 18.6 13,886 55,860 24.9 16,572 55,860 29.7
Indiana 1,550 21,640 7.2 2,199 22,170 9.9 2,962 22,170 13.4
Iowa 770 4,280 18.0 1,152 4,760 24.2 1,419 4,760 29.8
Kansas 523 5,570 9.4 726 5,060 14.3 898 5,060 17.7
Kentucky 756 13,170 5.7 1,215 12,990 9.4 1,614 12,990 12.4
Louisiana 2,187 15,490 14.1 3,318 15,920 20.8 3,920 15,920 24.6
Maine 312 3,270 9.5 495 3,950 12.5 638 3,950 16.2
Maryland 2,709 28,150 9.6 3,977 27,300 14.6 4,928 27,300 18.1
Massachusetts 5,500 25,110 21.9 7,616 24,900 30.6 9,265 24,900 37.2
Michigan 2,260 28,520 7.9 3,496 29,570 11.8 4,361 29,570 14.7
Minnesota 2,510 23,770 10.6 3,482 21,720 16.0 4,178 21,720 19.2
Mississippi 472 5,030 9.4 656 4,530 14.5 940 4,530 20.8
Missouri 1,890 19,420 9.7 2,737 18,370 14.9 3,465 18,370 18.9
Montana 121 2,750 4.4 185 2,290 8.1 267 2,290 11.7
Nebraska 351 2,590 13.6 475 2,180 21.8 617 2,180 28.3
Nevada 1,054 10,870 9.7 1,489 11,390 13.1 2,163 11,390 19.0
New Hampshire 321 3,110 10.3 500 3,020 16.6 617 3,020 20.4
New Jersey 3,299 28,590 11.5 4,619 25,280 18.3 5,660 25,280 22.4
New Mexico 610 6,720 9.1 810 6,800 11.9 1,074 6,800 15.8
New York 22,571 74,450 30.3 30,105 72,640 41.4 35,001 72,640 48.2
North Carolina 2,577 33,110 7.8 4,014 32,490 12.4 5,370 32,490 16.5
North Dakota 109 1,230 8.9 161 1,520 10.6 193 1,520 12.7
Ohio 3,500 40,940 8.5 4,785 40,320 11.9 6,105 40,320 15.1
Oklahoma 532 11,030 4.8 813 11,030 7.4 1,146 11,030 10.4
Oregon 2,042 20,720 9.9 2,751 19,750 13.9 3,372 19,750 17.1
Pennsylvania 6,110 36,160 16.9 8,553 36,490 23.4 10,111 36,490 27.7
Puerto Ricod 127 9,700 1.3 237 9,700 2.4 330 9,700 3.4
Rhode Island 632 4,360 14.5 866 3,880 22.3 1,084 3,880 27.9
South Carolina 712 10,390 6.9 1,251 10,390 12.0 1,726 10,390 16.6
South Dakota 54 1,000 5.4 99 910 10.9 148 910 16.3
Tennessee 1,719 22,890 7.5 2,609 22,460 11.6 3,886 22,460 17.3
Texas 11,093 123,400 9.0 17,731 123,790 14.3 22,989 123,790 18.6
Utah 1,049 6,900 15.2 1,489 6,840 21.8 2,018 6,840 29.5
Vermont 219 1,490 14.7 281 1,060 26.5 337 1,060 31.8
Virginia 2,052 33,670 6.1 3,140 31,430 10.0 4,389 31,430 14.0
Washington 6,334 35,600 17.8 8,236 40,050 20.6 9,823 40,050 24.5
West Virginia 235 3,660 6.4 372 5,250 7.1 568 5,250 10.8
Wisconsin 1,288 14,230 9.1 1,856 12,980 14.3 2,462 12,980 19.0
Wyoming 49 1,410 3.5 71 890 8.0 94 890 10.6
Table 4b. Number of persons prescribed PrEP, number of persons with PrEP indications, and PrEP coverage during January 2017 through September 2021, among persons aged ≥16 years, by area of residence—United States and Puerto Rico
2020 (COVID-19 pandemic) 2021 (January – September)
Persons Prescribed PrEPa Persons with PrEP Indicationsb PrEP Coveragec Persons Prescribed PrEPa Persons with PrEP Indicationsb PrEP Coveragec
Area of residence No. No. % No. No. %
Alabama 1,918 11,020 17.4 2,387 11,020 21.7
Alaska 244 1,780 13.7 255 1,780 14.3
Arizona 5,051 25,780 19.6 5,690 25,780 21.1
Arkansas 870 5,130 17.0 1,096 5,130 21.4
California 42,304 165,030 25.6 43,451 165,030 26.3
Colorado 4,765 25,120 19.0 5,238 25,120 20.9
Connecticut 2,477 9,560 25.9 2,532 9,560 26.5
Delaware 467 4,400 10.6 547 4,400 12.4
District of Columbia 5,953 12,950 46.0 6,062 12,950 46.8
Florida 34,581 125,330 27.6 36,017 125,330 28.7
Georgia 9,745 39,030 25.0 10,743 39,030 27.5
Hawaii 903 4,360 20.7 966 4,360 22.2
Idaho 660 4,790 13.8 725 4,790 15.1
Illinois 15,938 55,860 28.5 16,143 55,860 28.9
Indiana 3,198 22,170 14.4 3,708 22,170 16.7
Iowa 1,516 4,760 31.8 1,611 4,760 33.8
Kansas 944 5,060 18.7 1,083 5,060 21.4
Kentucky 1,668 12,990 12.8 1,898 12,990 14.6
Louisiana 3,603 15,920 22.6 3,670 15,920 23.1
Maine 663 3,950 16.8 772 3,950 19.5
Maryland 4,798 27,300 17.6 5,063 27,300 18.5
Massachusetts 9,372 24,900 37.6 8,641 24,900 34.7
Michigan 4,687 29,570 15.9 5,131 29,570 17.4
Minnesota 4,190 21,720 19.3 4,509 21,720 20.8
Mississippi 1,098 4,530 24.2 1,407 4,530 31.1
Missouri 3,570 18,370 19.4 3,659 18,370 19.9
Montana 299 2,290 13.1 344 2,290 15.0
Nebraska 725 2,180 33.3 842 2,180 38.6
Nevada 2,496 11,390 21.9 4,308 11,390 37.8
New Hampshire 649 3,020 21.5 690 3,020 22.8
New Jersey 5,921 25,280 23.4 6,264 25,280 24.8
New Mexico 1,237 6,800 18.2 1,378 6,800 20.3
New York 34,090 72,640 46.9 33,948 72,640 46.7
North Carolina 6,160 32,490 19.0 6,854 32,490 21.1
North Dakota 216 1,520 14.2 235 1,520 15.5
Ohio 6,833 40,320 16.9 7,427 40,320 18.4
Oklahoma 1,524 11,030 13.8 2,004 11,030 18.2
Oregon 3,819 19,750 19.3 3,991 19,750 20.2
Pennsylvania 10,608 36,490 29.1 11,458 36,490 31.4
Puerto Ricod 368 9,700 3.8 485 9,700 5.0
Rhode Island 1,153 3,880 29.7 1,329 3,880 34.3
South Carolina 2,120 10,390 20.4 2,549 10,390 24.5
South Dakota 144 910 15.8 179 910 19.7
Tennessee 5,168 22,460 23.0 6,330 22,460 28.2
Texas 27,520 123,790 22.2 30,482 123,790 24.6
Utah 2,370 6,840 34.6 2,865 6,840 41.9
Vermont 321 1,060 30.3 415 1,060 39.2
Virginia 5,131 31,430 16.3 5,438 31,430 17.3
Washington 10,025 40,050 25.0 9,898 40,050 24.7
West Virginia 522 5,250 9.9 612 5,250 11.7
Wisconsin 2,521 12,980 19.4 2,398 12,980 18.5
Wyoming 99 890 11.1 117 890 13.1

Abbreviations: PrEP, preexposure propphylaxis; FDA, Food and Drug Administration [footnotes only].
Note. Data for years 2020 and 2021 should be interpreted with caution due to the impact of the COVID-19 pandemic on filling PrEP prescriptions in state/local jurisdictions
aEstimated by using data from IQVIA pharmacy database reported through September 2021 based on an algorithm that included FDA approved drugs for PrEP. Data for which values are unknown were not reported thus values may not sum to column total.
bEstimated by using 2017 and 2018 data from National HIV Surveilance System, National Health and Nutrition Examination Survey, and U.S. Census Bureau’s American Community Survey. Data are rounded to the nearest 10. Data for which values are unknown were not reported thus values may not sum to column total. The data sources used to estimate the number of persons with indications for PrEP have different schedules of data availability. Consequently, the availability of a denominator may lag the availability of a numerator. In this table, 2017 denominators were used for 2017 PrEP coverage data; 2018 denominators were used for 2018 – 2021 PrEP coverage data.
cPrEP coverage, reported as a percentage, was calculated as the number who have been prescribed PrEP divided by the estimated number of persons who had indications for PrEP.
dNumber of persons with PrEP indications in Puerto Rico is not avaible in 2017. Number of persons with PrEP indications in 2018 is used for 2017 denominator.

Table 4c. Number of persons prescribed PrEP, number of persons with PrEP indications, and PrEP coverage during January 2017 through September 2021, among persons aged ≥16 years, by area of residence—Ending the HIV Epidemic Phase I jurisdictions
2017 2018 2019
Persons Prescribed PrEPa Persons with PrEP Indicationsb PrEP Coveragec Persons Prescribed PrEPa Persons with PrEP Indicationsb PrEP Coveragec Persons Prescribed PrEPa Persons with PrEP Indicationsb PrEP Coveragec
Area of residence No. No. % No. No. % No. No. %
Arizona
Maricopa County 1,796 23,540 7.6 2,813 22,720 12.4 3,520 22,720 15.5
California
Alameda County 1,412 7,260 19.4 1,858 8,930 20.8 2,163 8,930 24.2
Los Angeles County 8,668 64,180 13.5 12,111 67,450 18.0 13,681 67,450 20.3
Orange County 1,052 9,990 10.5 1,607 10,510 15.3 2,028 10,510 19.3
Riverside County 979 11,040 8.9 1,410 11,080 12.7 1,765 11,080 15.9
Sacramento County 579 5,460 10.6 786 5,920 13.3 947 5,920 16.0
San Bernardino County 375 12,450 3.0 605 11,890 5.1 751 11,890 6.3
San Diego County 2,348 19,420 12.1 3,364 14,500 23.2 3,700 14,500 25.5
San Francisco County 6,293 11,330 55.5 7,862 10,840 72.5 8,785 10,840 81.0
District of Columbia 3,807 13,710 27.8 5,017 12,950 38.7 5,817 12,950 44.9
Florida
Broward County 1,938 20,030 9.7 2,859 20,470 14.0 3,766 20,470 18.4
Duval County 249 9,250 2.7 373 8,970 4.2 503 8,970 5.6
Hillsborough County 602 12,670 4.8 1,087 12,910 8.4 1,374 12,910 10.6
Miami-Dade County 1,937 22,190 8.7 3,821 21,760 17.6 6,498 21,760 29.9
Orange County 1,003 16,500 6.1 1,864 15,310 12.2 2,764 15,310 18.1
Palm Beach County 371 7,620 4.9 578 9,170 6.3 874 9,170 9.5
Pinellas County 472 10,470 4.5 808 9,530 8.5 1,119 9,530 11.7
Georgia
Cobb County 269 3,570 7.5 384 3,070 12.5 556 3,070 18.1
DeKalb County 872 6,370 13.7 1,190 6,290 18.9 1,548 6,290 24.6
Fulton County 1,915 12,060 15.9 2,578 13,120 19.6 3,270 13,120 24.9
Gwinnett County 312 3,390 9.2 457 3,240 14.1 675 3,240 20.8
Illinois
Cook County 8,519 38,270 22.3 11,440 39,060 29.3 13,544 39,060 34.7
Indiana
Marion County 682 8,490 8.0 864 9,150 9.4 1,123 9,150 12.3
Louisiana
East Baton Rouge Parish 222 1,290 17.2 439 1,810 24.3 489 1,810 27.0
Orleans Parish 856 5,230 16.4 1,198 4,590 26.1 1,509 4,590 32.9
Maryland
Baltimore City 464 6,000 7.7 653 6,330 10.3 897 6,330 14.2
Montgomery County 522 5,790 9.0 766 5,770 13.3 892 5,770 15.5
Prince George’s County 453 3,830 11.8 667 4,040 16.5 813 4,040 20.1
Massachusetts
Suffolk County 1,671 7,050 23.7 2,218 6,520 34.0 2,749 6,520 42.2
Michigan
Wayne County 681 9,470 7.2 1,022 9,270 11.0 1,201 9,270 13.0
Nevada
Clark County 896 8,790 10.2 1,250 11,670 10.7 1,849 11,670 15.8
New Jersey
Essex County 393 5,190 7.6 578 4,090 14.1 673 4,090 16.5
Hudson County 633 4,720 13.4 866 4,650 18.6 1,046 4,650 22.5
New York
Bronx County 1,297 6,690 19.4 2,009 5,570 36.1 2,214 5,570 39.7
Kings County 4,746 15,300 31.0 6,324 15,650 40.4 7,487 15,650 47.8
New York County 9,473 14,790 64.1 12,162 15,540 78.3 13,953 15,540 89.8
Queens County 2,518 8,740 28.8 3,276 9,230 35.5 3,819 9,230 41.4
North Carolina
Mecklenburg County 649 9,430 6.9 959 8,450 11.3 1,340 8,450 15.9
Ohio
Cuyahoga County 596 8,200 7.3 810 7,520 10.8 949 7,520 12.6
Franklin County 1,315 13,660 9.6 1,640 11,620 14.1 2,039 11,620 17.5
Hamilton County 263 6,430 4.1 438 7,720 5.7 559 7,720 7.2
Pennsylvania
Philadelphia County 2,369 8,550 27.7 3,235 9,840 32.9 3,647 9,840 37.1
Puerto Rico
San Juan Municipiod —e 2,190 n/a —e 2,190 n/a —e 2,190 n/a
Tennessee
Shelby County 304 7,590 4.0 460 6,450 7.1 632 6,450 9.8
Texas
Bexar County 665 13,010 5.1 1,131 11,920 9.5 1,497 11,920 12.6
Dallas County 2,123 22,000 9.7 3,241 28,670 11.3 4,062 28,670 14.2
Harris County 2,529 39,780 6.4 3,949 40,670 9.7 4,901 40,670 12.1
Tarrant County 658 11,550 5.7 1,173 11,340 10.3 1,452 11,340 12.8
Travis County 2,200 10,810 20.4 3,375 11,590 29.1 4,543 11,590 39.2
Washington
King County 4,571 13,690 33.4 5,786 17,890 32.3 6,878 17,890 38.4
Table 4c. Number of persons prescribed PrEP, number of persons with PrEP indications, and PrEP coverage during January 2017 through September 2021, among persons aged ≥16 years, by area of residence—Ending the HIV Epidemic Phase I jurisdictions
2020 (COVID-19 pandemic) 2021 (January – September)
Persons Prescribed PrEPa Persons with PrEP Indicationsb PrEP Coveragec Persons Prescribed PrEPa Persons with PrEP Indicationsb PrEP Coveragec
Area of residence No. No. % No. No. %
Arizona
Maricopa County 3,888 22,720 17.1 4,373 22,720 19.2
California
Alameda County 2,029 8,930 22.7 1,895 8,930 21.2
Los Angeles County 14,796 67,450 21.9 15,970 67,450 23.7
Orange County 2,218 10,510 21.1 2,476 10,510 23.6
Riverside County 1,913 11,080 17.3 2,138 11,080 19.3
Sacramento County 967 5,920 16.3 933 5,920 15.8
San Bernardino County 816 11,890 6.9 999 11,890 8.4
San Diego County 3,767 14,500 26.0 3,790 14,500 26.1
San Francisco County 8,085 10,840 74.6 7,269 10,840 67.1
District of Columbia 5,953 12,950 46.0 6,062 12,950 46.8
Florida
Broward County 6,711 20,470 32.8 6,982 20,470 34.1
Duval County 742 8,970 8.3 767 8,970 8.6
Hillsborough County 1,516 12,910 11.7 1,689 12,910 13.1
Miami-Dade County 10,284 21,760 47.3 9,869 21,760 45.4
Orange County 3,870 15,310 25.3 4,101 15,310 26.8
Palm Beach County 3,015 9,170 32.9 2,361 9,170 25.7
Pinellas County 1,214 9,530 12.7 1,411 9,530 14.8
Georgia
Cobb County 643 3,070 20.9 698 3,070 22.7
DeKalb County 1,712 6,290 27.2 1,840 6,290 29.3
Fulton County 3,573 13,120 27.2 3,825 13,120 29.2
Gwinnett County 787 3,240 24.3 866 3,240 26.7
Illinois
Cook County 12,861 39,060 32.9 12,971 39,060 33.2
Indiana
Marion County 1,199 9,150 13.1 1,410 9,150 15.4
Louisiana
East Baton Rouge Parish 528 1,810 29.2 520 1,810 28.7
Orleans Parish 1,341 4,590 29.2 1,345 4,590 29.3
Maryland
Baltimore City 854 6,330 13.5 866 6,330 13.7
Montgomery County 902 5,770 15.6 988 5,770 17.1
Prince George’s County 823 4,040 20.4 882 4,040 21.8
Massachusetts
Suffolk County 2,804 6,520 43.0 2,385 6,520 36.6
Michigan
Wayne County 1,225 9,270 13.2 1,337 9,270 14.4
Nevada
Clark County 2,095 11,670 18.0 3,816 11,670 32.7
New Jersey
Essex County 706 4,090 17.3 724 4,090 17.7
Hudson County 1,050 4,650 22.6 1,100 4,650 23.7
New York
Bronx County 2,043 5,570 36.7 1,820 5,570 32.7
Kings County 7,411 15,650 47.4 7,649 15,650 48.9
New York County 13,669 15,540 88.0 13,880 15,540 89.3
Queens County 3,787 9,230 41.0 3,695 9,230 40.0
North Carolina
Mecklenburg County 1,571 8,450 18.6 1,712 8,450 20.3
Ohio
Cuyahoga County 961 7,520 12.8 1,091 7,520 14.5
Franklin County 2,317 11,620 19.9 2,448 11,620 21.1
Hamilton County 630 7,720 8.2 698 7,720 9.0
Pennsylvania
Philadelphia County 3,489 9,840 35.5 3,524 9,840 35.8
Puerto Rico
San Juan Municipiod —e 2,190 n/a 50 2,190 2.3
Tennessee
Shelby County 810 6,450 12.6 837 6,450 13.0
Texas
Bexar County 1,767 11,920 14.8 2,042 11,920 17.1
Dallas County 5,172 28,670 18.0 5,803 28,670 20.2
Harris County 5,966 40,670 14.7 6,607 40,670 16.2
Tarrant County 1,650 11,340 14.6 1,875 11,340 16.5
Travis County 5,076 11,590 43.8 5,204 11,590 44.9
Washington
King County 6,971 17,890 39.0 6,775 17,890 37.9

Abbreviations: PrEP, preexposure propphylaxis; FDA, Food and Drug Administration [footnotes only].
Note. Data for years 2020 and 2021 should be interpreted with caution due to the impact of the COVID-19 pandemic on filling PrEP prescriptions in state/local jurisdictions.

aEstimated by using data from IQVIA pharmacy database reported through September 2021 based on an algorithm that included FDA approved drugs for PrEP. Data for which values are unknown were not reported thus values may not sum to column total.
bEstimated by using 2017 and 2018 data from National HIV Surveilance System, National Health and Nutrition Examination Survey, and U.S. Census Bureau’s American Community Survey. Data are rounded to the nearest 10. Data for which values are unknown were not reported thus values may not sum to column total. The data sources used to estimate the number of persons with indications for PrEP have different schedules of data availability. Consequently, the availability of a denominator may lag the availability of a numerator. In this table, 2017 denominators were used for 2017 PrEP coverage data; 2018 denominators were used for 2018 – 2021 PrEP coverage data.
cPrEP coverage, reported as a percentage, was calculated as the number who have been prescribed PrEP divided by the estimated number of persons who had indications for PrEP.
dNumber of persons with PrEP indications in San Juan Municipio is not avaible in 2017. Number of persons with PrEP indications in 2018 is used for 2017 denominator.
eData value <40 was not reported due to unreliability.

Table 5. Ending the HIV Epidemic Phase I jurisdictions
Counties Territories States
Arizona Puerto Ricoa Alabama
Maricopa County San Juan Municipioa Arkansas
California Kentuckya
Alameda County Mississippi
Los Angeles County Missouri
Orange County Oklahoma
Riverside County South Carolina
Sacramento County
San Bernardino County
San Diego County
San Francisco County
District of Columbia
Florida
Broward County
Duval County
Hillsborough County
Miami-Dade County
Orange County
Palm Beach County
Pinellas County
Georgia
Cobb County
DeKalb County
Fulton County
Gwinnett County
Illinois
Cook County
Indiana
Marion County
Louisiana
East Baton Rouge Parish
Orleans Parish
Maryland
Baltimore City
Montgomery County
Prince George’s County
Massachusetts
Suffolk County
Michigan
Wayne County
Nevada
Clark County
New Jerseyb
Essex Countyb
Hudson Countyb
New York
Bronx County
Kings County
New York County
Queens County
North Carolina
Mecklenburg County
Ohio
Cuyahoga County
Franklin County
Hamilton County
Pennsylvaniaa
Philadelphia County
Tennessee
Shelby County
Texas
Bexar County
Dallas County
Harris County
Tarrant County
Travis County
Washington
King County

Abbreviations: CDC, the Centers for Disease Control and Prevention PrEP, preexposure prophylaxis; CD4, CD4+ T-lymphocyte count (cells/μL) or percentage.

Note. For more information on the Ending the HIV Epidemic in the U.S. initiative, see https://www.hiv.gov/federal-response/ending-the-hiv-epidemic/overviewexternal icon

aLinkage to care and viral suppression data are not provided for states and associated counties that have incomplete reporting of laboratory data to CDC: Kentucky, Pennsylvania (excluding Philadelphia), Puerto Rico, and Vermont.
bLinkage to care and viral suppression data are not provided for states and associated counties that do not have laws requiring reporting of all CD4 and viral loads laboratory results: New Jersey.

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View Page In:pdf icon Core Indicators for Monitoring the Ending the HIV Epidemic Initiative: National HIV Surveillance System Data Reported through December 2021; and Preexposure Prophylaxis (PrEP) Data Reported through September 2021
Page last reviewed: May 24, 2022
Content source: Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention