Estimates of lifetime risk are used to compare the burden of disease across populations. This method may be a useful tool for clinicians, partners and policy makers when describing the burden of HIV since it can be more readily understood by the public. We estimated lifetime risk of a HIV diagnosis by sex, race/ethnicity and place of residence.
HIV diagnosis, mortality and census population data were used to derive lifetime risk estimates of HIV diagnosis for all ages, by sex, race/ethnicity and place of residence. Data on HIV diagnoses were obtained from the National HIV Surveillance System (NHSS). The numbers of HIV diagnoses (NHSS) and non-HIV deaths (mortality data) during 2017?2019 were used to calculate probabilities of a HIV diagnosis at a given age, conditional on never having received a HIV diagnosis prior to that age using a competing risks method. The lifetime risk estimate is the cumulative probability of HIV diagnosis from birth. The analysis was conducted in DevCan 6.7.3. Comparisons were made to findings from a 2010?2014 analysis.
Based on 2017?2019 US data, the lifetime risk of a HIV diagnosis was 1 in 120 overall and 1 in 76 for males and 1 in 309 for females. At every age, males had a higher estimated lifetime risk than females (Figure). Lifetime risk for males was 1 in 27 for Black persons, 1 in 50 for Hispanic/Latino persons, 1 in 89 for Native Hawaiian/other Pacific Islander persons, 1 in 116 for American Indian/Alaska Native persons, 1 in 171 for White persons and 1 in 187 for Asian persons; and for females was 1 in 75 for Black persons, 1 in 287 for Hispanic/Latino persons, 1 in 435 for American Indian/Alaska Native persons, 1 in 611 for Native Hawaiian/other Pacific Islander persons, 1 in 874 for White persons and 1,298 for Asian persons. Lifetime risk improved in all groups except for American Indian/Alaska Native, Hispanic/Latino and Native Hawaiian/other Pacific Islander males and White females, as compared to 2010?2014. By jurisdiction, the lifetime risk ranged from 1 in 39 in DC to 1 in 655 in Wyoming. The states with the highest lifetime risks were Georgia (1 in 59), Florida (1 in 63), Louisiana (1 in 69), Nevada (1 in 84) and Maryland (1 in 85).
Overall, lifetime risk of HIV diagnosis has decreased among both males and females, but this decrease was not seen across all races/ethnicities. There is need for continued progress in HIV prevention and treatment since disparities still persist by sex and race/ethnicity.