During 2010-2014, American Indians/Alaska Natives (AIs/ANs) were among the two racial/ethnic groups that experienced increasing annual rates of diagnoses of HIV infection. At year-end 2014, one in five AIs/ANs living with HIV were unaware of their infection. The objective of this analysis was to describe trends among AIs/ANs in annual diagnoses and prevalence by subgroup and variations by place for the purpose of guiding HIV prevention efforts among this population.
Using National HIV Surveillance System (NHSS) data, we determined the number of HIV diagnoses reported to CDC from 2010 through 2014, and through year-end 2014 for prevalence, among US residents with diagnosed HIV infection classified as AI/AN, aged ≥ 13 years. We measured trends in annual diagnoses during 2010-2014 using arithmetic change and for 2014, we calculated diagnosis rate ratios for sex, age group, transmission category, and place of residence at diagnosis. We also measured trends in prevalence during 2010–2014 using estimated annual percent change (EAPC) with 95% confidence intervals (CI), overall and for transmission category and jurisdiction.
During 2010–2014, the overall rate of annual diagnoses of HIV infection among AIs/ANs increased by 17.3%. Annual diagnosis rates increased among male AIs/ANs by 25.5%, those aged 13-34 years by 28.0%, in the South by 37.7% and in large metropolitan areas by 16.3%. For 2014, the male to female diagnosis rate ratio was 4.1 and 9.3 for those aged 13-34 years as compared to those aged ≥ 55. In addition, AIs/ANs were 1.6 times as likely to have their HIV infection diagnosed in the West as compared to the Northeast and 3.4 times as likely to have their HIV infection diagnosed in a large metropolitan area as compared to a nonmetropolitan area. Overall prevalence increased, (EAPC 3.2, 2.1-4.3) as did the prevalence among men who have sex with men (EAPC 3.9, 1.6-6.3). Prevalence rates increased in 2 jurisdictions, were stable in 27, decreased in none and could not be calculated in 22 due to small cell sizes.
Increasing trends among AIs/ANs suggest growing vulnerability to HIV. Prevention efforts should be strengthened for all AIs/ANs-particularly for men who have sex with men, those aged 13-34 years, and those residing in urban areas and the West. The increasing trend in the South represents an emerging threat.