Number of people aged 13 years and older living with a diagnosis of human immunodeficiency virus (HIV) infection per 100,000 population.
The 2020 County Health Rankings used data from 2016 for this measure.
Reason for Including
HIV is a marker for high-risk health behaviors including intravenous drug use and sex without a condom or medicines to prevent HIV transmission. This can be a valuable source of data for communities in understanding the toll that this disease takes on the health care system, as treatment for HIV often exceeds the cost of similar chronic conditions.
Key Measure Methods
HIV Prevalence is a Rate
HIV Prevalence is the rate of diagnosed cases of HIV for people aged 13 years and older in a county per 100,000 population. Rates measure the number of events in a given time period (generally one or more years) divided by the average number of people at risk during that period. Rates help us compare risks of health factors across counties with different population sizes.
Some Data are Suppressed
A missing value is reported for counties with 1 to 4 HIV cases in the time frame.
This measure of HIV prevalence includes all county residents, including those living in group quarters such as prisons or on military bases. Some states, when releasing prevalence measures, exclude these populations. This may account for differences in these values and values from your state department of health.
It is important to recognize that community and internalized stigma may result in individuals not seeking testing, individuals in healthcare not responding to the needs of those who are HIV-positive, and a lack of information regarding prevention and safe practices, which can result in greater HIV transmission.[1,3,4]
The numerator is the number of HIV cases. HIV is a reportable disease meaning that when a provider treats a patient for HIV they are required to report that case to their health department.
The denominator is the total population.
Can This Measure Be Used to Track Progress
This measure can be used to track progress with some caveats. It is important to be aware that although an increase in reported infections may reflect an increase in disease prevalence, the increase could also be due to other factors. For example, an increase may also be reflective of expanded screening, better diagnostic tests, or improved reporting by a clinic or local health department. Communities with poor screening rates may have artificially low rates of HIV. These rates are also statistically adjusted to account for reporting delays and missing transmission category. Using the statistically adjusted data is preferable when tracking progress because they help to eliminate artifacts of reporting in the surveillance system.
Years of Data Used
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
Data on sexually transmitted infections were provided by the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP). The NCHHSTP is responsible for public health surveillance, prevention research, and programs to prevent and control human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS), other sexually transmitted diseases (STDs), viral hepatitis, and tuberculosis (TB). Center staff work in collaboration with governmental and nongovernmental partners at community, state, national, and international levels, applying well-integrated multidisciplinary programs of research, surveillance, technical assistance, and evaluation.
We recommend starting with the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP) database, which provides information on human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS), other sexually transmitted diseases (STDs), viral hepatitis, and tuberculosis (TB). Data on HIV prevalence can be obtained by age group, race, ethnicity, gender, transmission category, and more.
 Centers for Disease Control and Prevention. (2019). Ways to Stop HIV Stigma and Discrimination. Retrieved from https://www.cdc.gov/stophivtogether/campaigns/hiv-stigma/stop-hiv-stigma/index.html.
 Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents with HIV. Department of Health and Human Services. Available at http://aidsinfo.nih.gov/contentfiles/lvguidelines/AdultandAdolescentGL.pdf. Accessed Jan. 8, 2020.
 Valdiserri RO. HIV/AIDS Stigma: An Impediment to Public Health. American Journal of Public Health. 2002; 92, 341_342.
 Baugher AR, Beer L, Fagan JL, Mattson CL, Freedman M, Skarbinski J, Shouse RL. Prevalence of Internalized HIV-Related Stigma Among HIV-Infected Adults in Care, United States, 2011-2013. AIDS Behav. 2017 Sep;21(9):2600-2608.