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This coincides with an increase in hepatitis C infections and new outbreaks of HIV.31 For instance, Scott County in Indiana, with a population of only 23,744, experienced 181 new HIV infections in 2015.32 Overall, current data shows that the annual number of new HIV diagnoses among people who inject drugs (sometimes referred to as PWID) in the USA decreased by 48% between 20.33 However, the level at which this reduction occurred has slowed and there are concerns that it may stagnant or reverse due to increased levels of injecting.34 In 2015, 6% of new HIV diagnoses in the United States were attributed to injecting drug use and another 3% to male-to-male sexual contact and injecting drug use.Of the HIV diagnoses attributed people who inject drugs in 2015, 59% were among men, and 41% were among women.Around half of transgender people who received an HIV diagnosis from 2009 to 2014 lived in the Southern states of the USA.Although data remains limited, a 2013 study of 2,705 transgender women living in the USA found 22% were living with HIV.In 2010, the most recent data available, 20,093 USA prisoners were living with HIV, 91% of whom were men.Of these 3,913 were in the later stages of infection and had been diagnosed with AIDS.

This was updated in 2015, to run until 2020, and is structured around four core aims: reducing new HIV infections, increasing access to care and improving health outcomes for people living with HIV, reducing HIV-related disparities and health inequities and achieving a co-ordinated national response to the epidemic.5 Following the election of President Trump in 2016, concerns have been raised over the new administration’s approach to HIV, both globally and domestically.

Men who have sex with men (sometimes referred to as ‘MSM’) are the group most affected by HIV in the USA, accounting for an estimated 2% of the USA’s population, but 70% of new annual HIV infections.9 Between 20, new HIV infections among men who have sex with men remained stable at about 26,000 a year. For example, new infections declined by 16% among young men who have sex with men (aged 13 to 24) during this time, while increasing by 23% among 25 to 34-year-old men who have sex with men.

Similarly, new infections declined by 11% among white men who have sex with men but increased 14% among Hispanic/Latino men who have sex with men.10 Although new infections between 20 have remained stable overall among African American/black men who have sex with men, among younger populations (between the ages of 25-34-year-old) African American/black men who have sex with men they have risen by 30%.11 If current diagnosis rates continue, one in six American men who have sex with men will be diagnosed with HIV in their lifetime.

Heterosexual African American/black women and transgender women of all ethnicities are also disproportionately affected.

The USA is the greatest funder of the global response to HIV, but also has an ongoing HIV epidemic itself, with around 37,600 new infections a year.2 Stigma and discrimination continue to hamper people's access to HIV prevention as well as testing and treatment services, which fuels a cycle of new infections.

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