Deeper Look: The HIV Care Continuum

Step 1: HIV Diagnosis

Definition: Receiving a positive HIV test confirmed by a healthcare provider and becoming aware of one’s HIV status.

Why This Step Matters

Early diagnosis is the gateway to all HIV care and treatment. According to CDC data, 87% of people living with HIV in the United States knew their HIV status in 2024, but significant gaps remain. People who don’t know their status cannot access treatment, and a CDC analysis shows that nearly 80% of new HIV infections in the U.S. in 2016 came from the nearly 40% of people who either did not know they had HIV or who received a diagnosis but were not receiving HIV care and treatment.

Current Statistics from AIDSVu Data

• National Progress: The U.S. has made substantial improvements in HIV testing and diagnosis over recent years
• Geographic Variations: Most HIV cases occur in metropolitan areas with 500,000 or more people. The South has the highest number of people with HIV, but if population size is taken into account, the Northeast has the highest rate of people with HIV
• Demographic Disparities: Testing rates and diagnosis timing vary significantly across racial, ethnic, age, and risk groups

Barriers to Diagnosis

• Stigma surrounding HIV testing
• Limited access to healthcare services
• Lack of awareness about HIV risk
• Fear of discrimination
• Geographic barriers in rural areas

Step 2: Late HIV Diagnosis

Definition: Individuals diagnosed with stage 3 HIV (AIDS) within three months of an initial HIV diagnosis.

The Challenge of Late Diagnosis

Late diagnosis represents a critical missed opportunity for early intervention. When people receive their HIV diagnosis after the virus has already progressed to AIDS, they face more complex health challenges and have had more opportunities to unknowingly transmit the virus.

Key Statistics

According to a 2024 CDC report, 33% of people aged 55 to 64 in the U.S. who received a new HIV diagnosis in 2022 already had late-stage HIV infection (AIDS) when they were diagnosed, indicating a need for routinized HIV screening in this population.

Impact on Communities

• Higher healthcare costs due to advanced disease
• Increased mortality risk
• Greater transmission risk during undiagnosed period
• More complex treatment requirements

Step 3: Linkage to Care

Definition: Having at least one documented CD4 or viral load test within 30 days of HIV diagnosis.

The Critical First Month

The period immediately following HIV diagnosis is crucial. Research shows that people who are linked to care quickly are more likely to remain engaged in treatment and achieve viral suppression. The goal is to connect everyone who tests positive for HIV to medical care within one month of their diagnosis.

Current Performance

Among persons who received diagnoses of HIV infection during 2022, 82% were linked to care within one month of diagnosis. Asian persons had the highest percentage of linkage to care within one month (88%), and Native Hawaiian/other Pacific Islander persons (74%), American Indian/Alaska Native persons (78%), Black persons (78%), and women (80%) had the lowest percentages.

Factors Affecting Linkage

• Healthcare Access: Insurance coverage, proximity to HIV specialty care
• Social Support: Family acceptance, peer support networks
• System Factors: Care coordination, navigator programs
• Individual Factors: Mental health, substance use, competing priorities

Step 4: Receipt of Care

Definition: Having had at least one CD4 or viral load test performed by a healthcare professional, demonstrating ongoing engagement with HIV medical care.

Sustained Engagement Challenges

While initial linkage to care is important, sustained engagement presents ongoing challenges. According to CDC data, for every 100 people with diagnosed HIV in 2022, about 76% received some HIV care, 54% were retained in care, and 65% were virally suppressed.

Supporting Retention in Care

• Comprehensive Services: Integrating HIV care with other health services
• Patient-Centered Approach: Flexible scheduling, cultural competency
• Address Social Determinants: Some challenges with achieving and maintaining viral suppression include HIV stigma, physical health, mental health, and structural issues—such as food insecurity, unemployment, and unstable housing or homelessness
• Technology Integration: Telemedicine, mobile health applications

Step 5: Viral Suppression

Definition: Having a viral load test result of less than 200 copies/mL at the most recent test.

The Ultimate Goal

Viral suppression represents the pinnacle of HIV care success. When achieved and maintained, it provides tremendous benefits for both individual health and public health prevention efforts.

Current National Statistics

Among persons with diagnosed HIV and alive at year-end 2022, 65% were virally suppressed at the most recent viral load test. The lowest percentages of viral suppression were among Black persons (61%) and women overall (64%).

The U=U Revolution

Undetectable = Untransmittable (U = U), which means that once an individual is virally suppressed to the point where HIV cannot be detected in their blood, they effectively have no risk of sexually transmitting HIV to HIV-negative partners.

Addressing Disparities Across the Continuum

Racial and Ethnic Disparities

AIDSVu data consistently reveals significant disparities across racial and ethnic groups at each step of the continuum. These disparities reflect broader social and economic inequities that impact healthcare access and outcomes.

Geographic Variations

AIDSVu’s continuum maps allow viewers to look at city-level HIV surveillance data by race/ethnicity, sex, and age. In Fulton County (one of the two counties that make up metro Atlanta), approximately 60% of individuals living with HIV are virally suppressed.

Age-Related Challenges

People aged 55 to 64 accounted for 8% of the 37,966 new HIV diagnoses in 2022, and older adults face unique challenges including higher rates of late diagnosis and specific health complications.