Prevalence and Trends in HIV Infection and Testing Among Adults in the United States

The National Health and Nutrition Examination Surveys, 1999-2018

Geraldine M. McQuillan, PhD; Deanna Kruszon-Moran, MS; Silvina Masciotra, MS; Qiuping Gu, PhD; Renee Storandt, MT (ASCP), MSPH


J Acquir Immune Defic Syndr. 2021;86(5):523-529. 

In This Article

Abstract and Introduction


Background: HIV antibody testing has been included in the National Health and Nutrition Examination Survey, for ages 18–49 since 1999 and for ages 18–59 years since 2009 enabling estimation of trends in HIV prevalence as part of national surveillance in the U.S. household population. Self-reported HIV testing and antiretroviral use was also included in the survey since 1999.

Setting: A continuous household-based probability sample of the U.S. population.

Methods: From 1999 to 2018, 29,020 participants age 18–49 years were tested for HIV antibody and 34,092 participants age 18–59 years were asked about self-report of any previous HIV testing.

Results: HIV prevalence was 0.41% among those aged 18–59 in 2009–2018 with a nonsignificant trend over time among those aged 18–49 years from 1999–2002 to 2015–2018. However, significant declines in prevalence were seen among those aged 18–39 years (0.37%–0.11%), women (0.22%–0.06%) and non-Hispanic black persons (2.14%–0.80%). Participants aged 18–39 years self-reported a decline in HIV testing, whereas those aged 40–49 and 50–59 years, non-Hispanic black persons and women reported an increase in getting a HIV test. Prevalence of infection and self-reported history of HIV testing varied by demographic and risk groups. HIV testing among HIV-positive persons was 83.9%. Antiretroviral therapy among those HIV-positive was under 50%.

Conclusion: Although total HIV prevalence and previous self-reported HIV testing remained stable for the last 20 years, there were significant declines in age and demographic subgroups. Prevalence for both outcomes varied by demographic and risk variables.


The Centers for Disease Control and Prevention (CDC) has been collecting surveillance data on HIV infection since the onset of the HIV/AIDS epidemic in the United States (U.S.) in 1981. HIV Surveillance reports are based on diagnosed cases of HIV infection. In the latest HIV Surveillance Report, the percentage of diagnosed infections among persons living with HIV at year-end 2018 compared with 2014 decreased, whereas the prevalence of people living with HIV/AIDS increased.[1]

The National Health and Nutrition Examination Survey (NHANES) is one of a series of health-related surveys conducted by CDC's National Center for Health Statistics (NCHS).[2] NHANES provides surveillance data to monitor the health and nutritional status of the U.S. household population and the HIV data in this report are based on the presence of HIV antibody in the general population. Results of serologic testing and self-reported history of HIV testing from earlier NHANES surveys has been previously published.[3–5] This report presents 20-year trends from 1999 through 2018 of HIV prevalence on adults aged 18–49 and self-report of ever having had an HIV test on adults aged 18–59 years and examines associations with demographic and risk factor data for 2009–2018 combined among adults aged 18–59 years. The demographic characteristics of those using antiretroviral (ARV) treatment among people living with HIV were also examined.