Epi Profile Section 3 - Texans with New HIV Diagnoses

Overall Trends and Profile of Texans with New HIV Diagnoses

In 2018, 4,520 Texans were newly diagnosed with HIV, which means that every day about 12 Texans were diagnosed with HIV. The annual number of people with new HIV diagnoses has remained constant for the last 10 years (Figure 6).

Although the overall number of people with new diagnoses were flat over the past decade, new diagnoses decreased in Black women, PWID, and people who acquired HIV through heterosexual sex. The number of diagnoses in Hispanic MSM increased. These trends are shown later in this section.
 

Figure 6:  Number of Texans with new diagnoses, 2009-2018 

Figure 6:  Number of Texans with new diagnoses, 2009-2018

Source: Texas eHARS, 2018
Data for Figure 6


The diagnosis rate for Texas fell by 11% over the past 10 years. Since the overall annual number of Texans with new diagnosis did not change, the decline in rate is likely due to the increases in the total population of Texas.
 

Figure 7: Rate of Texans with new diagnoses, 2009-2018 

Figure 7: Rate of Texans with new diagnoses, 2009-2018

Source: Texas eHARS, 2018
Data for Figure 7


The profile of Texans with new diagnoses in 2018 shows a continuation of recent trends:

  • Four out of five people with new diagnoses were male; [8]
  • Three out of four were Black or Hispanic;
  • Three out of five were younger than 35;
  • At least half were Hispanic and Black MSM; and
  • Black and MSM Texans had disproportionately high diagnosis rates.

Table 9 at the end of this section shows detailed breakdowns of profile of Texans with new diagnoses over time.

Texans with New Diagnoses by Race/Ethnicity and Sex at Birth

Even though the overall number of Texans with new diagnoses was steady across the years, this masked changes. The number of Black Texans with new diagnoses fell by about 6% from 2009-2018, while the number of new diagnoses in Hispanic Texans rose by 19% (Figure 8 and Table 9). The decrease in Black Texans was driven primarily by decreases among Black women, and the increase in Hispanic Texans was driven by increases in Hispanic MSM.
 

Figure 8: Texans with new HIV diagnoses by race/ethnicity, 2009-2018 
Figure 8: Texans with new HIV diagnoses by race/ethnicity, 2009-2018 
Data for Figure 8
 

The decrease in the number of Black Texans with new diagnoses led to a 22% decrease in the diagnosis rate for this group (Figure 9). Despite this decrease, the diagnosis rate for Black Texans was 2.8 times higher than the rate for Hispanic Texans, the group with the next highest rate. The diagnosis rate for Black females is five times higher than the rate for Hispanic females, the group with the next highest rate (Table 5). 
 

Figure 9: Rates of new HIV diagnosis in Texas by selected race/ethnicity groups, 2009-2018
 
Source: eHARS, 2018 
Data for Figure 9


Table 5: Texans with new diagnoses and diagnosis rates by sex at birth and selected race/ethnicities, 2018

 

Males 

Females 

Total 

Race/Ethnicity 

Number 

% 

Rate 

Number 

% 

Rate 

Number 

% 

Rate 

White 

790 

21% 

13.4 

119 

15% 

2.0 

909 

20% 

7.6 

Black 

1,169 

32% 

70.2 

415 

51% 

23.4 

1,584 

35% 

46.0 

Hispanic 

1,565 

42% 

27.3 

250 

31% 

4.4 

1,815 

40% 

16.0 

All Others 

178 

5% 

 

34 

4% 

 

212 

5% 

 

TOTAL 

3,702 

 

26.0 

818 

 

5.7 

4,520 

100% 

15.7 

 

Texans with New Diagnoses by Age

The age profile of Texans who were diagnosed in 2018 varies by sex at birth in ways that have implications for designing testing and treatment programs. The profile of males leans towards younger ages and reflects increases in new diagnoses in young MSM of color. The age of females at diagnosis is tilted towards older women, with one in three females diagnosed in 2018 being 45 or older. During discussions in changes of the age profile of those newly diagnosed, keep in mind these differences.
 

Figure 10: Age profiles of Texans with new HIV diagnoses by sex at birth, 2018  


Data for Figure 10
 

Across the last 10 years, at least half of the newly diagnosed Texans were younger than 35 years old (Figure 11). New diagnosis in the 25-34-year-old age group increased by 25% over the past 10 years with consistent year after year increases.

Trends in youth (15-24-year-olds) are more complex. Comparing the number of new diagnoses in youth in 2009 and in 2018 makes it appear that the number of diagnoses made in this group was stable, but this is not the case. Between 2009 and 2013, the number of new diagnoses in youth increased, but between 2014 and 2018, the number of youth with new diagnoses fell by 11%. This decrease mirrors changes in the number of youth with new HIV infections, which fell significantly from 2010 to 2017 (data not shown).

While the decrease in new infections in youth is good news, the decrease in new diagnoses is a problem. Since we estimate that only about half of the youth living with HIV have been diagnosed (data not shown), the number of youth diagnosed each year needs to increase to assure full diagnosis and participation in care, and these efforts should be focused on young MSM. 

Figure 11: Texans with new diagnoses by age, 2009 - 2018
Figure 11: Texans with new diagnoses by age, 2009 - 2018 
Data for Figure 11
 

Table 6: Texans diagnosed with HIV in 2018 by sex at birth and age 

 

Males 

Females 

Total 

Age group (years) 

Number 

% 

Rate 

Number 

% 

Rate 

Number 

% 

Rate 

0-14 

<1% 

0.2 

<1% 

0.1 

<1% 

0.2 

15-24 

897 

24% 

43.4 

125 

15% 

6.4 

1,022 

23% 

25.4 

25-34 

1,429 

39% 

66.2 

223 

27% 

10.7 

1,652 

37% 

39.0 

34-44 

672 

18% 

34.5 

195 

24% 

10.1 

867 

19% 

22.3 

45-54  

450 

12% 

25.5 

159 

19% 

8.9 

609 

14% 

17.1 

55-64 

198 

5% 

12.6 

90 

11% 

5.4 

288 

6% 

8.9 

65+ 

51 

1% 

3.2 

22 

3% 

1.1 

73 

2% 

2.0 

TOTAL 

3,702 

 

26.0 

818 

 

5.7 

4,520 

100% 

15.7 

Texans with New Diagnoses by Mode of Transmission Groups

Over the past 10 years, MSM made up about 7 out of every 10 Texans with a new HIV diagnosis—an MSM was diagnosed with HIV every three hours. MSM is the only group to consistently show annual increases in new diagnoses (Figure 12). Most of these increases came from young MSM of color. 

In addition to having the greatest number of people with new HIV diagnoses, MSM had much higher diagnosis rates—up to 31 times higher than the overall diagnosis rate in 2018. The highest rates are seen in MSM of color. Section 4 of this profile has more details on new diagnoses in MSM. 

The number of new diagnoses in PWID and people who acquired HIV through heterosexual contact decreased across these years. These changes are also seen in Texans with new infections. The declining diagnoses in people who acquired HIV through heterosexual sex reflect the downward trends in the number of new diagnoses in Black women. 
 

Figure 12:  Texans with new diagnoses by selected mode of transmission groups, 2009-2018
Figure 12:  Texans with new diagnoses by selected mode of transmission groups, 2009-2018 
Data for Figure 12 
 

Mode of Transmission by Sex

As shown in Table 7, more than four out of five women diagnosed in 2018 acquired HIV though sex with a man. Most men also acquired HIV through sex with a man; a much smaller number of men acquired HIV through sex with a woman. Women have a higher biological risk of acquiring HIV from heterosexual contact than do men [9,10] which partially explains why males have a lower number of diagnoses attributable to heterosexual contact compared to females.
 

Table 7: Texans with new HIV diagnoses by transmission group and sex at birth, 2018 

 

Males 

Females 

Total 

Mode of transmission group 

Number 

% 

Number 

% 

Number 

% 

MSM 

3,177 

86% 

 

 

3,177 

70% 

PWID 

126 

3% 

116 

14% 

242 

5% 

MSM/PWID 

164 

4% 

 

 

164 

4% 

Heterosexual contact 

229 

6% 

698 

85% 

927 

21% 

Perinatal transmission 

<1% 

1% 

10 

<1% 

Total 

3,702 

 

818 

 

4,520 

100% 


Mode of Transmission by Race

Mode of transmission profiles differ by race/ethnicity. MSM made up three out of four White and Hispanic Texans diagnosed in 2018. Although MSM were still the largest group of Black Texans diagnosed in 2018, people who acquired HIV through heterosexual sex made up almost one in three Black Texans with new HIV diagnosis. Since people with heterosexual transmissions are predominately Black women, any decrease in new diagnoses in Black women will also show up as a decrease in cases due to heterosexual transmission.
 

Figure 13: Transmission group profile of Texans with new HIV diagnosis by race/ethnicity, 2018
Figure 13: Transmission group profile of Texans with new HIV diagnosis by race/ethnicity, 2018    
Source: Texas eHARS, 2018 
Data for Figure 13 
 

Table 8: Texans with new HIV diagnoses by race/ethnicity and mode of transmission group, 2018 

 

White 

Black 

Hispanic 

Mode of transmission group 

Number 

% 

Number 

% 

Number 

% 

MSM 

650 

71% 

987 

62% 

1,385 

76% 

PWID 

69 

8% 

90 

6% 

77 

4% 

MSM/PWID 

70 

8% 

23 

2% 

59 

3% 

Heterosexual contact 

120 

13% 

479 

30% 

290 

16% 

Perinatal transmission 

 

 

<1% 

<1% 

Total 

909 

20% 

1,584 

35% 

1,815 

40% 

Source: Texas eHARS, 2018 
 

Table 9: Texans diagnosed with HIV by selected characteristics, 2014-2018 

 

2014 

2015 

2016 

2017 

2018 

 

Number 

% 

Number 

% 

Number 

% 

Number 

% 

Number 

% 

TOTAL 

4,460 

100% 

4,552 

100% 

4,543 

100% 

4,365 

100% 

4,520 

100% 

Sex at birth 

 

 

 

 

 

 

 

 

 

 

Male 

3,626 

81% 

3,714 

82% 

3,748 

83% 

3,607 

83% 

3,702 

82% 

Female 

834 

19% 

838 

18% 

795 

17% 

758 

17% 

818 

18% 

Race/Ethnicity 

 

 

 

 

 

 

 

 

 

 

White 

859 

19% 

868 

19% 

877 

19% 

784 

18% 

909 

20% 

Black 

1,608 

36% 

1,600 

35% 

1,579 

35% 

1,589 

36% 

1,584 

35% 

Hispanic 

1,748 

39% 

1,831 

40% 

1,825 

40% 

1,804 

41% 

1,818 

40% 

Other 

68 

2% 

85 

2% 

76 

2% 

62 

1% 

83 

2% 

Multiple races 

177 

4% 

168 

4% 

186 

4% 

126 

3% 

129 

3% 

Age Group (years) 

 

 

 

 

 

 

 

 

 

 

0-14 

20 

0% 

17 

0% 

14 

0% 

10 

0% 

0% 

15-24 

1,151 

26% 

1,135 

25% 

1,052 

23% 

992 

23% 

1,022 

23% 

25-34 

1,464 

33% 

1,558 

34% 

1,708 

38% 

1,641 

38% 

1,652 

37% 

35-44 

895 

20% 

876 

19% 

808 

18% 

829 

19% 

867 

19% 

45-54 

628 

14% 

633 

14% 

625 

14% 

564 

13% 

609 

13% 

55-64 

235 

5% 

263 

6% 

273 

6% 

274 

6% 

288 

6% 

65+ 

67 

2% 

70 

2% 

63 

1% 

55 

1% 

73 

2% 

Transmission group 

 

 

 

 

 

 

 

 

 

 

MSM 

3,071 

69% 

3,146 

69% 

3,218 

71% 

3,072 

70% 

3,177 

70% 

PWID 

228 

5% 

238 

5% 

252 

6% 

221 

5% 

242 

5% 

MSM/PWID 

165 

4% 

183 

4% 

155 

3% 

185 

4% 

164 

4% 

Heterosexual sex 

976 

22% 

968 

21% 

908 

20% 

877 

20% 

927 

21% 

Perinatal 

20 

<1% 

17 

<1% 

10 

<1% 

10 

<1% 

10 

<1% 

Note: Due to rounding, numbers may not add up to 100%. 
Source: Texas eHARS, 2018 
 


Note 8. Sex at birth 

Note 9. Higgins, J. A., Hoffman, S., & Dworkin, S. L. (2010). Rethinking gender, heterosexual men, and women's vulnerability to HIV/AIDS. American journal of public health, 100(3), 435-445 

Note 10. Scully, E. P. (2018). Sex differences in HIV infection. Current HIV/AIDS Reports, 15(2), 136-146.
 


Texas HIV Epidemiologic Profile