Epi Profile Section 1 - Executive Summary
This epidemiologic profile is a snapshot of the Texas Human Immunodeficiency Virus (HIV) epidemic in 2018. It was created to assist public health planners, policy makers, and other stakeholders at the local and state level. The information comes primarily from routine disease surveillance and is supplemented with results of special studies and information on HIV care outcomes. More detailed information on data sources can be found at the end of the profile.
As of the end of 2018, 94,106 Texans were known to be living with a diagnosed HIV infection. This does not include the estimated 16,000 Texans who are living with HIV but were unaware of their status. Dramatic improvements in HIV treatment have lengthened the lifespans of people living with HIV (PLWH) and have kept deaths low at about 1,400 a year.
The annual number of HIV diagnoses in Texas has been stable for the past decade, with 4,520 new diagnoses in 2018. Since the number of new diagnoses are higher than the number of deaths, this results in increases in the number of Texans living with HIV.
Gay and bisexual men and other men who have sex with men (MSM) made up the largest group of PLWH and people with new diagnoses. Additionally, they are the only group that have shown steady increases in new diagnoses. This rise was driven primarily by increases in young Black and Hispanic MSM. We estimate that over 3% Black MSM and almost 1% of Hispanic MSM aged 18-24 years in Texas were diagnosed with HIV in 2018. The disproportionate impact on MSM is not limited to youth, as diagnosis rates are high in MSM of all ages and race/ethnicities.
While the number of Texans with new diagnoses was stable over the past 10 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%. The decrease in new diagnoses in Black Texans was driven primarily by decreases among Black women, and the increase in Hispanic Texans was driven by increases in Hispanic MSM.
The decrease in the number of Black Texans with new diagnoses led to a 22% drop in the diagnosis rate for this group. 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. Racial and ethnic disparities can also be seen in death rates and rates of coinfection with sexually transmitted disease and tuberculosis. These disparities are detailed in later sections in this profile.
Information in this profile points the way to reducing the number of Texans with new HIV infections. One key strategy is increasing the number of PLWH who are aware of their status. People can live with an HIV infection for years before being diagnosed. People who are not aware of their HIV infections cannot receive life-extending treatment, and they also have the greatest likelihood of transmitting HIV to others. DSHS estimates that about 85% of all Texans with HIV are aware of their HIV status. The DSHS goal is for 90% of people living with HIV to be aware of their status by 2030. This profile provides a solid picture of the profile of people with new diagnoses and with new infections that can be used to direct actions and resources.
A second key strategy is increasing the number of Texas PLWH who are consistently engaged in treatment and who have suppressed viral load, which means that they have a low level of HIV in the body. In addition to the health benefits of a suppressed viral load, there is scientific consensus that treatment also acts as prevention: people with suppressed viral load cannot sexually transmit the virus to others. The DSHS goals are for 90% of Texans with diagnosed HIV to be in continuous treatment, and for 90% of people on treatment to have suppressed viral loads by 2030. In 2018, around 70% of Texans diagnosed with HIV were in continuous treatment/retained in care, and around 86% of people on treatment had a suppressed viral load.
Reducing the number of Texans with HIV also rests on adopting effective prevention tools and strategies not covered in this report, such as scaling up use of pre-exposure prophylaxis medicine to prevent infections. No less important, but also beyond the scope of this report, is the exploration of the rich network of social and environmental factors that contribute to the disparities in HIV seen in racial/ethnic minorities and MSM and the role of stigma in reducing participation in prevention and treatment.
This profile provides a broad overview of HIV in Texas. Those interested in more detailed analysis or data on specific populations may send data requests to the Department of State Health Services at TBHIVSTDdata@dshs.texas.gov or create custom data tables at:
Note 2. Achieving Together: A Community Plan to End the HIV Epidemic in Texas. achievingtogethertx.org. Accessed September 13, 2019.
Note 3. RW Eisinger, CW Dieffenbach, AS Fauci. HIV viral load and transmissibility of HIV infection: undetectable equals untransmittible. Journal of the American Medical Association. 2019: (5):451-452.
Note 4. Achieving Together: A Community Plan to End the HIV Epidemic in Texas. achievingtogethertx.org. Accessed September 13, 2019.