Who is at risk for HIV?

Anyone can acquire HIV, and risk is built from factors — not identities. CDC organizes risk around specific things: a partner's viral load, having another sexually transmitted infection, condomless anal or vaginal sex, sharing injection equipment, and exposure during pregnancy, birth, or breastfeeding. Social and economic conditions shape who runs into those factors. CDC names believing only certain groups of people get HIV as an example of HIV stigma.

What actually creates risk

CDC's page on how HIV spreads is organized around risk factors, not categories of people. Most people acquire HIV through anal or vaginal sex, or by sharing needles, syringes, or other drug injection equipment such as cookers^[1]. Either partner can acquire HIV during anal or vaginal sex; being the receptive partner in anal sex carries a greater likelihood than being the insertive partner^[1].

Two factors change the odds in any encounter. Viral load: the higher a person's viral load, the more likely they are to transmit HIV. Another sexually transmitted infection: having an STI can make it more likely that a person acquires or transmits HIV^[1]. HIV can also pass to a baby during pregnancy, childbirth, and breastfeeding — CDC calls this perinatal transmission and notes it is the most common way children acquire HIV^[1].

Treatment reshapes the picture from the other direction: HIV treatment reduces the chance of transmission through sex or syringe sharing, and during pregnancy, childbirth, and breastfeeding^[1]. Some routes people worry about are, in the U.S., close to negligible. The U.S. blood supply and donated organs and tissues are thoroughly tested, so acquiring HIV from a transfusion, blood product, or transplant is very unlikely — and you cannot acquire HIV from donating blood. For health care personnel, the most likely occupational route is injury with a contaminated needle or other sharp object, and careful practice of standard precautions protects both patients and staff^[1].

Factors, groups, and an ongoing framing tension

CDC's own transmission page uses factor-based language, and CDC's stigma materials go further: CDC lists believing that only certain groups of people can get HIV as an example of HIV stigma, alongside making moral judgments about people who take steps to prevent HIV and feeling that people deserve HIV because of their choices^[2]. CDC's health equity page repeats that list and adds discrimination examples such as asking whether someone is "clean," or assuming someone has HIV because of their identity or behaviors^[3].

Be aware that federal pages are not fully aligned on this. HIV.gov's own "Who Is at Risk for HIV?" page still uses subpopulation framing, describing certain groups as more likely to acquire HIV because of the communities they live in, the subpopulations they belong to, and their risk behaviors^[4]. No federal source we could verify says CDC has formally retired the phrase "high-risk group." What we can say plainly is that CDC's transmission guidance is organized around factors, and that group-based assumptions are named as stigma in CDC's own stigma and equity materials^[2][3].

There's a practical reason to care. CDC's clinical testing guidance states that HIV crosses the boundaries of sexual orientation, sex, age, and ethnicity, and that risk-based screening may fail to identify some people with HIV — including women, members of minority races and ethnicities, people outside urban areas in low-incidence regions, people under 20, and heterosexual men and women who are unaware of their likelihood of acquiring HIV. CDC recommends routine opt-out screening in part because it removes the stigma associated with HIV testing^[5]. Sorting people into "at risk" and "not at risk" buckets misses people, and it also stings: CDC notes that stigma discourages people from engaging in HIV testing, prevention, and care, and that internalized stigma can lead to shame, fear of disclosure, isolation, and despair^[3].

The conditions that shape exposure

CDC defines social determinants of health as the non-medical factors that influence health outcomes — the conditions in which people are born, grow, work, live, and age — plus the wider set of forces and systems shaping daily life, explicitly including racism and systems such as economic policies, social norms, and political systems^[6]. CDC connects HIV and related infections to age, income, employment, and housing, and notes these often result in disparities by race and ethnicity, gender identity, sexual orientation, and geography — framing health inequities as stemming from unfair and unjust systems, policies, and practices^[6].

CDC's Fast Facts names the social and structural issues that continue to drive inequities: HIV stigma, homophobia, discrimination, poverty, and limited access to high-quality health care. It also names barriers to reaching an undetectable viral load — food insecurity, unemployment, and unstable housing or homelessness^[7]. These are not personal failings; they are conditions, and conditions can be changed by policy and funding.

Incarceration is one clear example. More than 5 million people are estimated to be under the supervision of U.S. adult correctional systems. In 2021, about 1.1% of people incarcerated in state and federal prisons were known to be living with HIV — roughly three times the prevalence in the general U.S. population. CDC also notes that a high proportion of people with justice system involvement have a history of unstable housing and mental health and substance use disorders, which increases vulnerability^[8].

What the 2024 data show — as context, not a definition

Surveillance tells us where the epidemic is concentrated right now, which matters for funding and outreach. It does not tell any individual whether they "count" as at risk. In 2024, CDC recorded 38,793 HIV diagnoses among people aged 13 and older in the U.S. and territories, a rate of 13.3 per 100,000. Male-to-male sexual contact accounted for 25,129 diagnoses (65%). Black/African American people accounted for 15,128 (39%) of diagnoses while making up about 12% of the U.S. population, a rate of 42.2 per 100,000. The South accounted for 19,785 (51%) of diagnoses. Injection drug use was reported in 2,426 (6%) of diagnoses^[9].

Read those numbers as a map of where inequity has landed, not as a list of who deserves attention. CDC's own equity and stigma pages ask us not to convert group-level data into assumptions about individuals^[3]. For trend context, CDC estimated 31,800 new HIV infections in 2022 — a 12% decrease overall from 2018 — while diagnoses increased 5% among people who inject drugs, and transgender people accounted for 2% (928) of 2022 diagnoses^[7].

One statistic argues hardest for routine testing over group-based targeting: CDC notes that about 40% of new HIV transmissions come from people who do not yet know they have HIV^[5]. Knowing your status — whatever your identity, relationship, or history — is what actually shifts risk.

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