Houston and Atlanta top list of U.S. Cities with new HIV cases

Atlanta and Houston see troubling increases in new HIV diagnoses, reflecting broader challenges across the southern United States.

While the rest of the United States has experienced a decrease in new HIV cases, cities in the South, including Atlanta and Houston, have seen an alarming rise in diagnoses. Public health experts point to a combination of social, economic, and healthcare factors as contributors to these growing numbers.

In 2021, Atlanta had the third-highest rate of new HIV diagnoses in the United States. The city’s rate of new cases was more than double that of other metropolitan areas, highlighting significant disparities in prevention and care. In 2024, Metro Atlanta had the third-highest rate of new HIV diagnoses in the United States with a rate of 24.6 new HIV diagnoses per 100,000 people with 92% of the cases being African American despite only making up 33% of the population.

Black and Hispanic males account for the majority of new infections in Atlanta, a trend influenced by systemic barriers to healthcare, limited access to HIV prevention resources, and persistent stigmas surrounding the virus. These stigmas discourage many individuals from seeking testing and treatment, exacerbating the issue.

Houston also reported troubling numbers, with an 8% increase in new HIV diagnoses in 2022 compared to the previous year. Hispanic/Latinx individuals made up the largest proportion of new cases, followed by Black/African Americans.

In 2022, 1,413 new diagnoses of HIV were reported in the Houston EMA, a 5% increase from 2021 (2021 total = 1,346). At the time of diagnosis, 90% resided in Houston/Harris County. At the end of calendar year 2022, there were 33,397 diagnosed people living with HIV in the Houston EMA, a 5% increase from 2021 (2021 total = 31,816). In 2022, 91% of PLWH who lived in the EMA resided in Houston/Harris County. In both Houston/Harris County and the Houston EMA, the rates of new HIV diagnoses and PLWH continue to exceed rates both for Texas and the United States in 2022. The rate of new HIV diagnoses in Houston/Harris County is more than twice the rate for the country. Compared to the general population in the Houston EMA, the PLWH population in 2022 is disproportionately male, predominantly African American, and 35 to 44 years of age. Among new HIV diagnoses, the largest proportion by age group is younger, ages 25 to 34. Among 33,397 HIV-diagnosed individuals in the Houston EMA in 2022, 76.4% had received care (at least one CD4/viral load test in the year); 55.2% were retained in HIV care (at least two CD4/viral load tests in the year, at least three months apart); and 62.2% maintained or reached viral load suppression (≤200 copies/mL). (source https://www.houstonhealth.org)

Male-to-male sexual contact (MSM) remains the most common risk factor for transmission in Houston. Experts cite a lack of access to healthcare and prevention services, as well as socioeconomic factors and poor social cohesion, as key drivers of the city’s rising numbers.

The South’s disproportionate share of new HIV cases reflects broader systemic challenges, including poverty, limited healthcare access, and enduring stigma surrounding HIV. These factors hinder individuals from obtaining regular testing, pre-exposure prophylaxis (PrEP), or antiretroviral therapy, which are critical for preventing transmission and managing the virus.

Public health advocates stress the importance of targeted interventions, such as increasing funding for HIV prevention programs, expanding access to culturally competent care, and addressing stigma within affected communities. Without such measures, the South risks falling further behind the rest of the country in combating the HIV epidemic.

As new HIV diagnoses decline nationally, the situation in Atlanta, Houston, and other parts of the South serves as a stark reminder of the work still needed to achieve health equity in the fight against HIV.

There are many resources for HIV testing and care, including the CDC, state public health departments, and local health departments.