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Trends and disparities in HIV before and after COVID-19 from 1999 to 2023

Iffat Ambreen Magsi1, Aman Advani2, Ehsanullah Alokozay3

  • 1Department of Medicine, Shaheed Mohtarma Benazir Bhutto Medical College, Liyari, Karachi, Pakistan.

Annals of Medicine and Surgery (2012)
|July 11, 2026
PubMed

Insights

HIV mortality continues to decline in the U.S., but the COVID-19 pandemic slowed progress. Post-COVID trends show varied impacts across demographics, with older adults and urban populations experiencing increased mortality.

Area of Science:

  • Public Health
  • Epidemiology
  • Infectious Disease Epidemiology

Background:

  • Persistent disparities in human immunodeficiency virus (HIV) related mortality exist across US demographic groups.
  • The COVID-19 pandemic potentially disrupted healthcare systems and influenced HIV mortality trends.

Purpose of the Study:

  • To evaluate HIV-related mortality trends in the U.S. from 1999 to 2023.
  • To specifically analyze changes in HIV mortality following the onset of the COVID-19 pandemic.

Main Methods:

  • Utilized CDC WONDER database for HIV-related deaths (ICD-10: B20-B24) in adults (25-85+).
  • Calculated age-adjusted mortality rates (AAMR) per 100,000 population.
  • Employed Joinpoint regression to analyze trends and estimate annual percent changes (APCs) and average annual percent changes (AAPCs).

Main Results:

  • Overall HIV mortality declined by an AAPC of -4.34% from 1999-2023, with a slower decline of -4.19% post-COVID (2020-2023).
  • Post-COVID trends revealed greater declines in women (-0.58%) than men (-3.90%), an increase in older adults (85+, +12.37%), and rising rates in urban (+2.33%) versus rural areas.
  • Racial disparities narrowed, with sharper post-COVID declines in Black (-6.21%) and Hispanic (-6.26%) populations compared to White (-1.33%) populations. The Southern U.S. remained the highest burden region.

Conclusions:

  • The COVID-19 pandemic has disrupted the decline of HIV mortality, particularly impacting elderly and urban populations.
  • While racial disparities have modestly narrowed, persistent inequities necessitate targeted and equitable public health interventions.
  • Understanding demographic and urbanization patterns is crucial for addressing ongoing HIV mortality challenges.

Keywords:
COVID-19 pandemicHIV-related mortalityUnited Statesepidemiologyhealth disparitiestrends

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