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The latest strategy, released in 2015, is structured around four core aims: reducing new HIV infections, increasing access to care and improving health outcomes for people living with HIV, reducing HIV-related disparities and health inequities and achieving a co-ordinated national response to the epidemic.6 The impact of the HIV epidemic in the USA is more serious among some groups than others.These key affected populations can be grouped by transmission category (for example, men who have sex with men) but also by race, with people of colour having significantly higher rates of HIV infection over white Americans.7 A complex set of economic and socioeconomic factors drive risk to these populations, including discrimination, stigma, poverty and a lack of access to care.8 Sexual networks is also a major determining factor, with populations at a high risk to HIV tending to have sex with people in their own communities.The majority of these belong to other key populations for HIV such as African Americans/black people or men who have sex with men.28 Others become infected while they are in prison – for example, via unprotected sex.A study in the New York area found 13% of incarcerated men and women reported being sexually active in the previous six months.29 “In almost any jurisdiction in the US, there’s a concentration of the epidemic in the correctional population.” Heroin use is increasing in the USA among men and women in most age groups and across all income levels, rising by 63% between 20.Other factors such as heightened levels of poverty, lack of access to adequate healthcare and stigma surrounding men who have sex with men also increase this group's risk of HIV infection.19 Young African American/black men who have sex with men (aged 13 to 24) are most affected.20 In 2014, 55% of young men who have sex with men newly diagnosed with HIV were African American/black.21 High HIV prevalence within the African American/black community and the increased likelihood of individuals within this community only having sex with others in the community heightens their risk of HIV.22 HIV continues to be a serious threat to the health of the Hispanic/Latino community.In 2014, Hispanic/Latino people accounted for almost a quarter of all estimated new diagnoses of HIV in the USA, despite representing about 17% of the total US population.23 Men accounted for 86% of all new infections among this community, and the large majority of infections resulted from sex between men.24 The Hispanic/Latino community faces a number of challenges to accessing HIV prevention and treatment services.

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31 However, despite this, between 20 the overall annual number of new HIV diagnoses among people who inject drugs (sometimes referred to as PWID) in the USA decreased by 26%.32 Recent changes in drug use and demographic trends could challenge this success, and the decline in diagnoses between 20 has levelled off more recently.33 In interviews as part of a survey of 22 cities in 2015, only a quarter of people who inject drugs said they received all their syringes from sterile sources.

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Fewer black people (21%) reported sharing syringes than Hispanics (33%) and whites (43%).

The racial composition of new people who inject drugs changed between 20, counting fewer black people (dropping from 38% to 19%) and more white people (an increase from 38% to 54%).

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