Healthy North Carolina 2030 (HNC 2030) identifies key public health indicators for our state. The State Health Improvement Plan has engaged statewide leaders in ongoing efforts to improve the health of North Carolinians through policies, programs, and systems related to these health indicators. One of those indicators, “HIV Diagnosis,” sets a target to decrease the rate of diagnosis to 6.0 per 100,000 adults and adolescents to improve sexual health across the state, contributing to the promotion of healthy development and improving overall well-being among residents.1
In 2023, North Carolina ranked tenth among all states for HIV diagnosis with a rate of 13.7 diagnoses per 100,000 people.2 More broadly, approximately 38,614 people in North Carolina were diagnosed and living with HIV as of 2024, an increase from 36,581 residents in 2022.2,3 During a time of shifts in the political landscape, economic challenges, and influential cultural movements, the growing number of those living with HIV underscores sexual health as a pressing public health issue at the state-level.
More recent trends show an increase in the HIV diagnosis rate, with 2025 data reflecting 15 diagnoses per 100,000 people.2 Despite the accessibility of treatment options, such as antiretroviral therapy (ART), these metrics continue to be influenced by factors such as changing care-seeking behaviors and social stigma, highlighting growing concern surrounding HIV in North Carolina.2
Human immunodeficiency virus (HIV) is a virus that attacks cells that help the body fight against infections, weakening the immune system and exacerbating immunity.4 As a virus, it spreads by contact with bodily fluids including blood, breast milk, and semen, through injection drug use, from unprotected sex, and through other common methods of transmission.4,5 If left untreated, an individual may experience symptoms including fever, headache, and rash, predisposing them to developing tuberculosis (TB), severe bacterial infections, and cancers such as lymphomas.5
As an illness, HIV progresses through 3 stages, which are described by severity of symptoms and susceptibility to other illnesses.2 At the final stage, individuals have damaged immune systems that are vulnerable to deadly illnesses, explained by symptoms including chills, swollen lymph nodes, and weight loss.2 It’s at this stage that someone is officially diagnosed with Acquired Immunodeficiency Syndrome (AIDS) and remains highly contagious, having an expected survivorship of 3 years without immediate treatment.2,4
Fortunately, effective preventive measures and treatments for HIV and AIDS are available. While HIV infection is incurable, preventive options like pre-exposure prophylaxis (PrEP) help reduce the risk of contracting and transmitting HIV from sex by about 99%.4–6 For people living with HIV and AIDS, treatment options, such as antiretroviral (ART) drugs or injections, preserves a person’s immune system.5,7,8 HIV medication can reduce the viral load in a person’s blood so that it’s undetectable by tests, suppressing symptoms and allowing people to live long and healthy lives.4,5,7,8 HIV-negative romantic partners are also protected since the virus won’t spread from undetectable individuals during sex.4,5
Even though HIV remains treatable, engaging in risky behaviors such as unprotected sex, excessive use of alcohol or substances, and sharing unsafe injectable needles, can increase people’s risk for contracting the disease.5 While these behaviors can be controlled for, there are factors that disproportionately affect identity-based communities across the state of North Carolina, contributing to the overall high HIV diagnosis rate.
In North Carolina, disproportionate trends in HIV diagnosis continue to impact marginalized communities, increasing the likelihood for future health complications. Across the state, 55% of the newly-diagnosed population in 2024 were aged 20 to 34 years old, reflecting the age demographic most susceptible to the disease with an overall rate of 35 diagnoses per 100,000 people.2 In addition, among all racial and ethnic groups, Black/African American people represented 53.9% of all newly-diagnosed HIV cases, with a rate of 39 diagnoses per 100,000 people.2 In combination with other indicators, such as sexual orientation, gender, and socioeconomic status, it’s important to consider the root causes disproportionately impacting these communities across the state.
Structural factors such as limited access to health care resources, provider and workforce shortages, and lack of reliable transportation within rural communities are major components influencing the discrepancies observed across the state.9,10 Additionally, psychosocial factors, such as lack of family support and social stigma surrounding HIV, can influence fear of disclosing positive status to friends and family members.6,9–11 Finally, the intersection these factors have with larger societal frameworks, such as poverty, racism, and culture, can influence how health outcomes related to HIV diagnosis manifest across the state.6,10,11
Understanding the determinants that affect sexual health across North Carolina is essential to decreasing the rate of HIV diagnosis. Today, care coordination programs, state and local health policies, and public health efforts continue to provide accessible and affordable care to detect and prevent HIV among vulnerable communities.
For those living with HIV, federally-funded programs such as the HIV Medication Assistance Program (HMAP) provide eligible consumers, such as those from low-income backgrounds, with essential medications to treat HIV and related conditions.12 Through national partnerships, the Centers for Disease Control and Prevention (CDC) has provided over 750,000 free HIV self-test kits to vulnerable populations across the state, highlighting how experts and leaders are dedicated to the continuous improvement in reducing the HIV diagnosis rate.13
Overall, further public health coordination is necessary to mitigate the sexual health challenges affecting the state of North Carolina. HIV diagnosis remains a pressing issue, and interventions aimed at improving access to testing, education, and resources may help to reduce health inequities affecting vulnerable communities. It’s through these channels of teamwork and collaboration that this HNC 2030 indicator could be achieved and maintained.
_______________________________________________
Written by
Casen Whitehead
Graduate Research Assistant, NCIOM
_______________________________________________