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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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Men who have sex with men (MSM) are most affected by HIV in the USA, accounting for more than two-thirds of all new HIV diagnoses in the country.9New infections are on the increase, increasing by 9% between 20.10 If current diagnosis rates continue, one in six men American men who have sex with men will be diagnosed with HIV in their lifetime.

Funded by CDC, this approach combines behavioural, medical and structural interventions targeted towards most at-risk populations in specific geographical areas.41 One such behavioural intervention is the ‘Peers Reaching Out and Modelling Intervention Strategy’ (PROMISE).

This is a community-led programme that has been successful in reducing HIV risk in groups such as people who inject drugs.

Nearly one in eight of these people are unaware they have HIV.1 The size of the epidemic is relatively small compared to the country’s population, but is heavily concentrated among several key affected populations.

Most new HIV infections occur among men who have sex with men (sometimes referred to as MSM), with African American/black men who have sex with men most affected.

In 2014, an estimated 1,350 Hispanic/Latino women and 1,483 white women were diagnosed with HIV, compared to 5,128 African American/black women.18 African American/black men and women are most likely to be infected through unprotected sex with a man or by injecting drugs.

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.The Immigration and Refugee Board (IRB) is Canada's largest independent administrative tribunal, responsible for making well-reasoned decisions on immigration and refugee matters efficiently, fairly and in accordance with the law.It consists of three divisions: the Refugee Protection Division; the Immigration Division; and the Immigration Appeal Division.This group accounted for 44% of all new HIV infections in 2014 and 43% of the total number of people living with HIV in the USA, despite only making up 12% of the population.16Among all African American/black people diagnosed with HIV in 2014, an estimated 57% (11,201) were men who have sex with men.Of these, 39% (4,321) were young men (aged 13 to 24).17 From 2005 to 2014, the number of new HIV diagnoses among African American/black women fell 42%, although it is still high compared to women from other racial or ethnic groups.Of these, 25,300 were unaware they had HIV – the highest rate of undiagnosed HIV in any age group.37 This age group is also the least likely to be receiving treatment for HIV.38 Results from CDC’s 2015 Youth Risk Behavior Surveillance System (YRBS)39,which monitors health risk behaviours among high school students, found: American health authorities are placing increased emphasis on the role that 'social determinants of health', such as a person's age, class, race, living environment and poor access to healthcare, have on their risk of becoming infected with HIV.