HIV diagnoses rose among Native Americans and Alaska Natives between 2014 and 2018, but death rates decreased, according to a study from the Centers for Disease Control and Prevention and the Indian Health Service, which is the primary source of health care for 1.6 million American Indians and Alaska Natives. Overall, the diagnosis rate was about the same in 2014 and 2018 (7.7 per 1,000 people), but this masked annual changes that varied by age. Adults ages 25 to 34 and 35 to 44 saw a steep climb from 2015 to 2016 followed by a decline, while those ages 13 to 24 saw a decrease followed by a rise from 2017 to 2018. Gay and bisexual men and two-spirit people accounted for nearly two thirds of new diagnoses, and the Navajo Nation had the highest burden (13.7 per 100,000). The proportion of Native Americans and Alaska Natives living with diagnosed HIV rose by 20.7% during the study period. The overall death rate among people living with HIV declined by 30.4%, but those ages 25 to 34 saw an increase from 2017 to 2018.