HIV/AIDS surveillance report : U.S. HIV and AIDS cases reported December June 1995
Corporate Authors:National Center for HIV, STD, and TB Prevention (U.S.). Division of HIV/AIDS Prevention.
Series:HIV/AIDS surveillance ; v. 7, no. 2
Description:Year-end edition, Vol. 7, No. 2.
The HIV/AIDS surveillance data in this report characterize the populations affected by HIV-related illness and death and provide a current profile of HIV/AIDS at the national level. The epidemic’s impact on the nation’s health was highlighted during 1995, when the cumulative number of reported AIDS cases surpassed one-half million. Of 513,486 persons with AIDS reported through December 1995, over 62 percent have died. Among persons ages 25 to 44 years, HIV infection is now the leading cause of death in men and the third leading cause in women. As expected, the number of cases reported during 1995 (74,180) was lower than the numbers reported during 1994 (79,897, Table 1) and 1993 (105,828), reflecting the waning effect of the expanded 1993 AIDS surveillance case definition. However, in 1995 the number of cases reported was 56 percent higher than in 1992 (47,453), before the case definition was expanded.
Because the numbers of cases reported annually during the period 1992 through 1995 have fluctuated, and because persons reported with AIDS during a calendar year had AIDS diagnosed during that year or prior years, CDC has developed statistical methods to examine temporal trends in the epidemic (see Technical Notes). These methods estimate the incidence of AIDS opportunistic illnesses (AIDS-OIs) by taking into account the change in the case definition and lags in reporting of cases to CDC. Results show that from 1992 through 1994, the estimated incidence of AIDS-OIs increased by 8 percent overall. Trends in the incidence of AIDS-OIs varied by region, race/ethnicity, sex, and mode of exposure (Tables 18, 19, 20). From 1992 through 1994, the incidence of AIDS-OIs increased in the South (13 percent) and the Northeast (11 percent), and among blacks (17 percent), Hispanics (13 percent), men (5 percent), and women (26 percent). Increases also occurred among Asians/Pacific Islanders and American Indians/Alaska Natives; however, these populations each account for less than 1 percent of estimated AIDS-OIs. By mode of HIV exposure, the largest increases occurred among heterosexual men and women who acquired HIV through injecting drug use (men 11 percent; women 12 percent) or through heterosexual contact (men 38 percent; women 46 percent). Although the incidence of estimated AIDS-OIs is increasing most rapidly among persons infected heterosexually, men who have sex with men continue to represent the largest number and proportion of persons estimated to have AIDS-OIs.
The demographic characteristics, behavioral risks, and geographic distribution of persons with AIDS reported during 1995 reflect shifts in the populations at risk for HIV/ AIDS, most notably the changing racial/ethnic profile shown on the cover of this report. The cover illustrates a shift in the epidemic from whites to minorities, especially blacks and Hispanics. In 1995, for the first time, the proportion of persons reported with AIDS who are black was equal to the proportion who are white (40 percent). In 1995, blacks and Hispanics represented the majority of cases among men (54 percent) and women (76 percent). The reported AIDS incidence rate per 100,000 among blacks (92.6) was 6 times higher than that among whites (15.4) and 2 times higher than that among Hispanics (46.2). Rates were lowest among American Indians/ Alaska Natives (12.3) and Asians/Pacific Islanders (6.2). However, HIV/AIDS surveillance data collected from medical records do not include measures of socioeconomic status such as education and income that may more accurately predict risk of HIV than demographic factors such as race/ethnicity.
Case report information obtained by health care providers through routine patient history-taking may include one or more risk behaviors or potential modes of exposure to HIV (Table 17). Efforts to prevent HIV infections through community-based prevention programs are enhanced by knowledge of HIV risk behaviors in the local community. Most adults/adolescents reported with AIDS have risk information recorded (93 percent, Table 3). Although persons most recently reported with AIDS are more likely to have unreported risk information because medical record reviews are incomplete or pending, most persons are ultimately identified as having a recognized risk factor (Figure 7). HIV reports provide a minimum estimate of the number and characteristics of persons in the community who have been tested for HIV; however, a higher proportion of HIV than AIDS reports has incomplete HIV exposure information. Persons reported with HIV (not AIDS) are younger, more likely to be women and black or Hispanic minorities, and more recently infected than persons reported with AIDS (Tables 22 through 26). HIV surveillance data should be interpreted with knowledge of local practices because they are influenced by the availability of HIV test facilities and the proportion of HIV-infected persons who seek or defer HIV testing.
Among men reported with AIDS in 1995, male-to-male sexual contact again accounted for the largest proportion of cases (51 percent), followed by injecting drug use (24 percent, Table 4). These proportions will increase slightly as exposure information is completed for persons initially reported without a risk for HIV infection (13 percent). Among young men (ages 20 to 24 years), male-to-male sexual contact and/or injecting drug use accounted for 76 percent of AIDS cases and 63 percent of HIV infection cases reported in 1995 (Tables 7 and 25, respectively).
Women accounted for 19 percent of adult/adolescent AIDS cases in 1995, the highest proportion yet reported among women. Most women acquired HIV infection through injecting drug use (38 percent) or sexual contact with a man with or at risk for HIV infection (38 percent, Table 5). The injecting drug use-associated epidemic among men is reflected in the heterosexual epidemic among women. Women may not recognize or report the risk behaviors of their partners, and health care providers may only record the HIV/AIDS status of a woman’s male partners and not her partners’ risk behaviors. Therefore, an increasing proportion of women are likely to be classified in the exposure category “sex with HIV-infected person, risk not specified.”
The epidemic in women is reflected in the epidemic in children, nearly all of whom acquired HIV infection perinatally. In 1995, 84 percent of children reported with AIDS were black or Hispanic, and AIDS rates per 100,000 population among black and Hispanic children were 16 and 6 times higher (6.4 and 2.3, respectively) than among white children (0.4, Table 10). The number of children reported with AIDS in 1995 (800) was lower than that reported in 1994 (1,034). Changes in surveillance practices, the number of infected women giving birth, and the clinical management of women and children may each have contributed to this decline. Studies are underway to determine the relative contributions of each of these factors. In 1995, the 28 states that reported HIV infection (not AIDS) among children reported 229 pediatric AIDS cases and 342 pediatric HIV cases (Table 24). In these states, reports of children perinatally exposed to HIV (with subsequent follow-up to determine infection status) will be useful in evaluating the impact of Public Health Service guidelines on preventing perinatal transmission (see Suggested Reading).
The 1993 expansion of the AIDS surveillance case definition has caused fluctuations in the numbers of reported AIDS cases during the past 3 years. However, reporting trends are gradually stabilizing. Each year since 1993, a larger proportion of persons with AIDS was reported based on immunologic criteria added to the case definition. State-to-state fluctuations in reporting patterns may reflect a number of factors, including use of laboratory-initiated reporting of severe immunosuppres- sion, enhanced surveillance efforts in some states, and increases in AIDS incidence in some geographic areas. In many of the states (Table 1) and metropolitan areas (Table 2) that reported more cases in 1995 than in 1994, HIV was introduced later than in the bicoastal epicenters, where the epidemic emerged early in the 1980s. However, reported AIDS incidence rates per 100,000 population remained highest in Puerto Rico, New York, Florida, New Jersey, Maryland, and Connecticut, and in heavily affected metropolitan areas, many of which are in these same states (e.g., Jersey City, San Francisco, West Palm Beach, San Juan, Baltimore, New Haven, Orlando, and Hartford).
To promote the uses of national HIV/AIDS surveillance data for tracking the epidemic, for program planning and evaluation, and for facilitating comparisons to state and local surveillance data, the HIV/AIDS Surveillance Report is now available through the Internet. See page 2 of this report for the address of CDC’s home page.
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