Trends in the HIV and AIDS Epidemic, 1998

CDC examined trends in HIV diagnoses reported through the integrated HIV and AIDS reporting systems in 25 states, ² adjusted for reporting delays. The analysis suggests that contrary to the declining trend in AIDS diagnoses, HIV diagnoses remained relatively stable in these states, but a higher proportion of HIV than AIDS cases were among women and minorities. The data also indicate a continuing toll among young people ages 13-24, with at least 2,000 young people diagnosed with HIV in these states every year.

Many of these new diagnoses are occurring among African Americans, women, and people infected heterosexually, with an increase observed among Hispanics. These data must be used to ensure targeted prevention efforts reach those in greatest need, with a primary focus on young African-American and Hispanic men and women at risk through sexual and drug-related behaviors. From January 1994 to June 1997:

There were a total of 72,905 adults and adolescents diagnosed with HIV or AIDS in these states. Of these, 52,690 (or 72% of the total cases) were initially diagnosed with HIV, compared to 20,215 cases (28%) initially diagnosed with AIDS.

Comparing HIV and AIDS diagnoses reported in these states provides a much clearer picture of shifts in the epidemic, with a greater percentage of HIV cases diagnosed among women and African Americans. Several key differences can be seen in the following chart:

Comparison of AIDS and HIV Diagnoses from 25 HIV Reporting States January 1994 -- June 1997
	Disease Status at Diagnosis
	HIV (%) Total Cases	AIDS (%) Total cases
Women	28	17
African Americans	57	45
Heterosexual Contact3	18	12

In the most recent full year from which overall trends in these states can be examined -- 1995 to 1996:

HIV diagnoses declined slightly among men (-3% from 10,762 to 10,395), but increased among women (+3% from 4,126 to 4,253).

HIV diagnoses declined slightly among African Americans (-3% from 8,569 to 8,300) and among whites (-2% from 5,093 to 4,966), but increased among Hispanics (+10% from 971 to 1,070). However, in these states, the number of cases among Hispanics was relatively small.

Taking a closer look at the impact of HIV among young people in these states, the majority of infections were diagnosed among African Americans and women. Of the 7,200 cases of HIV reported among 13- to 24-year-olds from January 1994 to June 1997:

• (3,203) were female

• (4,566) were African American and 5% (394) were Hispanic

• At least 26% (1,886) had heterosexually acquired infections, 31% (2,270) were in men who have sex with men, and 6% (449) were in injection drug users.⁴

While these data provide a reliable indication of the number and characteristics of individuals who have been diagnosed with HIV in confidential settings, they do not include individuals tested only at anonymous test sites or individuals who have not yet been tested. CDC estimates that two-thirds of people living with HIV infection have already been confidentially tested for HIV and know their status. Studies indicate that a high proportion of high-risk individuals have been tested, and given the increasing benefits of early knowledge of HIV status, more people are likely to seek testing and care. Therefore, HIV reporting is likely to become increasingly representative of trends in recent infections. And, as additional states implement HIV reporting, these data will become more representative of national trends in the epidemic.

References

2

States that had confidential, name-based HIV infection reporting from 1994 to 1997 are Alabama, Arizona, Arkansas, Colorado, Idaho, Indiana, Louisiana, Michigan, Minnesota, Mississippi, Missouri, Nevada, New Jersey, North Carolina, North Dakota, Ohio, Oklahoma, South Carolina, South Dakota, Tennessee, Utah, Virginia, West Virginia, Wisconsin, and Wyoming. Florida, New Mexico, and Nebraska have initiated name-based HIV reporting in recent years. Connecticut, Texas, and Oregon have confidential, name-based HIV infection reporting for pediatric cases only.

3 Because many of the cases of HIV infection initially reported without risk information are later determined to be related to heterosexual contact, those numbers likely underestimate the true number of individuals diagnosed with heterosexually acquired infection.

4 The percent of cases in each risk category represents a minimum percentage because a large percentage of cases are initially reported without risk information. When these cases are redistributed based on epidemiologic follow up, all of the categories increase.

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