June 26, 2003
This report presents the demographic characteristics of persons living with AIDS and HIV at the end of 2001, by state and metropolitan area of residence. The tables on AIDS are updates of previous similar reports published in 1998 and 2000; the HIV tables are new additions. Since the last report, the number of persons living with AIDS has increased in every state and nearly every metropolitan area over 500,000 population. Smaller metropolitan and nonmetropolitan areas also had increases in AIDS prevalence. We estimate that at the end of 2001, 362,000 people were living with AIDS in the United States, Washington, DC, Puerto Rico, and associated territories. This is a 14% increase in the number of persons living with AIDS compared with the end of 1999. Given the relatively stable incidence of AIDS in recent years, the increase in prevalence remains largely attributable to the continued success of medical treatments that increase the survival of persons diagnosed with AIDS.
Nearly half of the persons living with AIDS reside in 4 states: New York (17%), California (14%), Florida (11%) and Texas (7%). Most of the persons were male (78%) and 73% were 35 to 55 years old at the end of 2001. Two percent of persons living with AIDS were under 20 years old and another 2% were 65 or older. Thirty-seven percent were non-Hispanic white, 42% non-Hispanic black, and 20% Hispanic. Nearly 1% of the persons living with AIDS were Asian/Pacific Islander and <1% were American Indian/Alaska Native. These proportions have changed little from the estimates made in 1999.
As in our last report, 83% of persons living with AIDS lived in metropolitan areas over 500,000 population and 7% in nonmetroplitan areas. Not surprisingly, 40% of the persons living with AIDS reside in 10 large metropolitan areas, with New York City, Los Angeles, Washington, DC, Miami, and Philadelphia having the greatest number, as we reported in 1999. In both mid-size metropolitan areas and nonmetropolitan areas, white persons account for 44% of persons living with AIDS, compared with 36% in large metropolitan areas. In large metropolitan areas, a larger proportion (20%) of persons living with AIDS are Hispanic than in nonmetropolitan areas (13%). The proportion of persons living with AIDS who are black ranged from 42% in large metropolitan areas to 41% in nonmetropolitan areas. The proportion of Asian/Pacific Islanders (1%) or American Indian/Alaska Natives (<1%) does not vary between large, mid-size, or non-metropolitan areas.
Prevalence estimates by HIV exposure category are new to this report. Approximately 45% of persons living with AIDS were exposed to HIV through maleto- male sex, and 27% through injection drug use. Twenty percent of persons living with AIDS were exposed through heterosexual contact.
Our HIV estimates are only for the 25 states that began name-based HIV infection reporting before 1995. We estimate that over 100,000 persons are living with HIV in these 25 states. Persons living with AIDS in these 25 states constitute 30% of the 362,000 persons living with AIDS in the 50 United States. Compared with persons living with AIDS, a smaller proportion of persons living with HIV are male (73%) and younger: 30% are 20 to 34 years of age (compared to 16% of persons with AIDS), 42% are 35 to 44 years of age (44% of persons with AIDS), and 20% are 45 to 54 years of age (29% of persons with AIDS).
The racial/ethnic distribution of persons living with HIV reflects the racial/ethnic distribution of the 25 states for which we have reliable data and should not be assumed to be representative of all persons with HIV in the United States. In the 25 states, 52% of persons living with HIV are non-Hispanic blacks, 39% are non-Hispanic whites, and 7% are Hispanic. As more states collect data that can be used to make HIV prevalence estimates, it is likely that these proportions will change to reflect the racial/ethnic distribution of HIV in the US.
The distribution of HIV exposure categories may also be reflective of the states that are included, as well as possible shifts in HIV transmission. The proportion of persons living with HIV who were exposed through male-to-male sex (44%) is similar to that among persons living with AIDS; however, a smaller proportion attribute their HIV to injection drug use 20%) and a larger proportion attribute it to heterosexual transmission (28%).
In the 25 states included in this report, 71% of the persons living with HIV live in MSAs with over 500,000 population, compared to 83% of persons living with AIDS in the US. A larger proportion of persons living with HIV live in mid-size metropolitan areas (16%) and nonmetropolitan areas (13%) compared to persons living with AIDS. Again, this is reflective of the states included in the report, and not necessarily the geographical distribution of HIV infection. Newark, Denver, and Detroit have the most persons living with HIV in metropolitan areas among the 25 states.
The increased prevalence of persons with HIV and AIDS reflects the success of medical therapies and treatments and presents challenges for planners and providers of medical, prevention, and social services, as well as the affected individuals. Antiretroviral drug resistance is likely to increase, requiring new therapies and regimens to maintain health. Because people with HIV are surviving longer, emphasis on strategies to help infected persons prevent transmission, as well as encourage people to learn their HIV status, are necessary to decrease incident infections and stem the epidemic.