Patterns and Trends in HIV/AIDS Surveillance

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Chapter 3
Patterns and Trends in HIV/AIDS Surveillance

DETERMINING THE NUMBER OF PEOPLE INFECTED WITH HIV

The Centers for Disease Control and Prevention (CDC), headquartered in Atlanta, Georgia, keeps track of the number of people in the United States who are infected with HIV, the virus that is generally acknowledged to be the cause of AIDS.

These CDC figureswhich have always been acknowledged as estimateshave been criticized as being either too high or too low. Nonetheless, the historical continuity of the agency's data allows trend analyses to be done. Therefore, when viewed over a number of years, the figures provide a reasonable indication of the progress of the disease in the United States.

Estimates of HIV infection are important, as they directly influence public health, medical resource allocation, and political and economic decisions. Definitive figures are difficult to obtain because laws prevent testing for HIV without consent and permission. Furthermore, many people are understandably reluctant to participate in household surveys because of confidentiality concerns and fear of losing or failing to get insurance coverage.

Health officials contend that knowing the prevalence of HIV infections (prevalence is a measure of all cases of illness existing at a given point in time) is not as crucial as knowing whether the number of HIV infections is rising or falling. The rate at which people develop HIV/AIDS during a specified period of time is known as the incidence rate. Since there are no national studies to collect this data (not all states require reporting of new HIV cases), estimates are based on reports from states that mandate confidential reporting of HIV cases, along with other small studies and surveys. Officials with the CDC explain that a major problem has been the lack of knowledge about how many people have become infected prior to the beginning of the agency's regular collection of data. This would help to determine how the current incidence of HIV compares to previous years. Comparison of incidence rates is important because they are a direct measure of the rate at which individuals become ill and provide data to help estimate the risk or probability of illness.

The CDC data through December 2003 from the thirty-three states with confidential HIV reporting and adjusted estimates from reported cases in other states found that 174,639 people were living with HIV that have not yet progressed to AIDS. (See Table 3.1.) This is an increase from 127,058 reported through December 2000 and 161,976 as of December 2001. Of the 2003 total, 1,687 were children younger than thirteen years old (a drop from 2,905 in 2001) and 172,952 were adults and adolescents (an increase from 158,806 in 2001).

The CDC also compiles figures on the numbers of people living with AIDS. Through December 2003, 403,928 adults and adolescents were estimated to be living with AIDS, an increase from the reported 331,471 adults and adolescents through 2001. The number of children younger than thirteen living with AIDS through 2003 (1,942) was a drop from the 2,410 children through 2001. The December 2003 data also indicate that among U.S. territories, a total of 10,131 people were living with AIDS, an increase from the 10,096 reported through 2001. This total includes fifty-one children younger than thirteen (a decrease from eighty-two through 2001) and 10,080 adults and adolescents (9,749 through 2001).

AIDS CASE NUMBERS

The first cases of what came to be recognized as AIDS were reported in the United States in June 1981. Five young, homosexual males in Los Angeles were diagnosed with Pneumocystis carinii pneumonia and other opportunistic infections. By August 1989 approximately one hundred thousand cases of AIDS had been reported to the CDC. By December 1997 that number had risen to 641,086; of these, 390,692 people had died. As of December 2001 the total of all reported cases was 788,672; 467,910 of these people had died. Cumulatively through 2003 there were 872,629 reported cases of AIDS in the United States; 524,060 people had died of the disease. (See Table 3.2 and Table 3.3.)

TABLE 3.1
Estimated numbers of persons living with HIV infection or AIDS, by state or area of residence and age category, December 2003
Area of residence Living with HIV infection (not AIDS)a Living with AIDS
Adults or adolescents Children <13 years old Total Adults or adolescents Children <13 years old Total
Alabama 5,863 33 5,896 3,924 15 3,940
Alaska 262 0 261 269 2 271
Arizona 5,452 41 5,493 4,122 5 4,127
Arkansas 2,281 13 2,294 2,057 10 2,067
California 55,612 138 55,750
Colorado 6,118 14 6,132 3,672 3 3,675
Connecticut 6,959 30 6,989
Delaware 1,601 12 1,613
District of Columbia 8,785 63 8,848
Floridab 32,196 253 32,449 42,861 361 43,223
Georgia 13,963 60 14,023
Hawaii 1,314 4 1,318
Idaho 389 1 390 274 0 274
Illinois 14,241 80 14,321
Indiana 3,874 29 3,902 3,668 18 3,686
Iowa 469 4 473 725 3 728
Kansas 1,133 9 1,143 1,120 3 1,123
Kentucky 2,349 10 2,359
Louisiana 7,675 98 7,773 7,549 43 7,592
Maine 515 3 518
Maryland 12,830 81 12,911
Massachusetts 8,362 35 8,397
Michigan 5,799 72 5,871 5,562 22 5,584
Minnesota 3,136 24 3,160 1,890 10 1,900
Mississippi 4,341 34 4,375 2,856 19 2,875
Missouri 4,881 39 4,920 5,046 14 5,060
Montana 175 0 175
Nebraska 594 6 600 594 4 598
Nevada 3,377 15 3,392 2,648 6 2,654
New Hampshire 526 3 530
New Jersey 15,192 294 15,487 16,969 119 17,089
New Mexico 816 0 816 1,178 4 1,182
New York 66,311 349 66,660
North Carolina 11,118 86 11,204 6,519 25 6,545
North Dakota 72 1 73 56 1 57
Ohio 7,585 66 7,651 6,548 35 6,583
Oklahoma 2,615 18 2,633 2,081 4 2,085
Oregon 2,579 6 2,586
Pennsylvania 15,054 123 15,178
Rhode Island 1,093 10 1,103
South Carolina 6,906 64 6,970 6,349 29 6,379
South Dakota 197 2 199 104 1 105
Tennessee 6,612 66 6,678 5,806 11 5,817
Texas 20,820 305 21,125 29,958 85 30,043
Utah 687 9 696 1,098 0 1,098
Vermont 247 3 250
Virginia 9,182 60 9,242 7,682 53 7,735
Washington 5,102 6 5,108
West Virginia 686 5 690 640 5 645
Wisconsin 2,297 19 2,316 1,837 11 1,848
Wyoming 89 1 90 95 1 96
   Subtotal 172,714 1,683 174,396 393,375 1,942 395,317

During the mid-1990s the number of AIDS cases rose dramatically. This surge was not an actual numerical increase, but was due to the expanded 1993 AIDS surveillance definition, which added diseases and conditions that had not been part of the prior definition of AIDS. By the late 1990s the number of AIDS cases leveled off and began to decline, probably as a result of the increasing use of effective antiretroviral drugs that delay the progression of AIDS. The number of new cases reported between December 2001 and December 2003 (83,957, representing an annual average of 41,979) was higher than the 31,682 new cases reported between December 2000 and December 2001, but lower than the 42,156 new cases reported from December 1999 through December 2000, which in turn was lower than the 47,083 cases reported in the period from December 1998 through December 1999.

TABLE 3.1
Estimated numbers of persons living with HIV infection or AIDS, by state or area of residence and age category, December 2003 [continued]
Area of residence Living with HIV infection (not AIDS)a Living with AIDS
Adults or adolescents Children <13 years old Total Adults or adolescents Children <13 years old Total
Note: These numbers do not represent reported case counts. Rather, these numbers are point estimates, which result from adjustments of reported case counts. The reported case counts are adjusted for reporting delays. The estimates do not include adjustment for incomplete reporting. Age category is based on age as of end of 2003. Since 1999, the following 33 areas have had laws or regulations requiring confidential name-based HIV infection reporting: Alabama, Alaska, Arizona, Arkansas, Colorado, Florida, Idaho, Indiana, Iowa, Kansas, Louisiana, Michigan, Minnesota, Mississippi, Missouri, Nebraska, Nevada, New Jersey, New Mexico, North Carolina, North Dakota, Ohio, Oklahoma, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, Wisconsin, Wyoming, and the U.S. Virgin Islands. Since July 1997, Florida has had confidential name-based HIV infection reporting only for new diagnoses.
aIncludes only persons living with HIV infection that has not progressed to AIDS.
bFlorida (since July 1997) has had confidential name-based HIV infection reporting only for new diagnoses.
cTotal number of persons living with HIV infection (not AIDS) includes persons reported from areas with confidential name-based HIV infection reporting who were residents of other states or whose area of residence is unknown. Total number of persons living with AIDS includes persons whose area of residence is unknown. Because column totals were calculated independently of the values for the subpopulations, the values in each column may not sum to the column total.
Source: "Table 12. Estimated Numbers of Persons Living with HIV Infection (Not AIDS) or with AIDS at the End of 2003, by State or Area of Residence and Age Category," in HIV/AIDS Surveillance Report: Cases of HIV Infection and AIDS in the United States, 2003, vol. 15, Centers for Disease Control and Prevention, 2004, http://www.cdc.gov/hiv/stats/2003SurveillanceReport.pdf (accessed July 18, 2005)
U.S. dependencies, possessions, and associated nations
Guam 36 0 35
Pacific Islands, U.S. 4 0 4
Puerto Rico 9,748 49 9,798
Virgin Islands, U.S. 238 4 243 292 2 294
    Totalc 172,952 1,687 174,639 403,928 1,998 405,926

THE NATURE OF THE EPIDEMIC

The changes in the distribution of HIV illustrate the increasing diversity of those affected by the epidemic in the more than twenty years since AIDS was first diagnosed. In 1981 all of the 189 AIDS cases reported in the United States were males. Three-fourths of these were men who have sex with men (in the 2003 CDC surveys, this category has been changed to male-to-male sexual contact, or MTM) living in New York and California. In 1990, of the more than 43,000 AIDS cases reported by all states, approximately 30% were from New York and California, 11% were women, and about 2% were children. In 1999 the proportions of reported cases among women, African-Americans, Hispanics, and people exposed through heterosexual contact all increased. On the other hand, the percentage of reported cases among whites and MTM declined somewhat.

Regional Differences

AIDS cases have been reported in all fifty states, the District of Columbia, and four U.S. territories. But the distribution of cases is far from even. In 2003 the annual adult and adolescent AIDS incidence rates per one hundred thousand population in the United States and U.S. possession and territories (see Figure 3.1) varied from 10.5 in North Dakota to 1,833.2 in the District of Columbia (the same pattern was evident from 1999 to 2000). Most recently reported cases show a concentration on the East Coast (particularly Connecticut, Maryland, New Jersey, and Delaware, with respective rates of 243.9, 284.4, 239.3, and 235.6, and Florida, with a rate of 301.9). Also prominent were Puerto Rico (rate of 316.6) and the U.S. Virgin Islands (rate of 345.4). Figure 3.2 shows the corresponding HIV and AIDS rates for children younger than thirteen in 2003.

RATES IN MAJOR METROPOLITAN AREAS

The majority of AIDS cases are concentrated in larger metropolitan regions (the city and surrounding suburbs). Metropolitan areas with populations of five hundred thousand or more accounted for 81% of all reported cases between 2000 and 2001 and 84% of the cumulative totals since 1981 (cumulative totals include both those who have died and those still living). In 2002 and 2003 the metropolitan AIDS incidence rates per one hundred thousand people were highest on the coasts, such as in New York City (60.1 and 59.2, respectively), Miami (49.2 and 45.8), Baltimore (48.4 and 39.3), Jersey City, New Jersey (32.6 and 28.3), Fort Lauderdale, Florida (44.0 and 39.9), West Palm Beach, Florida (48.1 and 36.7), Baton Rouge, Louisiana (49.4 and 33.7), Newark, New Jersey (27.6 and 25.8), Columbia, South Carolina (37.0 and 33.5), and San Francisco (31.9 and 45.2). On the other hand, Midwest metropolitan areas displayed the lowest rates: Akron, Ohio (4.1 and 3.4), Grand Rapids, Michigan (4.7 and 4.4), and Youngstown, Ohio (4.1 and 4.3). Ann Arbor, Michigan, had the lowest overall metropolitan rate (3.0 and 3.3), followed by Salt Lake City, Utah (3.8 and 4.3), and Scranton, Pennsylvania (3.9 and 5.4). (See Table 3.4.)

TABLE 3.2
Estimated numbers of deaths of persons with AIDS, by year of death and selected characteristics, 19992003
Year of death Cumulative through 2003a
1999 2000 2001 2002 2003
Note: These numbers do not represent reported case counts. Rather, these numbers are point estimates, which result from adjustments of reported case counts. The reported case counts are adjusted for reporting delays and for redistribution of cases in persons initially reported without an identified risk factor. The estimates do not include adjustment for incomplete reporting.
aIncludes persons who died with AIDS, from the beginning of the epidemic through 2003.
bIncludes hemophilia, blood transfusion, perinatal, and risk factor not reported or not identified.
cIncludes hemophilia, blood transfusion, and risk factor not reported or not identified.
dIncludes persons of unknown race or multiple races and persons of unknown sex. Cumulative total includes 640 persons of unknown race or multiple races. Because column totals were calculated independently of the values for the subpopulations, the values in each column may not sum to the column total.
Source: "Table 7. Estimated Numbers of Deaths of Persons with AIDS, by Year of Death and Selected Characteristics, 19992003United States," in HIV/AIDS Surveillance Report: Cases of HIV Infection and AIDS in the United States, 2003, vol. 15, Centers for Disease Control and Prevention, 2004, http://www.cdc.gov/hiv/stats/2003SurveillanceReport.pdf (accessed July 18, 2005)
Age at death (years)
<13 97 51 48 35 29 5,103
13-14 18 8 4 11 8 252
15-24 232 216 270 199 229 9,789
25-34 3,258 2,823 2,512 2,143 1,928 142,761
35-44 7,706 7,138 7,525 6,896 6,970 216,093
45-54 4,994 5,203 5,548 5,737 5,964 104,064
55-64 1,556 1,631 1,873 1,840 2,146 33,717
65 630 670 743 696 741 12,282
Race/ethnicity
White, not Hispanic 5,834 5,559 5,524 5,128 4,767 230,289
Black, not Hispanic 9,106 8,832 9,345 8,923 9,048 195,891
Hispanic 3,341 3,162 3,435 3,274 3,915 92,370
Asian/Pacific Islander 113 103 108 94 85 3,340
American Indian/Alaska Native 79 67 83 79 78 1,529
Transmission category
    Male adult or adolescent
    Male-to-male sexual contact 6,703 6,316 6,479 6,012 6,015 257,898
    Injection drug use 4,425 4,182 4,298 4,126 4,166 107,797
    Male-to-male sexual contact and injection drug use 1,335 1,334 1,396 1,285 1,233 38,083
    Heterosexual contact 1,403 1,417 1,585 1,526 1,644 23,080
    Otherb 194 204 174 166 140 9,846
        Subtotal 14,061 13,454 13,932 13,116 13,198 436,704
    Female adult or adolescent
    Injection drug use 2,051 1,925 1,985 1,956 2,056 39,848
    Heterosexual contact 2,157 2,192 2,444 2,335 2,584 37,901
    Otherb 97 92 92 89 95 4,115
        Subtotal 4,305 4,209 4,521 4,379 4,736 81,864
    Child (<13 yrs at diagnosis)
    Perinatal 117 72 67 58 78 4,961
    Otherc 8 5 4 4 5 531
        Subtotal 124 78 71 62 83 5,492
Region of residence
Northeast 5,698 5,294 5,344 5,015 6,140 168,213
Midwest 1,712 1,685 1,839 1,550 1,343 50,258
South 7,406 7,352 7,624 7,526 7,068 178,447
West 2,952 2,681 2,817 2,520 2,588 107,767
U.S. dependencies, possessions, and associated nations 723 729 900 947 877 19,375
    Totald 18,491 17,741 18,524 17,557 18,017 524,060

There are several reasons for the higher rates in urban areas. First, metropolitan areas are more cosmopolitan and, by definition, more tolerant of alternative lifestyles such as those of MTM, a group with high-risk sexual behaviors. Second, large metropolitan areas also have greater numbers of intravenous drug users (IDUs), another major risk factor for HIV infection. Third, while HIV infection and transmission are not restricted to more populated areas, those who need and seek treatment may

TABLE 3.3
Reported AIDS cases and annual rates, by area of residence and age category, cumulative through 2003
Area of residence 2002 2003 Cumulative through 2003a
No. Rate No. Rate Adults or adolescents Children (<13 years) Total
aIncludes persons with a diagnosis of AIDS, reported from the beginning of the epidemic through 2003.
bIncludes persons whose state or area of residence is unknown. Cumulative total includes 620 persons whose state or area of residence is unknown.
Source: "Table 14. Reported AIDS Cases and Annual Rates (per 100,000 Population), by Area of Residence and Age Category, Cumulative through 2003United States," in HIV/AIDS Surveillance Report: Cases of HIV Infection and AIDS in the United States, 2003, vol. 15, Centers for Disease Control and Prevention, 2004, http://www.cdc.gov/hiv/stats/2003SurveillanceReport.pdf (accessed July 18, 2005)
Alabama 433 9.7 472 10.5 7,531 76 7,607
Alaska 35 5.5 23 3.5 559 6 565
Arizona 633 11.6 614 11.0 9,166 42 9,208
Arkansas 239 8.8 188 6.9 3,543 38 3,581
California 4,228 12.1 5,903 16.6 132,650 642 133,292
Colorado 326 7.2 366 8.0 8,042 31 8,073
Connecticut 611 17.7 736 21.1 13,284 180 13,464
Delaware 193 23.9 213 26.1 3,206 25 3,231
District of Columbia 926 162.7 961 170.6 15,660 181 15,841
Florida 4,979 29.8 4,666 27.4 93,235 1,490 94,725
Georgia 1,471 17.2 1,907 22.0 27,697 218 27,915
Hawaii 131 10.6 110 8.7 2,816 17 2,833
Idaho 31 2.3 26 1.9 569 3 572
Illinois 2,111 16.8 1,730 13.7 29,857 282 30,139
Indiana 491 8.0 507 8.2 7,450 54 7,504
Iowa 90 3.1 77 2.6 1,554 13 1,567
Kansas 71 2.6 116 4.3 2,647 12 2,659
Kentucky 304 7.4 219 5.3 4,162 30 4,192
Louisiana 1,163 26.0 1,041 23.2 15,519 134 15,653
Maine 28 2.2 52 4.0 1,075 9 1,084
Maryland 1,848 33.9 1,570 28.5 26,606 312 26,918
Massachusetts 808 12.6 757 11.8 18,311 214 18,525
Michigan 795 7.9 680 6.7 13,215 111 13,326
Minnesota 162 3.2 177 3.5 4,225 27 4,252
Mississippi 436 15.2 508 17.6 5,742 57 5,799
Missouri 388 6.8 403 7.1 10,346 60 10,406
Montana 17 1.9 7 0.8 363 3 366
Nebraska 71 4.1 59 3.4 1,286 10 1,296
Nevada 313 14.4 277 12.4 5,209 28 5,237
New Hampshire 39 3.1 37 2.9 985 10 995
New Jersey 1,456 17.0 1,516 17.5 45,936 767 46,703
New Mexico 86 4.6 109 5.8 2,381 8 2,389
New York 6,741 35.2 6,684 34.8 160,109 2,337 162,446
North Carolina 1,045 12.6 1,083 12.9 13,335 121 13,456
North Dakota 3 0.5 3 0.5 114 1 115
Ohio 773 6.8 775 6.8 13,373 129 13,502
Oklahoma 205 5.9 213 6.1 4,414 27 4,441
Oregon 300 8.5 242 6.8 5,580 19 5,599
Pennsylvania 1,789 14.5 1,895 15.3 29,639 349 29,988
Rhode Island 107 10.0 102 9.5 2,337 26 2,363
South Carolina 822 20.0 774 18.7 11,724 94 11,818
South Dakota 11 1.4 13 1.7 214 4 218
Tennessee 772 13.3 837 14.3 10,686 54 10,740
Texas 3,076 14.2 3,379 15.3 62,592 391 62,983
Utah 68 2.9 73 3.1 2,156 20 2,176
Vermont 12 1.9 16 2.6 451 6 457
Virginia 948 13.0 777 10.5 15,544 179 15,723
Washington 471 7.8 525 8.6 10,953 34 10,987
West Virginia 82 4.5 94 5.2 1,341 11 1,352
Wisconsin 187 3.4 184 3.4 4,103 33 4,136
Wyoming 11 2.2 8 1.6 210 2 212
   Subtotal 42,336 14.7 43,704 15.0 863,702 8,927 872,629
U.S. dependencies, possessions, and associated nations
Guam 2 1.2 6 3.7 64 1 65
Pacific Islands, U.S. 0 0.0 1 0.7 2 0 2
Puerto Rico 1,135 29.4 1,065 27.5 27,903 398 28,301
Virgin Islands 54 49.6 34 31.2 585 18 603
   Totalb 43,578 14.9 44,963 15.2 892,875 9,348 902,223

migrate to these areas for access to medical care and social services. In many smaller communities medical care may be unavailable and financial and/or social barriers may limit access to health care services.

Rates among MTM: A Decline?

Table 3.5 displays CDC data on reported AIDS cases by age category, transmission category, and sex. The CDC reported 44,811 new adult and adolescent AIDS cases from January through December 2003, an increase from the 42,983 and 41,960 cases during the same periods in 2001 and 2000, respectively. Of the 2003 total, 33,250 were adult and adolescent males (compared with 31,901 in 2001 and 31,501 in 2000). Of these males, the portion attributable to transmission among MTM who did not also inject drugs was 15,859 cases (48% of total) in 2003, representing an increase from the 13,265 cases (42%) in 2001 and 13,562 cases (43%) in 2000. Since an additional 4,866 (15%) of MTM in 2003, 1,502 (5%) in 2001, and 1,548 MTM (5%) in 2000 also used intravenous drugs, it is unclear whether AIDS was acquired from sexual behavior or intravenous drug use. Examination of data from 1981 (when record keeping began) until December 2003 reveals that men in the MTM exposure category who did not use intravenous drugs accounted for 55% of all men who had acquired AIDS and 45% of all reported AIDS cases. This latter percentage is slightly less than the cumulative 46% in both 2001 and 2000.

Rates among Women

In 2003 reported AIDS cases among women that were attributable to intravenous drug use (2,262) comprised 20% of the total number of cases (11,561), as compared with 2,212 cases in 2001 (20% of 11,082 cases). In 2000, 2,609 cases (25% of the total of 10,459 cases) represented intravenous drug use. With respect to intravenous drug use, previous percentages were 23% in 1998 and 1999, and 19% in 1995. The actual number of cases remained fairly constant from 1994 to 199713,887 in 1994, 13,764 in 1995, 13,767 in 1996, and 13,105 in 1997then dropping to 10,998 in 199899 and 10,459 in 2000 before increasing to 11,082 in 2001 and 11,561 in 2003. (See Table 3.5.)

When considering the role of heterosexual contact in the acquisition of AIDS, the proportion was far higher for women in 2003 (5,234 cases, representing 45% of the total of 11,561) than for men (3,371, representing 10% of the total of 40,947). Women with a history of heterosexual contact as their only risk factor made up 37% of all female cases in 2001. In contrast, 9% of men acquired HIV through heterosexual contact in 2001.

Decline in AIDS Due to Blood Transfusions

As a result of screening procedures for blood and blood products that began in 1985, the number of AIDS cases among adult and adolescent transfusion recipients decreased between 1995 (664 cases) and 1997 (409 cases). A pronounced decrease between 1998 and 1999 (266 cases) has been followed by 282 cases in 2000, 218 cases in 2001, and 219 in 2003. (See Table 3.5.)

The number of AIDS cases among adults and adolescents with hemophilia has also decreased. In 1996, 330 cases were reported. In 1997, 201 cases were reported. The number of new cases among hemophiliacs declined to 171 in 1999, 96 in 2000, 106 in 2001, and 85 in 2003. (See Table 3.5.)

Current Age and Gender Distribution

Of the 902,223 cumulative total reported cases of AIDS in 2003, 892,875 (99%) were among adults and adolescents. (See Table 3.5.) The remaining 9,348 cases (representing 1% of the cumulative total) were children under the age of thirteen. According to the CDC, which has distinct case definitions for the two age groups, as of December 2003 more people between the ages of thirty-five and forty-four were living with either HIV or full-blown AIDS (168,322; 41.5% of all cases) than in any other age category. (See Table 3.6 and Table 3.7.)

TABLE 3.4
Reported AIDS cases and annual rates, by metropolitan area of residence and age category, cumulative through 2003
Area of residence 2002 2003 Cumulative through 2003
No. Rate No. Rate Adults or adolescents Children (<13 years) Total
Akron, OH 29 4.1 24 3.4 659 1 660
Albany-Schenectady-Troy, NY 108 12.2 101 11.3 2,023 24 2,047
Albuquerque, NM 42 5.7 47 6.3 1,254 2 1,256
Allentown-Bethlehem-Easton, PA 54 8.3 82 12.4 1,043 13 1,056
Ann Arbor, MI 18 3.0 20 3.3 450 9 459
Atlanta, GA 1,015 23.2 1,212 27.1 19,248 121 19,369
Austin-San Marcos, TX 215 16.0 153 11.1 4,390 27 4,417
Bakersfield, CA 128 18.5 103 14.4 1,329 8 1,337
Baltimore, MD 1,257 48.4 1,028 39.3 17,833 214 18,047
Baton Rouge, LA 303 49.4 209 33.7 2,620 20 2,640
Bergen-Passaic, NJ 142 10.2 199 14.3 5,938 85 6,023
Birmingham, AL 115 12.3 127 13.5 2,237 23 2,260
Boston-Brocktn-Nashua, MA-NH Necma 721 11.7 664 10.8 16,100 190 16,290
Buffalo-Niagra Falls, NY 92 7.9 104 9.0 2,156 19 2,175
Charleston, SC 138 24.5 92 16.1 1,834 17 1,851
Charlotte-Gast.-Rock Hill, NC-SC 219 13.9 262 16.2 2,748 23 2,771
Chicago, IL 1,849 21.9 1,527 18.0 25,806 251 26,057
Cincinnati, OH-KY-IN 240 14.4 71 4.2 2,248 16 2,264
Cleveland-Lorain-Elyria, OH 170 7.6 199 8.9 3,894 46 3,940
Colorado Springs, CO 23 4.2 38 6.9 534 5 539
Columbia, SC 204 37.0 187 33.5 2,589 18 2,607
Columbus, OH 150 9.5 218 13.6 2,682 13 2,695
Dallas, TX 752 20.1 745 19.5 14,530 37 14,567
Dayton-Springfield, OH 46 4.9 100 10.6 1,201 17 1,218
Daytona Beach, FL 114 22.0 51 9.6 1,393 15 1,408
Denver, CO 230 10.5 261 11.8 6,319 22 6,341
Detroit, MI 579 13.0 483 10.8 9,176 74 9,250
El Paso, TX 79 11.4 92 13.0 1,350 10 1,360
Fort Lauderdale, FL 750 44.0 690 39.9 14,736 257 14,993
Fort Wayne, IN 31 6.1 18 3.5 382 3 385
Fort Worth-Arlington, TX 180 10.0 252 13.7 3,782 27 3,809
Fresno, CA 99 10.3 91 9.2 1,436 15 1,451
Gary, IN 62 9.7 45 7.0 887 6 893
Grand Rapids-Muskegon-Holland, MI 52 4.7 49 4.4 903 5 908
Greensboro/Winstn-Salem/H.Pt., NC 119 9.3 150 11.6 2,056 21 2,077
Greenville-Spartanburg-Andersn, SC 76 7.7 118 11.9 1,798 7 1,805
Harrisburg-Lebanon-Carlisle, PA 64 10.1 94 14.7 1,286 11 1,297
Hartford, CT Necma 199 17.0 285 24.2 4,624 47 4,671
Honolulu, HI 86 9.6 84 9.3 2,013 14 2,027
Houston, TX 979 22.2 1,324 29.4 22,014 166 22,180
Indianapolis, IN 275 16.6 263 15.7 3,575 24 3,599
Jacksonville, FL 271 23.5 283 24.0 5,255 73 5,328
Jersey City, NJ 199 32.6 172 28.3 7,096 121 7,217
Kansas City, MO-KS 125 6.8 138 7.5 4,333 13 4,346
Knoxville, TN 46 6.5 56 7.9 858 7 865
Lakeland-Winter Haven, FL 88 17.6 115 22.5 1,529 19 1,548
Las Vegas, NV-AZ 290 16.9 258 14.5 4,346 27 4,373
Little Rock-N. Little Rock, AR 89 15.0 53 8.8 1,260 14 1,274
Los Angeles-Long Beach, CA 1,549 15.9 2,558 25.9 47,136 243 47,379
Louisiville, KY-IN 137 13.2 110 10.5 2,025 19 2,044
McAllen-Edinburg-Mission, TX 42 6.8 46 7.2 501 11 512
Melbourne-Titusvlle-Palm Bay, FL 75 15.1 76 15.0 1,435 11 1,446
Memphis, TN-AR-MS 399 34.5 362 31.0 4,168 19 4,187
Miami, FL 1,139 49.2 1,072 45.8 27,023 502 27,525
Middlesex-Somerset-Hunterdon, NJ 140 11.6 118 9.7 3,541 73 3,614
Milwaukee-Waukesha, WI 113 7.5 103 6.8 2,284 19 2,303
Minneapolis-St. Paul, MN-WI 144 4.7 156 5.1 3,757 21 3,778
Mobile, AL 83 15.2 90 16.3 1,448 18 1,466
Monmouth-Ocean, NJ 100 8.6 84 7.1 3,127 64 3,191
Nashville, TN 196 15.4 271 21.0 3,353 17 3,370
Nassau-Suffolk, NJ 259 9.3 258 9.2 7,370 115 7,485

Cumulatively, the total number of AIDS cases that were reported in adults and adolescents in 2003 occurred predominantly in males (729,478 cases). (See Table 3.5.) Adult and adolescent females accounted for 163,396 cumulative cases (18.6% of the total). (See Table 3.5.)

TABLE 3.4
Reported AIDS cases and annual rates, by metropolitan area of residence and age category, cumulative through 2003 [continued]
Area of residence 2002 2003 Cumulative through 2003
No. Rate No. Rate Adults or adolescents Children (<13 years) Total
Note: Includes persons from 50 states, the District of Columbia, and Puerto Rico, because of the lack of census information for the U.S. dependencies, possessions, and associated nations.
Includes persons whose county of residence is unknown.
Source: "Table 15. Reported AIDS Cases and Annual Rates (per 100,000 Population), by Metropolitan Area of Residence and Age Category, Cumulative through 2003United States," in HIV/AIDS Surveillance Report: Cases of HIV Infection and AIDS in the United States, 2003, vol. 15, Centers for Disease Control and Prevention, 2004, http://www.cdc.gov/hiv/stats/2003SurveillanceReport.pdf (accessed July 18, 2005)
N Havn-Brpt-Dnbry-Wtrbry, CT Necma 358 20.7 396 22.7 7,535 125 7,660
New Orleans, LA 521 39.0 438 32.7 8,125 71 8,196
New York, NY 5,649 60.1 5,580 59.2 135,086 2,092 137,178
Newark, NJ 569 27.6 534 25.8 18,519 329 18,848
Norfolk-VA Beach-Newport News, VA 289 18.0 158 9.7 4,494 63 4,557
Oakland, CA 277 11.3 380 15.4 8,913 47 8,960
Oklahoma City, OK 107 9.7 100 8.9 2,097 7 2,104
Omaha, NE-IA 51 7.0 42 5.7 902 3 905
Orange County, CA 228 7.8 251 8.5 6,335 39 6,374
Orlando, FL 528 30.1 487 27.0 7,434 85 7,519
Philadelphia, PA-NJ 1,417 27.6 1,288 24.9 22,737 281 23,018
Phoenix-Mesa, AZ 512 14.7 421 11.7 6,557 28 6,585
Pittsburgh, PA 141 6.0 244 10.4 2,874 19 2,893
Portland-Vancouver, OR-WA 224 11.2 181 8.9 4,494 9 4,503
Providence-Warwick, RI Necma 100 10.2 92 9.3 2,191 23 2,214
Raleigh-Durham-Chapel Hill, NC 214 16.9 205 15.8 2,565 23 2,588
Richmond-Petersburg, VA 102 10.0 135 13.1 2,946 32 2,978
Riverside-San Bernardino, CA 282 8.1 472 13.0 7,933 58 7,991
Rochester, NY 191 17.4 138 12.5 2,786 13 2,799
Sacramento, CA 103 5.9 133 7.4 3,542 24 3,566
St. Louis, MO-IL 218 8.3 224 8.5 5,395 41 5,436
Salt Lake City-Ogden, UT 52 3.8 60 4.3 1,868 14 1,882
San Antonio, TX 200 12.0 166 9.8 4,484 28 4,512
San Diego, CA 467 16.1 516 17.6 11,945 58 12,003
San Francisco, CA 546 31.9 767 45.2 29,609 46 29,655
San Jose, CA 118 7.0 113 6.7 3,466 15 3,481
San Juan-Bayamon, PR 705 35.4 678 33.9 17,497 247 17,744
Sarasota-Bradenton, FL 105 16.9 123 19.4 1,801 25 1,826
ScrantonWilkes-BarreHazleton, PA 24 3.9 33 5.4 497 5 502
Seattle-Bellevue-Everett, WA 316 12.8 380 15.3 7,673 19 7,692
Springfield, MA Necma 80 13.1 89 14.4 1,984 25 2,009
Stockton-Lodi, CA 80 13.0 80 12.6 935 13 948
Syracuse, NY 65 8.9 59 8.0 1,497 9 1,506
Tacoma, WA 32 4.4 34 4.6 963 9 972
Tampa-St Pete.-Clearwater, FL 504 20.3 557 22.0 9,933 105 10,038
Toledo, OH 56 9.0 36 5.8 701 12 713
Tucson, AZ 68 7.7 128 14.3 1,834 10 1,844
Tulsa, OK 49 6.0 66 8.0 1,312 10 1,322
Vallejo-Fairfield-Napa, CA 52 9.6 66 12.1 1,551 11 1,562
Ventura, CA 38 4.9 32 4.0 913 3 916
Washington, DC-MD-VA-WV 1,832 35.6 1,743 33.3 28,096 304 28,400
West Palm Beach-Boca Raton, FL 571 48.1 446 36.7 8,889 221 9,110
Wichita, KS 21 3.8 41 7.4 809 2 811
Wilmington-Newark, DE-MD 154 25.6 170 28.0 2,556 18 2,574
Youngstown-Warren, OH 24 4.1 25 4.3 444 0 444
Metropolitan areas with 500,000 or more population 35,728 19.2 36,548 19.4 749,638 7,950 757,588
Metropolitan areas with 50,000 to 499,999 population 4,337 8.9 4,608 9.4 83,394 832 84,226
Nonmetropolitan 3,220 5.7 3,414 6.0 54,828 515 55,343
   Total 43,471 14.9 44,769 15.2 891,605 9,325 900,930

Race or Ethnicity and AIDS

The changing racial/ethnic profile characteristics of Americans with AIDS from 1993 through 2001 reflect a shift in the population at risk for HIV/AIDS. In 1993 there were 60,587 cases reported among African-Americans. By 2000 the number of cases had reached 135,562. (See Table 3.7.) The number of cases among African-Americans has grown steadily since (146,057 in 2001, 156,771 in 2002, and 167,938 in 2003). The corresponding case figures for non-Hispanic whites are 80,185 in 1993, 113,617 in 2000, 120,186 in 2001, 127,257 in 2002, and 134,678 in 2003. The number of AIDS cases among African-Americans has exceeded those among whites from 1998 through 2003.

TABLE 3.5
Reported AIDS cases, by age category, transmission category, and sex, cumulative through 2003
Transmission category Males Females Total
2003 Cumulative through 2003a 2003 Cumulative through 2003a 2003 Cumulative through 2003a
No. % No. % No. % No. % No. % No. %
aIncludes persons with a diagnosis of AIDS, reported from the beginning of the epidemic through 2003. Cumulative total includes 1 person of unknown sex.
bAIDS developed in 46 adults/adolescents and 3 children after they received blood that had tested negative for HIV antibodies. AIDS developed in 14 additional adults after they received tissue, organs, or artificial insemination from HIV-infected donors. Four of the 14 received tissue or organs from a donor who was negative for HIV antibody at the time of donation.
cIncludes 36 adults/adolescents who were exposed to HIV-infected blood, body fluids, or concentrated virus in health care, laboratory, or household settings, as supported by seroconversion, epidemiologic, and/or laboratory evidence. One person was infected after intentional inoculation with HIV-infected blood. For an additional 361 persons who acquired HIV infection perinatally, AIDS was diagnosed after age 13. These 361 persons are tabulated under the adult/adolescent, not the pediatric, transmission category.
dIncludes 5 children who were exposed to HIV-infected blood as supported by seroconversion, epidemiologic, and/or laboratory evidence: 1 child was infected after intentional inoculation with HIV-infected blood and 4 children were exposed to HIV-infected blood in a household setting. Of the 178 children, 23 had sexual contact with an adult with or at high risk for HIV infection.
Source: "Table 17. Reported AIDS Cases, by Age Category, Transmission Category, and Sex, Cumulative through 2003United States," in HIV/AIDS Surveillance Report: Cases of HIV Infection and AIDS in the United States, 2003, vol. 15, Centers for Disease Control and Prevention, 2004, http://www.cdc.gov/hiv/stats/2003SurveillanceReport.pdf (accessed July 18, 2005)
Adult or adolescent
Male-to-male sexual contact 15,859 48 401,392 55 15,859 35 401,392 45
Injection drug use 4,866 15 156,575 21 2,262 20 61,621 38 7,128 16 218,196 24
Male-to-male sexual contact and injection drug use 1,695 5 57,998 8 1,695 4 57,998 6
Hemophilia/coagulation disorder 74 0 5,130 1 11 0 318 0 85 0 5,448 1
Heterosexual contact 3,371 10 40,947 6 5,234 45 70,200 43 8,605 19 111,147 12
    Sex with injection drug user 477 1 10,930 1 985 9 24,148 15 1,462 3 35,078 4
    Sex with bisexual male 0 0 0 0 223 2 4,402 3 223 0 4,402 0
    Sex with person with hemophilia 7 0 80 0 16 0 465 0 23 0 545 0
    Sex with HIV-infected transfusion recipient 24 0 505 0 37 0 705 0 61 0 1,210 0
    Sex with HIV-infected person, risk factor not specified 2,863 9 29,432 4 3,973 34 40,480 25 6,836 15 69,912 8
Receipt of blood transfusion, blood components, or tissueb 111 0 5,219 1 108 1 4,076 2 219 0 9,295 1
Other/risk factor not reported or identifiedc 7,274 22 62,217 9 3,946 34 27,181 17 11,220 25 89,399 10
    Subtotal 33,250 100 729,478 100 11,561 100 163,396 100 44,811 100 892,875 100
Child (<13 years at diagnosis)
Hemophilia/coagulation disorder 0 0 227 5 0 0 7 0 0 0 234 3
Mother with the following risk factor for, or documented, HIV infection: 61 87 4,232 88 70 85 4,317 95 131 86 8,549 91
    Injection drug use 6 9 1,643 34 11 13 1,645 36 17 11 3,288 35
    Sex with injection drug user 8 11 784 16 6 7 741 16 14 9 1,525 16
    Sex with bisexual male 0 0 95 2 2 2 102 2 2 1 197 2
    Sex with person with hemophilia 1 1 21 0 0 0 15 0 1 1 36 0
    Sex with HIV-infected transfusion recipient 0 0 11 0 0 0 16 0 0 0 27 0
    Sex with HIV-infected person, risk factor not specified 18 26 705 15 18 22 737 16 36 24 1,442 15
    Receipt of blood transfusion, blood components, or tissue 0 0 73 2 0 0 83 2 0 0 156 2
    Has HIV infection, risk factor not specified 28 40 900 19 33 40 978 21 61 40 1,878 20
Receipt of blood transfusion, blood components, or tissueb 1 1 244 5 1 1 143 3 2 1 387 4
Other/risk factor not reported or identifiedd 8 11 80 2 11 13 98 2 19 13 178 2
    Subtotal 70 100 4,783 100 82 100 4,565 100 152 100 9,348 100
    Total 33,320 100 734,261 100 11,643 100 167,961 100 44,963 100 902,223 100

In 1999 African-Americans accounted for 40.6% of people estimated to be living with HIV/AIDS. This figure rose to 47.7% in 2001 through 2003. In contrast, the proportion of non-Hispanic whites living with HIV/AIDS went from 38.5% (1999) to 39.2% (2001), 38.7% (2002), and 38.3% (2003).

TABLE 3.6
Estimated numbers of persons living with AIDS, by year and selected characteristics, 19992003
1999 2000 2001 2002 2003
Note: These numbers do not represent reported case counts. Rather, these numbers are point estimates, which result from adjustments of reported case counts. The reported case counts are adjusted for reporting delays and for redistribution of cases in persons initially reported without an identified risk factor. The estimates do not include adjustment for incomplete reporting.
aIncludes hemophilia, blood transfusion, perinatal, and risk factor not reported or not identified.
bIncludes hemophilia, blood transfusion, and risk factor not reported or not identified.
cIncludes persons of unknown race or multiple races and persons of unknown sex. Because column totals were calculated independently of the values for the subpopulations, the values in each column may not sum to the column total.
Source: "Table 10. Estimated Numbers of Persons Living with AIDS, by Year and Selected Characteristics, 19992003United States," in HIV/AIDS Surveillance Report: Cases of HIV Infection and AIDS in the United States, 2003, vol. 15, Centers for Disease Control and Prevention, 2004, http://www.cdc.gov/hiv/stats/2003SurveillanceReport.pdf (accessed July 18, 2005)
Age as of end of year (years)
<13 3,034 2,843 2,605 2,335 1,998
13-14 440 517 645 728 768
15-24 4,719 4,991 5,229 5,668 6,313
25-34 60,184 56,686 53,687 51,410 49,906
35-44 141,295 151,180 158,173 163,732 168,322
45-54 77,216 89,461 102,252 115,613 129,311
55-64 19,258 22,922 27,197 32,703 38,997
65 5,058 6,132 7,251 8,583 10,310
Race/ethnicity
White, not Hispanic 119,674 126,162 132,258 139,089 146,544
Black, not Hispanic 126,044 137,524 148,469 160,022 172,278
Hispanic 61,194 66,266 71,034 75,782 80,623
Asian/Pacific Islander 2,484 2,755 3,056 3,414 3,826
American Indian/Alaska Native 1,047 1,166 1,262 1,380 1,498
Transmission category
    Male adult or adolescent
    Male-to-male sexual contact 140,216 150,172 160,076 171,035 182,989
    Injection drug use 58,006 61,249 63,723 66,003 68,191
    Male-to-male sexual contact and injection drug use 21,667 22,403 23,033 23,690 24,334
    Heterosexual contact 20,595 23,478 26,471 29,835 33,324
    Othera 3,807 3,922 4,062 4,204 4,345
        Subtotal 244,291 261,223 277,366 294,767 313,183
    Female adult or adolescent
    Injection drug use 25,744 27,317 28,602 29,670 30,710
    Heterosexual contact 35,603 40,422 45,097 50,142 55,685
    Othera 1,746 1,908 2,067 2,239 2,420
        Subtotal 63,093 69,647 75,765 82,052 88,815
    Child (<13 years at diagnosis)
    Perinatal 3,672 3,714 3,763 3,808 3,788
    Otherb 148 145 145 143 139
        Subtotal 3,820 3,860 3,908 3,951 3,927
Region of residence
Northeast 92,741 99,964 105,970 111,506 116,827
Midwest 31,016 33,470 35,725 38,513 41,668
South 115,991 125,396 135,465 146,421 158,962
West 62,300 66,280 69,931 74,253 78,333
U.S. dependencies, possessions, and associated nations 9,157 9,621 9,949 10,077 10,136
    Totalc 311,205 334,731 357,040 380,771 405,926

In 2003 Hispanics accounted for 9,133 new reported AIDS cases. Corresponding figures for whites and African-Americans were 13,612 and 21,064, respectively. The total number of male and female adult and adolescent reported AIDS cases in Asian-Americans/Pacific Islanders (558) and Native Americans/Alaska Natives (220) were the lowest of all racial/ethnic groups in the United States. (See Table 3.8 and Table 3.9.)

In 2003 the total (male and female) reported AIDS incidence rate per one hundred thousand adults and adolescents among African-Americans (75.2) was more than ten times higher than that among non-Hispanic white Americans (7.2), more than seven times than that of Native Americans/Alaska Natives (10.4), and almost three times that of Hispanics (26.8). Rates were lowest among Asian-Americans/Pacific Islanders (4.8). (See Table 3.10.)

TABLE 3.7
Estimated numbers of persons living with HIV/AIDS by year, 200003
2000 2001 2002 2003
Note: These numbers do not represent reported case counts. Rather, these numbers are point estimates, which result from adjustments of reported case counts. The reported case counts are adjusted for reporting delays and for redistribution of cases in persons initially reported without an identified risk factor. The estimates do not include adjustment for incomplete reporting.
Data include persons with a diagnosis of HIV infection. This includes persons with a diagnosis of HIV only, a diagnosis of HIV infection and a later AIDS diagnosis, and concurrent diagnoses of HIV infection and AIDS.
Since 1999, the following 33 areas have had laws or regulations requiring confidential name-based HIV infection reporting: Alabama, Alaska, Arizona, Arkansas, Colorado, Florida, Idaho, Indiana, Iowa, Kansas, Louisiana, Michigan, Minnesota, Mississippi, Missouri, Nebraska, Nevada, New Jersey, New Mexico, North Carolina, North Dakota, Ohio, Oklahoma, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, Wisconsin, Wyoming, and the U.S. Virgin Islands. Since July 1997, Florida has had confidential name-based HIV infection reporting only for new diagnoses.
aIncludes hemophilia, blood transfusion, perinatal, and risk factor not reported or not identified.
bIncludes hemophilia, blood transfusion, and risk factor not reported or not identified.
cIncludes persons of unknown race or multiple races and persons of unknown sex. Because column totals were calculated independently of the values for the subpopulations, the values in each column may not sum to the column total.
Source: "Table 8. Estimated Numbers of Persons Living with HIV/AIDS, by Year and Selected Characteristics, 2000200333 Areas with Confidential Name-Based HIV Infection Reporting," in HIV/AIDS Surveillance Report: Cases of HIV Infection and AIDS in the United States, 2003, vol. 15, Centers for Disease Control and Prevention, 2004, http://www.cdc.gov/hiv/stats/2003SurveillanceReport.pdf (accessed July 18, 2005)
Age as of end of year (years)
<13 2,898 2,867 2,796 2,614
13-14 336 442 519 618
15-24 11,297 11,931 12,409 13,134
25-34 67,688 66,711 66,416 66,446
35-44 124,116 132,137 139,133 145,288
45-54 60,616 70,407 80,757 91,567
55-64 14,579 17,314 20,988 25,237
65 4,002 4,840 5,687 6,710
Race/ethnicity
White, not Hispanic 113,617 120,186 127,257 134,678
Black, not Hispanic 135,562 146,057 156,771 167,938
Hispanic 31,950 35,508 39,358 43,241
Asian/Pacific Islander 1,034 1,171 1,344 1,595
American Indian/Alaska Native 1,508 1,606 1,737 1,873
Transmission category
     Male adult or adolescent
    Male-to-male sexual contact 128,956 138,629 149,336 160,433
    Injection drug use 36,526 38,098 39,630 41,207
    Male-to-male sexual contact and injection drug use 19,097 19,642 20,175 20,773
    Heterosexual contact 25,262 28,115 31,042 34,124
    Othera 2,817 2,891 2,972 3,071
        Subtotal 212,658 227,375 243,154 259,609
    Female adult or adolescent
    Injection drug use 19,789 20,650 21,381 22,173
    Heterosexual contact 47,963 53,245 58,547 63,981
    Othera 1,450 1,547 1,660 1,787
        Subtotal 69,202 75,442 81,588 87,940
    Child (<13 years at diagnosis)
    Perinatal 3,260 3,434 3,593 3,720
    Otherb 406 393 367 342
        Subtotal 3,666 3,827 3,960 4,062
        Totalc 285,531 306,649 328,705 351,614

The racial and ethnic difference is particularly alarming among children under the age of thirteen. As shown in Table 3.10, in 2003 the rate of HIV per one hundred thousand population for African-American children (0.5) was five times the rate for Hispanic children (0.1). The other categories were negligible.

The racial disparity is also reflected in the acquisition of HIV/AIDS by infants born to HIV-infected mothers. In the years 2000 through 2003 the number of reported cases of HIV/AIDS among African-American infants has been a minimum of four times greater than the reported cases for non-Hispanic whites and Hispanic infants born to HIV-infected mothers. (See Table 3.11.)

HOW HIV IS TRANSMITTED

HIV can be transmitted by sexual contact with an infected person; by needle sharing among infected intravenous drug users; through the receipt of infected blood, blood products, or tissue; and directly from an infected mother to her infant during pregnancy, delivery, or breastfeeding.

TABLE 3.8
Reported AIDS cases for female adults and adolescents, by transmission category and race/ethnicity, cumulative through 2003
Includes persons with a diagnosis of AIDS, reported from the beginning of the epidemic through 2003. Cumulative total includes 338 females of unknown race or multiple races.
Source: "Table 21. Reported AIDS Cases for Female Adults and Adolescents, by Transmission Category and Race/Ethnicity, Cumulative through 2003United States," in HIV/AIDS Surveillance Report: Cases of HIV Infection and AIDS in the United States, 2003, vol. 15, Centers for Disease Control and Prevention, 2004, http://www.cdc.gov/hiv/stats/2003SurveillanceReport.pdf (accessed July 18, 2005)
Transmission category White, not Hispanic Black, not Hispanic Hispanic
2003 Cumulative through 2003 2003 Cumulative through 2003 2003 Cumulative through 2003
No. % No. % No. % No. % No. % No. %
Injection drug use 557 29 13,695 41 1,277 17 35,767 37 385 18 11,695 37
Hemophilia/coagulation disorder 3 0 117 0 5 0 128 0 3 0 60 0
Heterosexual contact: 809 42 13,877 41 3,253 44 40,193 42 1,055 50 15,294 48
    Sex with injection drug user 220 12 5,293 16 525 7 12,526 13 218 10 6,103 19
    Sex with bisexual male 47 2 1,701 5 118 2 1,885 2 54 3 701 2
    Sex with person with hemophilia 12 1 314 1 3 0 103 0 1 0 42 0
    Sex with HIV-infected transfusion recipient 4 0 334 1 25 0 230 0 7 0 114 0
    Sex with HIV-infected person, risk factor not specified 526 28 6,235 19 2,582 35 25,449 26 775 37 8,334 26
Receipt of blood transfusion, blood components, or tissue 18 1 1,868 6 60 1 1,477 2 25 1 604 2
Other/risk factor not reported or identified 522 27 4,127 12 2,734 37 18,796 20 630 30 3,901
    Total 1,909 100 33,684 100 7,329 100 96,361 100 2,098 100 31,554 100
Transmission category Islander Asian/Pacific American Indian/Alaska Native Totals
2003 Cumulative through 2003 2003 Cumulative through 2003 2003 Cumulative through 2003
No. % No. % No. % No. % No. % No. %
Injection drug use 6 6 121 13 23 39 242 43 2,262 20 61,621 38
Hemophilia/coagulation disorder 0 0 8 1 0 0 3 1 11 0 318 0
Heterosexual contact: 56 55 459 51 22 37 228 41 5,234 45 70,200 43
    Sex with injection drug user 11 11 104 12 4 7 92 16 985 9 24,148 15
    Sex with bisexual male 3 3 78 9 1 2 29 5 223 2 4,402 3
    Sex with person with hemophilia 0 0 4 0 0 0 2 0 16 0 465 0
    Sex with HIV-infected transfusion recipient 1 1 20 2 0 0 3 1 37 0 705 0
    Sex with HIV-infected person, risk factor not specified 41 40 253 28 17 29 102 18 3,973 34 40,480 25
Receipt of blood transfusion, blood components, or tissue 4 4 101 11 1 2 15 3 108 1 4,076 2
Other/risk factor not reported or identified 36 35 212 24 13 22 70 13 3,946 34 27,181 17
    Total 102 100 901 100 59 100 558 100 11,561 100 163,396 100

In the United States MTM remain the majority of HIV carriers, although prevalence among heterosexuals is on the rise. In 1987, 70% of adult and adolescent males with AIDS had a single risk factor of a history of highrisk sexual activity. The proportion of affected MTM has dropped to 45% (2001 through 2003). Adult and adolescent males with a history of intravenous drug use as their only risk factor made up 14% of all cases in 1987. This proportion has changed only marginally in the intervening years, remaining relatively stable at 15% in 2003. (See Table 3.9.)

The proportion of adult and adolescent females with AIDS whose only risk factor was intravenous drug use has dropped from 50% in 1987 to 39% in 2001. Adult and adolescent females with a history of heterosexual contact as their only risk factor made up 38% of all female cases in 1997. By 2001 that proportion increased to 41%, and through 2003 has increased to 45%. (See Table 3.8.) Researchers suggest that one reason for steadily increasing HIV infection and AIDS among heterosexuals is that an increased proportion report multiple sex partners, which is a risk factor for HIV infection.

Undetermined Risk

In 2003 there were 11,220 adult and adolescent (both male and female) cases of AIDS with an undetermined risk. (See Table 3.5.) That is, there was no reported history of exposure to HIV through any of the routes listed in the exposure categories. These include people currently being investigated by local health departments, people whose exposure history was incomplete at the time of their death, those who refused to be interviewed or whose cases were not followed up, and those who were interviewed but no follow-up occurred. When an exposure mode is identified during follow-up, patients are reclassified into the appropriate exposure category.

TABLE 3.9
Reported AIDS cases for male adults and adolescents, by transmission category and race/ethnicity, cumulative through 2003
Includes persons with a diagnosis of AIDS, reported from the beginning of the epidemic through 2003. Cumulative total includes 1,316 males of unknown race or multiple races.
Source: "Table 19. Reported AIDS Cases for Males and Adolescents, by Transmission Category and Race/Ethnicity, Cumulative through 2003United States," in HIV/AIDS Surveillance Report: Cases of HIV Infection and AIDS in the United States, 2003, vol. 15, Centers for Disease Control and Prevention, 2004, http://www.cdc.gov/hiv/stats/2003SurveillanceReport.pdf (accessed July 18, 2005)
Transmission category White, not Hispanic Black, not Hispanic Hispanic
2003 Cumulative through 2003 2003 Cumulative through 2003 2003 Cumulative through 2003
No. % No. % No. % No. % No. % No. %
Male-to-male sexual contact 7,679 66 244,758 73 4,699 34 93,413 37 3,054 43 57,128 43
Injection drug use 1,051 9 31,164 9 2,454 18 80,282 32 1,290 18 44,277 33
Male-to-male sexual contact and injection drug use 793 7 28,795 9 548 4 19,182 8 311 4 9,313 7
Hemophilia/coagulation disorder 56 0 3,964 1 6 0 599 0 9 0 453 0
Heterosexual contact: 454 4 7,010 2 2,047 15 24,428 10 799 11 9,021 7
    Sex with injection drug user 76 1 2,221 1 253 2 6,410 3 141 2 2,195 2
    Sex with person with hemophilia 4 0 38 0 2 0 29 0 0 0 11 0
    Sex with HIV-infected transfusion recipient 4 0 177 0 11 0 205 0 7 0 109 0
    Sex with HIV-infected person, risk factor not specified 370 3 4,574 1 1,781 13 17,784 7 651 9 6,706 5
Receipt of blood transfusion, blood components, or tissue 30 0 3,227 1 49 0 1,205 0 28 0 646 0
Other/risk factor not reported or identified 1,640 14 14,519 4 3,932 29 33,905 13 1,544 22 12,659 9
    Total 11,703 100 333,437 100 13,735 100 253,014 100 7,035 100 133,497 100
Transmission category Asian/Pacific Islander American Indian/Alaska Native Total
2003 Cumulative through 2003 2003 Cumulative through 2003 2003 Cumulative through 2003
No. % No. % No. % No. % No. % No. %
Male-to-male sexual contact 254 56 4,084 69 93 58 1,299 56 15,859 48 401,392 55
Injection drug use 26 6 292 5 22 14 370 16 4,866 15 156,575 21
Male-to-male sexual contact and injection drug use 19 4 227 4 15 9 392 17 1,695 5 57,998 8
Hemophilia/coagulation disorder 2 0 72 1 1 1 32 1 74 0 5,130 1
Heterosexual contact: 42 9 305 5 11 7 92 4 3,371 10 40,947 6
    Sex with injection drug user 3 1 55 1 2 1 28 1 477 1 10,930 1
    Sex with person with hemophilia 0 0 1 0 0 0 0 0 7 0 80 0
    Sex with HIV-infected transfusion recipient 1 0 8 0 1 1 3 0 24 0 505 0
    Sex with HIV-infected person, risk factor not specified 38 8 241 4 8 5 61 3 2,863 9 29,432 4
Receipt of blood transfusion, blood components, or tissue 3 1 118 2 0 0 9 0 111 0 5,219 1
Other/risk factor not reported or identified 110 24 792 13 19 12 130 6 7,274 22 62,217 9
    Total 456 100 5,890 100 161 100 2,324 100 33,250 100 729,478 100

MORTALITY FROM AIDS

By 1999 the average life expectancy for Americans had risen to an all-time high of 76.7 years. This figure would have been higher, according to the CDC, were it not for heart diseases (the leading cause of death for all age categories), malignant neoplasms (the leading cause of death for those ages forty-five to sixty-four), and accidents (the leading cause of death for those ages fifteen to forty-four). AIDS is also among the top ten leading causes of death among the latter age group. According to CDC statistics compiled in 2003, since 1999 AIDS has claimed the lives of 368,643 Americans ages fifteen to forty-four, representing 70% of the total numbers of deaths (524,060). (See Table 3.2.)

TABLE 3.10
Estimated number of cases and rates of AIDS, by race/ethnicity, age category, and sex, 2003
Race/ethnicity Adults or adolescents Children (<13 years) Total
Males Females Total
No. Rate No. Rate No. Rate No. Rate No. Rate
Note: These numbers do not represent reported case counts. Rather, these numbers are point estimates, which result from adjustments of reported case counts. The reported case counts are adjusted for reporting delays. The estimates do not include adjustment for incomplete reporting.
Data exclude cases from the U.S. dependencies, possessions, and associated nations, as well as cases in persons whose state or area of residence is unknown, because of the lack of census information by race and age categories for these areas.
Includes persons of unknown race or multiple races. Total includes 193 persons of unknown race or multiple races. Because column totals were calculated independently of the values for the subpopulations, the values in each column may not sum to the column total.
Source: "Table 5. Estimated Numbers of Cases and Rates (per 100,000 Population) of AIDS, by Race/Ethnicity, Age Category, and Sex, 200350 States and the District of Columbia," in HIV/AIDS Surveillance Report: Cases of HIV Infection and AIDS in the United States, 2003, vol. 15, Centers for Disease Control and Prevention, 2004, http://www.cdc.gov/hiv/stats/2003SurveillanceReport.pdf (accessed July 18, 2005)
White, not Hispanic 10,450 12.8 1,725 2.0 12,175 7.2 9 0.0 12,184 6.1
Black, not Hispanic 13,624 103.8 7,551 50.2 21,174 75.2 40 0.5 21,214 58.2
Hispanic 6,087 40.3 1,744 12.4 7,831 26.8 7 0.1 7,839 20.0
Asian/Pacific Islander 408 8.3 86 1.6 494 4.8 0 0 494 4.0
American Indian/Alaska Native 150 16.2 46 4.8 196 10.4 0 0 196 8.1
    Total 30,851 26.6 11,211 9.2 42,062 17.7 58 0.1 42,120 14.5

Nearly 100% of AIDS patients die within seven years of the initial diagnosis of the late stage of HIV infection. Some deaths are not reported to the CDC or are reported as deaths from other causes. So the reported case-fatality rate (the number of deaths from a disease divided by the number of cases of that disease) is surely an underestimate. The case-fatality rate is frequently used as a measure of the severity of a disease and to estimate the probability of death among diagnosed cases.

The number of deaths due to AIDS peaked at 51,670 in 1995. Since then the number of deaths has been dropping. In 2003 the disease killed 18,017 Americans. Fewer people are dying from AIDS because of more effective treatment. As fewer people become infected with HIV, the death rate in subsequent years will drop proportionally. The statistics for children under the age of thirteen at the time of diagnosis, however, remain grimhalf die before their first birthday, while the other half do not live to adolescence.

According to 2001 CDC data (the latest available as of this writing), 70% (328,588) of the males and females who have died from AIDS since the epidemic began were aged twenty-five to forty-four. In that age group, 49,839 (11%) were female and 278,749 (60%) were male. White and black males made up the largest group of cumulative deaths (139,152 and 87,774, respectively), with Hispanic males (48,902) and black females (28,918) ranking third and fourth.

TABLE 3.11
Reported cases of HIV/AIDS in infants born to HIV-infected mothers, by selected characteristics, 200003
Year of report
2000 2001 2002 2003
Note: Since 1994, the following 25 states have had laws and regulations requiring confidential name-based HIV infection reporting: 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.
Data include children with a diagnosis of HIV infection. This includes children with a diagnosis of HIV infection only, a diagnosis of HIV infection and a later AIDS diagnosis, and concurrent diagnoses of HIV infection and AIDS.
aStatus in the surveillance system as of June 2004.
bIncludes children of unknown or multiple race.
Source: "Table 23. Reported Cases of HIV/AIDS in Infants Born to HIV-Infected Mothers, by Year of Report and Selected Characteristics, 1994200325 States with Confidential Name-Based HIV Infection Reporting," in HIV/AIDS Surveillance Report: Cases of HIV Infection and AIDS in the United States, 2003, vol. 15, Centers for Disease Control and Prevention, 2004, http://www.cdc.gov/hiv/stats/2003SurveillanceReport.pdf (accessed July 18, 2005)
Child's race/ethnicity
White, not Hispanic 14 20 22 15
Black, not Hispanic 90 91 68 62
Hispanic 17 15 18 8
Asian/Pacific Islander 1 1 1 1
American Indian/Alaska Native 0 0 1 1
Perinatal transmission category
Mother with, or at risk for, HIV infection:
   Injection drug use 32 26 10 7
   Sex with injection drug user 12 11 11 6
   Sex with bisexual male 2 5 2 5
   Sex with person with hemophilia 1 1 0 1
   Sex with HIV-infected transfusion recipient 0 0 0 0
   Sex with HIV-infected person, risk not specified 44 47 39 38
   Receipt of blood transfusion, blood components, or tissue 0 3 1 0
   Has HIV infection, risk not specified 31 34 48 33
Child's diagnosis statusa
HIV infection 95 91 77 75
AIDS 27 36 34 15
    Totalb 122 127 111 90

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Patterns and Trends in HIV/AIDS Surveillance

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