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 residenceLiving with HIV infection (not AIDS)aLiving with AIDS
Adults or adolescentsChildren <13 years oldTotalAdults or adolescentsChildren <13 years oldTotal
Alabama5,863335,8963,924153,940
Alaska26202612692271
Arizona5,452415,4934,12254,127
Arkansas2,281132,2942,057102,067
California55,61213855,750
Colorado6,118146,1323,67233,675
Connecticut6,959306,989
Delaware1,601121,613
District of Columbia8,785638,848
Floridab32,19625332,44942,86136143,223
Georgia13,9636014,023
Hawaii1,31441,318
Idaho38913902740274
Illinois14,2418014,321
Indiana3,874293,9023,668183,686
Iowa46944737253728
Kansas1,13391,1431,12031,123
Kentucky2,349102,359
Louisiana7,675987,7737,549437,592
Maine5153518
Maryland12,8308112,911
Massachusetts8,362358,397
Michigan5,799725,8715,562225,584
Minnesota3,136243,1601,890101,900
Mississippi4,341344,3752,856192,875
Missouri4,881394,9205,046145,060
Montana1750175
Nebraska59466005944598
Nevada3,377153,3922,64862,654
New Hampshire5263530
New Jersey15,19229415,48716,96911917,089
New Mexico81608161,17841,182
New York66,31134966,660
North Carolina11,1188611,2046,519256,545
North Dakota7217356157
Ohio7,585667,6516,548356,583
Oklahoma2,615182,6332,08142,085
Oregon2,57962,586
Pennsylvania15,05412315,178
Rhode Island1,093101,103
South Carolina6,906646,9706,349296,379
South Dakota19721991041105
Tennessee6,612666,6785,806115,817
Texas20,82030521,12529,9588530,043
Utah68796961,09801,098
Vermont2473250
Virginia9,182609,2427,682537,735
Washington5,10265,108
West Virginia68656906405645
Wisconsin2,297192,3161,837111,848
Wyoming8919095196
   Subtotal172,7141,683174,396393,3751,942395,317

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 residenceLiving with HIV infection (not AIDS)aLiving with AIDS
Adults or adolescentsChildren <13 years oldTotalAdults or adolescentsChildren <13 years oldTotal
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
Guam36035
Pacific Islands, U.S.404
Puerto Rico9,748499,798
Virgin Islands, U.S.23842432922294
    Totalc172,9521,687174,639403,9281,998405,926

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 deathCumulative through 2003a
19992000200120022003
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)
<1397514835295,103
13-141884118252
15-242322162701992299,789
25-343,2582,8232,5122,1431,928142,761
35-447,7067,1387,5256,8966,970216,093
45-544,9945,2035,5485,7375,964104,064
55-641,5561,6311,8731,8402,14633,717
6563067074369674112,282
Race/ethnicity
White, not Hispanic5,8345,5595,5245,1284,767230,289
Black, not Hispanic9,1068,8329,3458,9239,048195,891
Hispanic3,3413,1623,4353,2743,91592,370
Asian/Pacific Islander11310310894853,340
American Indian/Alaska Native79678379781,529
Transmission category
    Male adult or adolescent
    Male-to-male sexual contact6,7036,3166,4796,0126,015257,898
    Injection drug use4,4254,1824,2984,1264,166107,797
    Male-to-male sexual contact and injection drug use1,3351,3341,3961,2851,23338,083
    Heterosexual contact1,4031,4171,5851,5261,64423,080
    Otherb1942041741661409,846
        Subtotal14,06113,45413,93213,11613,198436,704
    Female adult or adolescent
    Injection drug use2,0511,9251,9851,9562,05639,848
    Heterosexual contact2,1572,1922,4442,3352,58437,901
    Otherb97929289954,115
        Subtotal4,3054,2094,5214,3794,73681,864
    Child (<13 yrs at diagnosis)
    Perinatal117726758784,961
    Otherc85445531
        Subtotal124787162835,492
Region of residence
Northeast5,6985,2945,3445,0156,140168,213
Midwest1,7121,6851,8391,5501,34350,258
South7,4067,3527,6247,5267,068178,447
West2,9522,6812,8172,5202,588107,767
U.S. dependencies, possessions, and associated nations72372990094787719,375
    Totald18,49117,74118,52417,55718,017524,060

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 residence20022003Cumulative through 2003a
No.RateNo.RateAdults or adolescentsChildren (<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)
Alabama4339.747210.57,531767,607
Alaska355.5233.55596565
Arizona63311.661411.09,166429,208
Arkansas2398.81886.93,543383,581
California4,22812.15,90316.6132,650642133,292
Colorado3267.23668.08,042318,073
Connecticut61117.773621.113,28418013,464
Delaware19323.921326.13,206253,231
District of Columbia926162.7961170.615,66018115,841
Florida4,97929.84,66627.493,2351,49094,725
Georgia1,47117.21,90722.027,69721827,915
Hawaii13110.61108.72,816172,833
Idaho312.3261.95693572
Illinois2,11116.81,73013.729,85728230,139
Indiana4918.05078.27,450547,504
Iowa903.1772.61,554131,567
Kansas712.61164.32,647122,659
Kentucky3047.42195.34,162304,192
Louisiana1,16326.01,04123.215,51913415,653
Maine282.2524.01,07591,084
Maryland1,84833.91,57028.526,60631226,918
Massachusetts80812.675711.818,31121418,525
Michigan7957.96806.713,21511113,326
Minnesota1623.21773.54,225274,252
Mississippi43615.250817.65,742575,799
Missouri3886.84037.110,3466010,406
Montana171.970.83633366
Nebraska714.1593.41,286101,296
Nevada31314.427712.45,209285,237
New Hampshire393.1372.998510995
New Jersey1,45617.01,51617.545,93676746,703
New Mexico864.61095.82,38182,389
New York6,74135.26,68434.8160,1092,337162,446
North Carolina1,04512.61,08312.913,33512113,456
North Dakota30.530.51141115
Ohio7736.87756.813,37312913,502
Oklahoma2055.92136.14,414274,441
Oregon3008.52426.85,580195,599
Pennsylvania1,78914.51,89515.329,63934929,988
Rhode Island10710.01029.52,337262,363
South Carolina82220.077418.711,7249411,818
South Dakota111.4131.72144218
Tennessee77213.383714.310,6865410,740
Texas3,07614.23,37915.362,59239162,983
Utah682.9733.12,156202,176
Vermont121.9162.64516457
Virginia94813.077710.515,54417915,723
Washington4717.85258.610,9533410,987
West Virginia824.5945.21,341111,352
Wisconsin1873.41843.44,103334,136
Wyoming112.281.62102212
   Subtotal42,33614.743,70415.0863,7028,927872,629
U.S. dependencies, possessions, and associated nations
Guam21.263.764165
Pacific Islands, U.S.00.010.7202
Puerto Rico1,13529.41,06527.527,90339828,301
Virgin Islands5449.63431.258518603
   Totalb43,57814.944,96315.2892,8759,348902,223

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 residence20022003Cumulative through 2003
No.RateNo.RateAdults or adolescentsChildren (<13 years)Total
Akron, OH294.1243.46591660
Albany-Schenectady-Troy, NY10812.210111.32,023242,047
Albuquerque, NM425.7476.31,25421,256
Allentown-Bethlehem-Easton, PA548.38212.41,043131,056
Ann Arbor, MI183.0203.34509459
Atlanta, GA1,01523.21,21227.119,24812119,369
Austin-San Marcos, TX21516.015311.14,390274,417
Bakersfield, CA12818.510314.41,32981,337
Baltimore, MD1,25748.41,02839.317,83321418,047
Baton Rouge, LA30349.420933.72,620202,640
Bergen-Passaic, NJ14210.219914.35,938856,023
Birmingham, AL11512.312713.52,237232,260
Boston-Brocktn-Nashua, MA-NH Necma72111.766410.816,10019016,290
Buffalo-Niagra Falls, NY927.91049.02,156192,175
Charleston, SC13824.59216.11,834171,851
Charlotte-Gast.-Rock Hill, NC-SC21913.926216.22,748232,771
Chicago, IL1,84921.91,52718.025,80625126,057
Cincinnati, OH-KY-IN24014.4714.22,248162,264
Cleveland-Lorain-Elyria, OH1707.61998.93,894463,940
Colorado Springs, CO234.2386.95345539
Columbia, SC20437.018733.52,589182,607
Columbus, OH1509.521813.62,682132,695
Dallas, TX75220.174519.514,5303714,567
Dayton-Springfield, OH464.910010.61,201171,218
Daytona Beach, FL11422.0519.61,393151,408
Denver, CO23010.526111.86,319226,341
Detroit, MI57913.048310.89,176749,250
El Paso, TX7911.49213.01,350101,360
Fort Lauderdale, FL75044.069039.914,73625714,993
Fort Wayne, IN316.1183.53823385
Fort Worth-Arlington, TX18010.025213.73,782273,809
Fresno, CA9910.3919.21,436151,451
Gary, IN629.7457.08876893
Grand Rapids-Muskegon-Holland, MI524.7494.49035908
Greensboro/Winstn-Salem/H.Pt., NC1199.315011.62,056212,077
Greenville-Spartanburg-Andersn, SC767.711811.91,79871,805
Harrisburg-Lebanon-Carlisle, PA6410.19414.71,286111,297
Hartford, CT Necma19917.028524.24,624474,671
Honolulu, HI869.6849.32,013142,027
Houston, TX97922.21,32429.422,01416622,180
Indianapolis, IN27516.626315.73,575243,599
Jacksonville, FL27123.528324.05,255735,328
Jersey City, NJ19932.617228.37,0961217,217
Kansas City, MO-KS1256.81387.54,333134,346
Knoxville, TN466.5567.98587865
Lakeland-Winter Haven, FL8817.611522.51,529191,548
Las Vegas, NV-AZ29016.925814.54,346274,373
Little Rock-N. Little Rock, AR8915.0538.81,260141,274
Los Angeles-Long Beach, CA1,54915.92,55825.947,13624347,379
Louisiville, KY-IN13713.211010.52,025192,044
McAllen-Edinburg-Mission, TX426.8467.250111512
Melbourne-Titusvlle-Palm Bay, FL7515.17615.01,435111,446
Memphis, TN-AR-MS39934.536231.04,168194,187
Miami, FL1,13949.21,07245.827,02350227,525
Middlesex-Somerset-Hunterdon, NJ14011.61189.73,541733,614
Milwaukee-Waukesha, WI1137.51036.82,284192,303
Minneapolis-St. Paul, MN-WI1444.71565.13,757213,778
Mobile, AL8315.29016.31,448181,466
Monmouth-Ocean, NJ1008.6847.13,127643,191
Nashville, TN19615.427121.03,353173,370
Nassau-Suffolk, NJ2599.32589.27,3701157,485

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 residence20022003Cumulative through 2003
No.RateNo.RateAdults or adolescentsChildren (<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 Necma35820.739622.77,5351257,660
New Orleans, LA52139.043832.78,125718,196
New York, NY5,64960.15,58059.2135,0862,092137,178
Newark, NJ56927.653425.818,51932918,848
Norfolk-VA Beach-Newport News, VA28918.01589.74,494634,557
Oakland, CA27711.338015.48,913478,960
Oklahoma City, OK1079.71008.92,09772,104
Omaha, NE-IA517.0425.79023905
Orange County, CA2287.82518.56,335396,374
Orlando, FL52830.148727.07,434857,519
Philadelphia, PA-NJ1,41727.61,28824.922,73728123,018
Phoenix-Mesa, AZ51214.742111.76,557286,585
Pittsburgh, PA1416.024410.42,874192,893
Portland-Vancouver, OR-WA22411.21818.94,49494,503
Providence-Warwick, RI Necma10010.2929.32,191232,214
Raleigh-Durham-Chapel Hill, NC21416.920515.82,565232,588
Richmond-Petersburg, VA10210.013513.12,946322,978
Riverside-San Bernardino, CA2828.147213.07,933587,991
Rochester, NY19117.413812.52,786132,799
Sacramento, CA1035.91337.43,542243,566
St. Louis, MO-IL2188.32248.55,395415,436
Salt Lake City-Ogden, UT523.8604.31,868141,882
San Antonio, TX20012.01669.84,484284,512
San Diego, CA46716.151617.611,9455812,003
San Francisco, CA54631.976745.229,6094629,655
San Jose, CA1187.01136.73,466153,481
San Juan-Bayamon, PR70535.467833.917,49724717,744
Sarasota-Bradenton, FL10516.912319.41,801251,826
ScrantonWilkes-BarreHazleton, PA243.9335.44975502
Seattle-Bellevue-Everett, WA31612.838015.37,673197,692
Springfield, MA Necma8013.18914.41,984252,009
Stockton-Lodi, CA8013.08012.693513948
Syracuse, NY658.9598.01,49791,506
Tacoma, WA324.4344.69639972
Tampa-St Pete.-Clearwater, FL50420.355722.09,93310510,038
Toledo, OH569.0365.870112713
Tucson, AZ687.712814.31,834101,844
Tulsa, OK496.0668.01,312101,322
Vallejo-Fairfield-Napa, CA529.66612.11,551111,562
Ventura, CA384.9324.09133916
Washington, DC-MD-VA-WV1,83235.61,74333.328,09630428,400
West Palm Beach-Boca Raton, FL57148.144636.78,8892219,110
Wichita, KS213.8417.48092811
Wilmington-Newark, DE-MD15425.617028.02,556182,574
Youngstown-Warren, OH244.1254.34440444
Metropolitan areas with 500,000 or more population35,72819.236,54819.4749,6387,950757,588
Metropolitan areas with 50,000 to 499,999 population4,3378.94,6089.483,39483284,226
Nonmetropolitan3,2205.73,4146.054,82851555,343
   Total43,47114.944,76915.2891,6059,325900,930

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 categoryMalesFemalesTotal
2003Cumulative through 2003a2003Cumulative through 2003a2003Cumulative 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 contact15,85948401,3925515,85935401,39245
Injection drug use4,86615156,575212,2622061,621387,12816218,19624
Male-to-male sexual contact and injection drug use1,695557,99881,695457,9986
Hemophilia/coagulation disorder7405,130111031808505,4481
Heterosexual contact3,3711040,94765,2344570,200438,60519111,14712
    Sex with injection drug user477110,9301985924,148151,462335,0784
    Sex with bisexual male000022324,402322304,4020
    Sex with person with hemophilia7080016046502305450
    Sex with HIV-infected transfusion recipient240505037070506101,2100
    Sex with HIV-infected person, risk factor not specified2,863929,43243,9733440,480256,8361569,9128
Receipt of blood transfusion, blood components, or tissueb11105,219110814,076221909,2951
Other/risk factor not reported or identifiedc7,2742262,21793,9463427,1811711,2202589,39910
    Subtotal33,250100729,47810011,561100163,39610044,811100892,875100
Child (<13 years at diagnosis)
Hemophilia/coagulation disorder0022750070002343
Mother with the following risk factor for, or documented, HIV infection:61874,2328870854,31795131868,54991
    Injection drug use691,6433411131,6453617113,28835
    Sex with injection drug user8117841667741161491,52516
    Sex with bisexual male00952221022211972
    Sex with person with hemophilia112100015011360
    Sex with HIV-infected transfusion recipient001100016000270
    Sex with HIV-infected person, risk factor not specified18267051518227371636241,44215
    Receipt of blood transfusion, blood components, or tissue0073200832001562
    Has HIV infection, risk factor not specified28409001933409782161401,87820
Receipt of blood transfusion, blood components, or tissueb112445111433213874
Other/risk factor not reported or identifiedd811802111398219131782
    Subtotal701004,783100821004,5651001521009,348100
    Total33,320100734,26110011,643100167,96110044,963100902,223100

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
19992000200120022003
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)
<133,0342,8432,6052,3351,998
13-14440517645728768
15-244,7194,9915,2295,6686,313
25-3460,18456,68653,68751,41049,906
35-44141,295151,180158,173163,732168,322
45-5477,21689,461102,252115,613129,311
55-6419,25822,92227,19732,70338,997
655,0586,1327,2518,58310,310
Race/ethnicity
White, not Hispanic119,674126,162132,258139,089146,544
Black, not Hispanic126,044137,524148,469160,022172,278
Hispanic61,19466,26671,03475,78280,623
Asian/Pacific Islander2,4842,7553,0563,4143,826
American Indian/Alaska Native1,0471,1661,2621,3801,498
Transmission category
    Male adult or adolescent
    Male-to-male sexual contact140,216150,172160,076171,035182,989
    Injection drug use58,00661,24963,72366,00368,191
    Male-to-male sexual contact and injection drug use21,66722,40323,03323,69024,334
    Heterosexual contact20,59523,47826,47129,83533,324
    Othera3,8073,9224,0624,2044,345
        Subtotal244,291261,223277,366294,767313,183
    Female adult or adolescent
    Injection drug use25,74427,31728,60229,67030,710
    Heterosexual contact35,60340,42245,09750,14255,685
    Othera1,7461,9082,0672,2392,420
        Subtotal63,09369,64775,76582,05288,815
    Child (<13 years at diagnosis)
    Perinatal3,6723,7143,7633,8083,788
    Otherb148145145143139
        Subtotal3,8203,8603,9083,9513,927
Region of residence
Northeast92,74199,964105,970111,506116,827
Midwest31,01633,47035,72538,51341,668
South115,991125,396135,465146,421158,962
West62,30066,28069,93174,25378,333
U.S. dependencies, possessions, and associated nations9,1579,6219,94910,07710,136
    Totalc311,205334,731357,040380,771405,926

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
2000200120022003
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)
<132,8982,8672,7962,614
13-14336442519618
15-2411,29711,93112,40913,134
25-3467,68866,71166,41666,446
35-44124,116132,137139,133145,288
45-5460,61670,40780,75791,567
55-6414,57917,31420,98825,237
654,0024,8405,6876,710
Race/ethnicity
White, not Hispanic113,617120,186127,257134,678
Black, not Hispanic135,562146,057156,771167,938
Hispanic31,95035,50839,35843,241
Asian/Pacific Islander1,0341,1711,3441,595
American Indian/Alaska Native1,5081,6061,7371,873
Transmission category
     Male adult or adolescent
    Male-to-male sexual contact128,956138,629149,336160,433
    Injection drug use36,52638,09839,63041,207
    Male-to-male sexual contact and injection drug use19,09719,64220,17520,773
    Heterosexual contact25,26228,11531,04234,124
    Othera2,8172,8912,9723,071
        Subtotal212,658227,375243,154259,609
    Female adult or adolescent
    Injection drug use19,78920,65021,38122,173
    Heterosexual contact47,96353,24558,54763,981
    Othera1,4501,5471,6601,787
        Subtotal69,20275,44281,58887,940
    Child (<13 years at diagnosis)
    Perinatal3,2603,4343,5933,720
    Otherb406393367342
        Subtotal3,6663,8273,9604,062
        Totalc285,531306,649328,705351,614

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 categoryWhite, not HispanicBlack, not HispanicHispanic
2003Cumulative through 20032003Cumulative through 20032003Cumulative through 2003
No.%No.%No.%No.%No.%No.%
Injection drug use5572913,695411,2771735,767373851811,69537
Hemophilia/coagulation disorder30117050128030600
Heterosexual contact:8094213,877413,2534440,193421,0555015,29448
    Sex with injection drug user220125,29316525712,52613218106,10319
    Sex with bisexual male4721,701511821,88525437012
    Sex with person with hemophilia121314130103010420
    Sex with HIV-infected transfusion recipient4033412502300701140
    Sex with HIV-infected person, risk factor not specified526286,235192,5823525,44926775378,33426
Receipt of blood transfusion, blood components, or tissue1811,86866011,47722516042
Other/risk factor not reported or identified522274,127122,7343718,79620630303,901
    Total1,90910033,6841007,32910096,3611002,09810031,554100
Transmission categoryIslander Asian/PacificAmerican Indian/Alaska NativeTotals
2003Cumulative through 20032003Cumulative through 20032003Cumulative through 2003
No.%No.%No.%No.%No.%No.%
Injection drug use66121132339242432,2622061,62138
Hemophilia/coagulation disorder008100311103180
Heterosexual contact:5655459512237228415,2344570,20043
    Sex with injection drug user111110412479216985924,14815
    Sex with bisexual male337891229522324,4023
    Sex with person with hemophilia004000201604650
    Sex with HIV-infected transfusion recipient1120200313707050
    Sex with HIV-infected person, risk factor not specified4140253281729102183,9733440,48025
Receipt of blood transfusion, blood components, or tissue44101111215310814,0762
Other/risk factor not reported or identified363521224132270133,9463427,18117
    Total1021009011005910055810011,561100163,396100

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 categoryWhite, not HispanicBlack, not HispanicHispanic
2003Cumulative through 20032003Cumulative through 20032003Cumulative through 2003
No.%No.%No.%No.%No.%No.%
Male-to-male sexual contact7,67966244,758734,6993493,413373,0544357,12843
Injection drug use1,051931,16492,4541880,282321,2901844,27733
Male-to-male sexual contact and injection drug use793728,7959548419,182831149,3137
Hemophilia/coagulation disorder5603,9641605990904530
Heterosexual contact:45447,01022,0471524,42810799119,0217
    Sex with injection drug user7612,221125326,410314122,1952
    Sex with person with hemophilia403802029000110
    Sex with HIV-infected transfusion recipient4017701102050701090
    Sex with HIV-infected person, risk factor not specified37034,57411,7811317,784765196,7065
Receipt of blood transfusion, blood components, or tissue3003,22714901,20502806460
Other/risk factor not reported or identified1,6401414,51943,9322933,905131,5442212,6599
    Total11,703100333,43710013,735100253,0141007,035100133,497100
Transmission categoryAsian/Pacific IslanderAmerican Indian/Alaska NativeTotal
2003Cumulative through 20032003Cumulative through 20032003Cumulative through 2003
No.%No.%No.%No.%No.%No.%
Male-to-male sexual contact254564,0846993581,2995615,85948401,39255
Injection drug use26629252214370164,86615156,57521
Male-to-male sexual contact and injection drug use1942274159392171,695557,9988
Hemophilia/coagulation disorder20721113217405,1301
Heterosexual contact:42930551179243,3711040,9476
    Sex with injection drug user3155121281477110,9301
    Sex with person with hemophilia0010000070800
    Sex with HIV-infected transfusion recipient108011302405050
    Sex with HIV-infected person, risk factor not specified3882414856132,863929,4324
Receipt of blood transfusion, blood components, or tissue311182009011105,2191
Other/risk factor not reported or identified1102479213191213067,2742262,2179
    Total4561005,8901001611002,32410033,250100729,478100

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/ethnicityAdults or adolescentsChildren (<13 years)Total
MalesFemalesTotal
No.RateNo.RateNo.RateNo.RateNo.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 Hispanic10,45012.81,7252.012,1757.290.012,1846.1
Black, not Hispanic13,624103.87,55150.221,17475.2400.521,21458.2
Hispanic6,08740.31,74412.47,83126.870.17,83920.0
Asian/Pacific Islander4088.3861.64944.8004944.0
American Indian/Alaska Native15016.2464.819610.4001968.1
    Total30,85126.611,2119.242,06217.7580.142,12014.5

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
2000200120022003
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 Hispanic14202215
Black, not Hispanic90916862
Hispanic1715188
Asian/Pacific Islander1111
American Indian/Alaska Native0011
Perinatal transmission category
Mother with, or at risk for, HIV infection:
   Injection drug use3226107
   Sex with injection drug user1211116
   Sex with bisexual male2525
   Sex with person with hemophilia1101
   Sex with HIV-infected transfusion recipient0000
   Sex with HIV-infected person, risk not specified44473938
   Receipt of blood transfusion, blood components, or tissue0310
   Has HIV infection, risk not specified31344833
Child's diagnosis statusa
HIV infection95917775
AIDS27363415
    Totalb12212711190

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Patterns and Trends in HIV/AIDS Surveillance

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