U.S. HIV and AIDS cases reported through December 1998
Year-end edition Vol. 10, No. 2
Estimated number of persons living with AIDS, 1992 through 1997, by sex, race/ethnicity, and region, United States
Acquired immunodeficiency syndrome (AIDS) is a specific group of diseases or conditions which are indicative of severe immunosuppression related to infection with the human immunodeficiency virus (HIV).
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Public Health Service Centers for Disease Control and Prevention National Center for HIV, STD, and TB Prevention Atlanta, Georgia 30333
CDC
CENTERS FOR DISEASE CONTROL AND PREVENTION
The HIV/AIDS Surveillance Report is published semiannually by the Division of HIV/AIDS Prevention — Surveillance and Epidemiology, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, GA 30333. The year-end edition contains additional tables and graphs. All data are provisional.
Suggested Citation: Centers for Disease Control and Prevention. HIV/AIDS Surveillance Report , 1998;10(No. 2):[inclusive page numbers].
Centers for Disease Control and Prevention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Jeffery P. Koplan, M.D., M.P.H. Director National Center for HIV, STD, and TB Prevention . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Helene D. Gayle, M.D., M.P.H. Director Division of HIV/AIDS Prevention — Surveillance and Epidemiology . . . . . . . . . . . . . . . . . . . Kevin M. De Cock, M.D. Director Surveillance Branch . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Patricia L. Fleming, Ph.D., M.S. Chief Reporting and Analysis Section . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Pascale M. Wortley, M.D., M.P.H. Chief Shari C.Steinberg, M.S., M.P.H. Surveillance Report Coordinator Statistics and Data Management Branch . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Phillip H. Rhodes, Ph.D. Chief Xenophon M. Santas Assistant Chief
Single copies of the HIV/AIDS Surveillance Report are available free from the CDC National Prevention Information Network, P.O. Box 6003, Rockville, MD 20849-6003; telephone 1–800–458–5231 or 1–301–562–1098. Individuals or organizations can be added to the mailing list by writing to CDC, MASO/MSB/IDS, Mailstop A-22, 1600 Clifton Rd., N.E., Atlanta, GA 30333. Internet users may view an electronic copy of the Report by visiting CDC’s home page (www.cdc.gov) and selecting the topic “Publications, Software, & Products.” Confidential information, referrals, and educational material on AIDS are available from the CDC National AIDS Hotline: 1–800–342–2437, 1–800–344–7432 (Spanish access), and 1–800–243–7889 (TTY, deaf access).
The HIV/AIDS Surveillance Report is accessible via Internet: www.cdc.gov
The HIV/AIDS logo on the cover is used with permission of the American Red Cross.
Federal Recycling Program
Printed on recycled paper
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Contents
Commentary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Reports of HIV infection and AIDS cases Table 1. Persons reported to be living with HIV infection and with AIDS, by state and age group . . . . . . . . . . . . . . 7 Table 2. AIDS cases and annual rates per 100,000 population, by state and age group . . . . . . . . . . . . . . . . . . . . . 8 Table 3. HIV infection cases, by state and age group . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Table 4. AIDS cases and annual rates per 100,000 population, by metropolitan area and age group . . . . . . . . . . 10 Figure 1. Male adult/adolescent AIDS annual rates per 100,000 population . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Figure 2. Female adult/adolescent AIDS annual rates per 100,000 population . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Figure 3. Male adult/adolescent HIV infection and AIDS cases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Figure 4. Female adult/adolescent HIV infection and AIDS cases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Table 5. AIDS cases by age group, exposure category, and sex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Table 6. HIV infection cases by age group, exposure category, and sex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Table 7. AIDS cases by sex, age at diagnosis, and race/ethnicity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 Table 8. HIV infection cases by sex, age at diagnosis, and race/ethnicity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Table 9. Male adult/adolescent AIDS cases by exposure category and race/ethnicity . . . . . . . . . . . . . . . . . . . . . . 18 Table 10. Male adult/adolescent HIV infection cases by exposure category and race/ethnicity . . . . . . . . . . . . . . . . 19 Table 11. Female adult/adolescent AIDS cases by exposure category and race/ethnicity . . . . . . . . . . . . . . . . . . . . 20 Table 12. Female adult/adolescent HIV infection cases by exposure category and race/ethnicity . . . . . . . . . . . . . . 21 Table 13. AIDS cases in adolescents and adults under age 25, by sex and exposure category . . . . . . . . . . . . . . . 22 Table 14. HIV infection cases in adolescents and adults under age 25, by sex and exposure category . . . . . . . . . 23 Table 15. Pediatric AIDS cases by exposure category and race/ethnicity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 Table 16. Pediatric HIV infection cases by exposure category and race/ethnicity. . . . . . . . . . . . . . . . . . . . . . . . . . . 25 Figure 5. Pediatric AIDS cases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 Table 17. Documented and possible occupationally acquired AIDS/HIV infection, by occupation . . . . . . . . . . . . . . 26 Figure 6. Investigations of adult/adolescent AIDS cases ever classified as risk not reported or identified. . . . . . . . 27 Table 18. Adult/adolescent AIDS cases by single and multiple exposure categories . . . . . . . . . . . . . . . . . . . . . . . . 28 Table 19. AIDS cases and annual rates per 100,000 population, by race/ethnicity, age group, and sex . . . . . . . . . 29 Table 20. Adult/adolescent AIDS cases among Hispanics, by exposure category and place of birth. . . . . . . . . . . . 29 Table 21. Deaths in persons with AIDS, by race/ethnicity, age at death, and sex . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 AIDS incidence, prevalence, and deaths, adjusted for unreported risk and delays in reporting AIDS incidence Table 22. Estimated male adult/adolescent AIDS incidence, by exposure category and race/ethnicity . . . . . . . . . . 31 Table 23. Estimated female adult/adolescent AIDS incidence, by exposure category and race/ethnicity. . . . . . . . . 32 Table 24. Estimated AIDS incidence in adolescents and adults under age 25, by sex and exposure category . . . 33 AIDS incidence trends Figure 7. Estimated AIDS incidence, by region of residence and year of diagnosis. . . . . . . . . . . . . . . . . . . . . . . . . Figure 8. Estimated AIDS incidence, by race/ethnicity and year of diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Figure 9. Estimated male adult/adolescent AIDS incidence, by exposure category and year of diagnosis . . . . . . . Figure 10. Estimated female adult/adolescent AIDS incidence, by exposure category and year of diagnosis. . . . . . Figure 11. Estimated pediatric AIDS incidence, by year of diagnosis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 34 35 35 36
Persons living with AIDS, trends Table 25. Estimated persons living with AIDS, by region of residence and year. . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 Table 26. Estimated persons living with AIDS, by race/ethnicity and year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 Table 27. Estimated persons living with AIDS, by age group, sex, exposure category, and year . . . . . . . . . . . . . . . 37 Deaths of persons with AIDS, trends Table 28. Estimated deaths of persons with AIDS, by region of residence and year of death . . . . . . . . . . . . . . . . . 38 Table 29. Estimated deaths of persons with AIDS, by race/ethnicity and year of death . . . . . . . . . . . . . . . . . . . . . . 38 Table 30. Estimated deaths of persons with AIDS, by age group, sex, exposure category, and year of death. . . . . 39 Technical Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
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Commentary
During 1998, 48,269 persons were reported with AIDS, more than half (57%) from the states of New York, Florida, New Jersey, California, and Texas. A total of 688,200 persons have been reported with AIDS since the beginning of the epidemic. In 1997, the most recent full year for which estimates of the numbers of persons living with AIDS are available (because of the lag time needed to take reporting delays into account, see technical notes), an estimated 270,841 persons were living with AIDS, a 12% increase from 1996. The number of persons living with AIDS increased as a result of improved survival for AIDS patients who were receiving treatment and substantial decreases in the number of deaths in 1997. Between 1992 and 1997, the number of persons living with AIDS increased in all groups, as a result of the 1993 expanded AIDS case definition and more recently, improved survival. The characteristics of persons living with AIDS have changed, reflecting changes in the populations affected by the HIV/AIDS epidemic. Women accounted for 13.8% of persons living with AIDS in 1992, compared with 19.1% in 1997. By the end of 1997, the number of blacks living with AIDS, which increased from 32.7% of persons living with AIDS in 1992 to 39.2% in 1997, was almost identical to the number of whites living with AIDS. Persons living in the South accounted for 33.6% of cases in 1992 and 36.7% in 1997, and persons living in the Northeast accounted for 28.3% in 1992 and 30.3% in 1997; the proportion living in the West declined from 23.8% to 20.4%. The characteristics of persons living with AIDS (sex, age, race/ethnicity) as of the end of 1997 in all states and metropolitan statistical areas were published in a supplemental report in February 1999, the first in a series of reports intended to provide additional data on selected topics. This report can be accessed at http://www.cdc.gov/nchstp/hiv_aids/ stats/hasrsupp.htm . In the 33 states and territories that report HIV infection, 19,393 persons with HIV infection but not AIDS were reported during 1998. In addition, 1,871 persons were reported first with HIV and then with AIDS during 1998; for this report these persons are counted only once as AIDS cases. In these same states, a total of 97,962 persons are reported as living with HIV infection (table 1); that is, as of the end of 1998, they are not known to have AIDS or to have died. Because not all HIV-infected persons have been tested, the number of persons reported to be living with HIV represents a minimum estimate of the number of persons living with HIV infection. Differences among states in the relative proportion of prevalent cases reported as HIV compared to AIDS (table 1) are the result of many factors: they may reflect variations in testing patterns, access to care, and survival; differences in the distribution of affected populations in terms of sex, race, and risk; and differences in the stage of the epidemic. In addition, factors related to the implementation of HIV reporting, such as the date of implemen-tation and whether prevalent HIV cases were reportable at implementation, also affect these proportions. For example, the recent implementation of HIV reporting in Florida and New Mexico, initiated in July 1997 and January 1998, respectively, accounts for the low number of persons reported as living with HIV infection compared with the number reported as living with AIDS. HIV reporting data are increasingly necessary to monitor the effect of the epidemic because of the therapies that have reduced AIDS incidence. By the end of 1998, 29 states and the Virgin Islands had implemented the confidential name-based reporting of HIV infection in adolescents and adults; three additional states report pediatric HIV infection only. States that have initiated confidential name-based HIV reporting in the past 2 years are Florida, Iowa, New Mexico, and Virgin Islands; Alaska, New York, and Texas are beginning HIV case surveillance in 1999. Although AIDS incidence can no longer provide unbiased information on HIV incidence patterns as it has in the past, because of the effect of potent antiretroviral therapies, the monitoring of AIDS incidence nonetheless remains critical. Persons reported with AIDS increasingly represent persons whose diagnosis was too late for them to benefit from treatments, persons who either did not seek or had no access to care, or persons for whom treatment failed. Monitoring this population remains of the utmost importance, and supplemental studies will be needed to determine the reasons for continued AIDS incidence. Historically, AIDS incidence data have served as the basis for assessing needs for prevention and treatment programs. Because of the effect of treatment on AIDS incidence, incidence is no longer the
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most appropriate means of describing the needs of different populations, as areas that are providing care effectively would seem to need fewer resources. AIDS prevalence, rather than AIDS incidence, provides a more accurate measure of the number of persons who require treatment resources because it reflects the total number of persons living with AIDS. AIDS prevalence too, however, will increasingly underestimate the number of persons in care. Because AIDS will not develop in a growing number of HIV-infected persons as they benefit from new therapies, all states should conduct surveillance for persons with a diagnosis of HIV infection as well as those with a diagnosis of AIDS. However, until such data are available, AIDS prevalence will remain the best measure of the impact of the epidemic, and the most accurate, equitable means of estimating the need for patient services. The effect of treatment on AIDS incidence and the shift in emphasis from AIDS to HIV require new ways of thinking about surveillance data. With respect to AIDS data, year-to-year changes reflect differences in the historic pattern of HIV infection and differences in access to, and utilization of, care; comparisons among groups must take both these factors into account. With respect to HIV surveillance data, reports of diagnosis of HIV infection bear little relationship to the actual time of infection, with the exception of young persons or persons for whom a proxy measure of recency of infection, such as a high CD4+T-lymphocyte count, is available. Information such as CD4+ T-lymphocyte count at the initial diagnosis of HIV infection on a representative sample of persons can be used to estimate the proportion of new HIV diagnoses that represent recent HIV infections. Until such information is available, the number and characteristics of persons living with diagnosed HIV infection and those living with AIDS will be helpful in planning for prevention, treatment, and other services needed to further reduce transmission and to improve survival and quality of life for infected persons. The dramatic decreases in pediatric AIDS clearly demonstrate that the Public Health Service guidelines for zidovudine use during pregnancy and for the counseling and testing of pregnant women have been implemented and are decreasing the perinatal transmission of HIV. States that report pediatric exposure and HIV infection have been especially effective in monitoring the reasons for decreases in perinatal transmission. The swiftness of the decline has suggested that the goal of eliminating perinatal transmission of HIV may be attainable. Pediatric HIV and AIDS surveillance will play an increasingly important role in identifying populations of women in need of outreach
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and thus ensuring access to testing and treatment services for these women as well as to ensure that their infants will be healthy. The next few years will represent a time of transition for HIV/AIDS surveillance. AIDS incidence will continue to be affected by therapy, but the full effect of new therapies on AIDS incidence is not yet known. At the same time, HIV surveillance is gradually being implemented by an increasing number of states. During this transition, the data on prevalence will probably be more useful than data on incidence for public health planning purposes while incidence data will probably be more useful in identifying populations that may require outreach to improve timely access to testing and treatment. To accurately describe affected populations, CDC plans to work closely with state surveillance programs and with the many users of the surveillance data to provide technical assistance in interpreting the data during this time of transition.
Suggested reading:
CDC. HIV/AIDS Surveillance Supplemental Report: Characteristics of Persons Living with AIDS at the End of 1997, 1999;5(No. 1):1-13. CDC. National HIV Prevalence Surveys, 1997 Summary. Atlanta, GA: CDC; 1998:1-25. CDC. Success in implementing PHS guidelines to reduce perinatal transmission of HIV. MMWR 1998;47:688-91 [published errata appear in MMWR 1998;47:718]. All the MMWR articles are available at www.cdc.gov/nchstp/hiv_aids/pubs/mmwr.htm .
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Table 1. Persons reported to be living with HIV infection1 and with AIDS, by state and age group, reported through December 19982
State of residence (Date HIV reporting initiated) Alabama (Jan. 1988) Alaska Arizona (Jan. 1987) Arkansas (July 1989) California Colorado (Nov. 1985) Connecticut (July 1992)5 Delaware District of Columbia Florida (July 1997) Georgia Hawaii Idaho (June 1986) Illinois Indiana (July 1988) Iowa (July 1998) Kansas Kentucky Louisiana (Feb. 1993) Maine Maryland Massachusetts Michigan (April 1992) Minnesota (Oct. 1985) Mississippi (Aug. 1988) Missouri (Oct. 1987) Montana Nebraska (Sept. 1995) Nevada (Feb. 1992) New Hampshire New Jersey (Jan. 1992) New Mexico (Jan. 1998) New York North Carolina (Feb. 1990) North Dakota (Jan. 1988) Ohio (June 1990) Oklahoma (June 1988) Oregon (Sept. 1988)5 Pennsylvania Rhode Island South Carolina (Feb. 1986) South Dakota (Jan. 1988) Tennessee (Jan. 1992) Texas (Feb. 1994)5 Utah (April 1989) Vermont Virginia (July 1989) Washington West Virginia (Jan. 1989) Wisconsin (Nov. 1985) Wyoming (June 1989) Subtotal Living with HIV infection3 Adults/ Children adolescents <13 years old 4,475 — 3,556 1,717 — 5,107 — — — 8,561 — — 257 — 3,082 99 — — 5,866 — — — 3,944 2,273 3,741 3,868 — 399 2,356 — 11,254 396 — 7,787 58 4,153 1,950 — — — 6,331 160 4,739 — 757 — 6,788 — 452 2,037 60 96,223 40 — 35 20 — 27 97 — — 84 — — 4 — 27 1 — — 94 — — — 81 25 42 40 — 6 23 — 359 3 — 105 1 60 14 16 — — 107 5 48 257 5 — 68 — 3 30 — 1,727 Total 4,515 — 3,591 1,737 — 5,134 97 — — 8,645 — — 261 — 3,109 100 — — 5,960 — — — 4,025 2,298 3,783 3,908 — 405 2,379 — 11,613 399 — 7,892 59 4,213 1,964 16 — — 6,438 165 4,787 257 762 — 6,856 — 455 2,067 60 97,950 — — — 12 97,962 Living with AIDS4 Adults/ Children adolescents <13 years old 2,493 220 2,376 1,307 39,680 2,520 5,187 983 5,080 30,223 8,701 847 189 7,677 2,438 501 800 1,277 4,649 357 8,049 4,845 3,950 1,405 1,566 3,628 149 393 1,935 434 12,961 801 45,993 3,605 41 3,717 1,411 1,783 8,705 802 3,614 57 3,494 20,726 781 157 4,659 3,513 421 1,396 58 262,554 9 2 8,064 196 271,115 24 2 6 23 214 6 76 11 92 592 84 5 — 114 14 4 4 11 56 7 156 75 35 12 27 18 — 3 12 3 251 6 799 52 — 39 10 7 155 6 28 1 18 144 7 2 83 15 3 11 2 3,325 — — 172 8 3,509 Total 2,517 222 2,382 1,330 39,894 2,526 5,263 994 5,172 30,815 8,785 852 189 7,791 2,452 505 804 1,288 4,705 364 8,205 4,920 3,985 1,417 1,593 3,646 149 396 1,947 437 13,212 807 46,792 3,657 41 3,756 1,421 1,790 8,860 808 3,642 58 3,512 20,870 788 159 4,742 3,528 424 1,407 60 265,879 9 2 8,236 204 274,624 Cumulative totals Adults/ Children adolescents <13 years old 6,968 220 5,932 3,024 39,680 7,627 5,187 983 5,080 38,784 8,701 847 446 7,677 5,520 600 800 1,277 10,515 357 8,049 4,845 7,894 3,678 5,307 7,496 149 792 4,291 434 24,215 1,197 45,993 11,392 99 7,870 3,361 1,783 8,705 802 9,945 217 8,233 20,726 1,538 157 11,447 3,513 873 3,433 118 358,777 9 2 8,064 207 367,349 64 2 41 43 214 33 173 11 92 676 84 5 4 114 41 5 4 11 150 7 156 75 116 37 69 58 — 9 35 3 610 9 799 157 1 99 24 23 155 6 135 6 66 401 12 2 151 15 6 41 2 5,052 — — 172 9 5,237 Total 7,032 222 5,973 3,067 39,894 7,660 5,360 994 5,172 39,460 8,785 852 450 7,791 5,561 605 804 1,288 10,665 364 8,205 4,920 8,010 3,715 5,376 7,554 149 801 4,326 437 24,825 1,206 46,792 11,549 100 7,969 3,385 1,806 8,860 808 10,080 223 8,299 21,127 1,550 159 11,598 3,528 879 3,474 120 363,829 9 2 8,236 216 372,586
U.S. dependencies, possessions, and associated nations Guam — — Pacific Islands, U.S. — — Puerto Rico — — Virgin Islands, U.S. (Dec. 1998) 11 1 Total 96,234 1,728
1 Includes only persons reported with HIV infection who have not developed AIDS. 2Persons reported with vital status "alive" as of the last update. Excludes persons whose vital status is 3Includes only persons reported from states with confidential HIV infection reporting. Excludes 1,934
unknown. adults/adolescents and 51 children reported from states with confidential HIV infection reporting whose state of residence is unknown or who are residents of other states. 4Includes 290 adults/adolescents and 4 children whose state of residence is unknown. 5Connecticut and Texas have confidential HIV infection reporting for pediatric cases only; Oregon has confidential HIV infection reporting for children less than 6 years old.
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Table 2. AIDS cases and annual rates per 100,000 population, by state and age group, reported through December 1998, United States
1997 1998 Rate 13.1 8.4 9.8 9.6 21.6 9.8 37.4 31.3 188.2 41.2 23.0 8.0 4.3 15.3 8.8 3.5 6.1 9.3 25.0 4.1 36.3 13.9 9.0 4.5 12.6 10.5 4.7 5.5 35.0 4.7 40.1 9.7 72.3 11.4 1.9 7.6 8.5 9.3 15.9 15.4 20.3 1.5 14.4 24.1 7.4 4.9 17.4 11.3 6.9 4.9 3.3 21.7 No. 484 29 645 203 5,654 314 666 174 989 5,448 1,295 161 32 1,304 484 75 126 280 951 31 1,639 924 714 190 415 443 29 72 258 42 2,134 209 8,714 788 6 685 285 204 1,740 128 777 15 695 3,967 139 20 998 441 86 203 6 46,311 2 — 1,711 35 48,269 Rate 11.1 4.7 13.8 8.0 17.3 7.9 20.3 23.4 189.1 36.5 16.9 13.5 2.6 10.8 8.2 2.6 4.8 7.1 21.8 2.5 31.9 15.0 7.3 4.0 15.1 8.1 3.3 4.3 14.8 3.5 26.3 12.0 47.9 10.4 0.9 6.1 8.5 6.2 14.5 12.9 20.3 2.0 12.8 20.1 6.6 3.4 14.7 7.8 4.7 3.9 1.2 17.1 1.3 — 44.3 29.6 17.6 Adults/ adolescents 5,251 435 6,090 2,553 109,481 6,416 10,231 2,163 11,228 68,939 19,816 2,234 447 21,442 5,382 1,138 2,082 2,839 11,018 827 18,430 13,610 9,865 3,372 3,562 8,190 294 942 3,875 801 37,517 1,812 126,495 8,838 96 10,138 3,274 4,349 20,755 1,839 7,692 140 6,940 47,994 1,651 344 11,110 8,618 945 3,204 157 656,861 21 4 21,915 396 679,739 Cumulative totals Children <13 years old 67 5 21 38 575 28 173 18 166 1,337 191 15 2 242 37 9 11 22 118 9 286 199 104 22 53 55 3 9 26 8 713 8 2,180 110 — 117 26 16 285 20 75 4 48 356 21 4 159 33 8 26 2 8,060 — — 382 15 8,461 Total 5,318 440 6,111 2,591 110,056 6,444 10,404 2,181 11,394 70,276 20,007 2,249 449 21,684 5,419 1,147 2,093 2,861 11,136 836 18,716 13,809 9,969 3,394 3,615 8,245 297 951 3,901 809 38,230 1,820 128,675 8,948 96 10,255 3,300 4,365 21,040 1,859 7,767 144 6,988 48,350 1,672 348 11,269 8,651 953 3,230 159 664,921 21 4 22,297 411 688,200
State of residence
Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Subtotal
No. 568 51 446 242 6,958 380 1,221 230 997 6,051 1,719 95 52 1,833 519 100 159 362 1,090 51 1,851 850 880 211 345 569 41 91 588 55 3,235 168 13,117 850 12 851 282 303 1,910 152 770 11 775 4,672 152 29 1,175 634 126 254 16 58,099
U.S. dependencies, possessions, and associated nations Guam 2 1.4 Pacific Islands, U.S. 1 0.3 Puerto Rico 2,037 53.2 Virgin Islands, U.S. 98 83.8 Total1
1
60,270
22.1
U.S. totals presented in this report include data from the United States (50 states and the District of Columbia), and from U.S. dependencies, possessions, and independent nations in free association with the United States. See Technical Notes. Totals include 546 persons whose state of residence is unknown.
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Table 3. HIV infection cases1 by state, reported in 1998; and cumulative totals, by state and age group, through December 1998, from areas with confidential HIV infection reporting
Cumulative totals State of residence (Date HIV reporting initiated) Alabama (Jan. 1988) Arizona (Jan. 1987) Arkansas (July 1989) Colorado (Nov. 1985) Connecticut (July 1992)2 Florida (July 1997) Idaho (June 1986) Indiana (July 1988) Iowa (July 1998) Louisiana (Feb. 1993) Michigan (April 1992) Minnesota (Oct. 1985) Mississippi (Aug. 1988) Missouri (Oct. 1987) Nebraska (Sept. 1995) Nevada (Feb. 1992) New Jersey (Jan. 1992) New Mexico (Jan. 1998) North Carolina (Feb. 1990) North Dakota (Jan. 1988) Ohio (June 1990) Oklahoma (June 1988) Oregon (Sept. 1988)2 South Carolina (Feb. 1986) South Dakota (Jan. 1988) Tennessee (Jan. 1992) Texas (Feb. 1994)2 Utah (April 1989) Virginia (July 1989) West Virginia (Jan. 1989) Wisconsin (Nov. 1985) Wyoming (June 1989) Subtotal 1998 521 473 240 285 10 6,837 25 366 84 1,030 584 238 507 465 84 260 1,473 388 1,021 8 906 280 5 899 12 756 65 57 810 62 199 8 18,958 Adults/ adolescents 4,660 3,934 1,742 5,326 — 8,714 309 3,193 100 6,181 4,632 2,407 3,895 4,003 418 2,568 12,555 402 8,482 66 4,521 2,058 — 6,628 177 4,884 — 770 7,252 482 2,168 65 102,592 Children <13 years old 41 39 20 28 105 85 4 28 1 107 95 28 42 40 6 24 370 3 114 1 62 15 16 109 5 48 272 5 72 3 31 — 1,819 Total 4,701 3,973 1,762 5,354 105 8,799 313 3,221 101 6,288 4,727 2,435 3,937 4,043 424 2,592 12,925 405 8,596 67 4,583 2,073 16 6,737 182 4,932 272 775 7,324 485 2,199 65 104,411
U.S. dependencies, possessions, and associated nations Virgin Islands, U.S. (Dec. 1998) 10 Persons reported from states with confidential HIV reporting who were residents of other states3 Total
11
1
12
425 19,393
2,097 104,700
55 1,875
2,152 106,575
1Includes only persons reported with HIV infection who have not developed AIDS. 2Connecticut and Texas have confidential HIV infection reporting for pediatric cases
only; Oregon has confidential HIV infection reporting for children less than 6 years old. 3Includes 341 persons reported from states with confidential HIV infection reporting, but whose state of residence is unknown. See Technical Notes.
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Table 4. AIDS cases and annual rates per 100,000 population, by metropolitan area and age group, reported through December 1998, United States
1997 Metropolitan area of residence (with 500,000 or more population) Akron, Ohio Albany-Schenectady, N.Y. Albuquerque, N.Mex. Allentown, Pa. Ann Arbor, Mich. Atlanta, Ga. Austin, Tex. Bakersfield, Calif. Baltimore, Md. Baton Rouge, La. Bergen-Passaic, N.J. Birmingham, Ala. Boston, Mass. Buffalo, N.Y. Charleston, S.C. Charlotte, N.C. Chicago, Ill. Cincinnati, Ohio Cleveland, Ohio Columbia, S.C. Columbus, Ohio Dallas, Tex. Dayton, Ohio Denver, Colo. Detroit, Mich. El Paso, Tex. Fort Lauderdale, Fla. Fort Worth, Tex. Fresno, Calif. Gary, Ind. Grand Rapids, Mich. Greensboro, N.C. Greenville, S.C. Harrisburg, Pa. Hartford, Conn. Honolulu, Hawaii Houston, Tex. Indianapolis, Ind. Jacksonville, Fla. Jersey City, N.J. Kansas City, Mo. Knoxville, Tenn. Las Vegas, Nev. Little Rock, Ark. Los Angeles, Calif. Louisville, Ky. McAllen, Tex. Memphis, Tenn. Miami, Fla. Middlesex, N.J. Milwaukee, Wis. Minneapolis-Saint Paul, Minn. Mobile, Ala. Monmouth-Ocean, N.J. Nashville, Tenn. Nassau-Suffolk, N.Y. New Haven, Conn. New Orleans, La. New York, N.Y. Newark, N.J. No. 77 218 102 61 25 1,168 246 68 1,271 196 427 174 755 407 114 145 1,560 184 259 153 124 922 63 292 553 131 1,004 319 61 72 63 88 107 125 470 76 1,767 223 342 510 209 58 528 98 2,586 185 29 277 1,666 220 156 181 103 197 281 551 666 562 9,865 1,358 Rate 11.2 24.9 15.1 9.9 4.6 32.1 23.0 10.9 51.3 34.4 32.0 19.3 13.0 35.0 21.3 10.7 19.8 11.4 11.6 30.3 8.5 29.5 6.6 15.4 12.4 19.0 68.2 20.5 7.1 11.6 6.1 7.6 11.8 20.3 42.5 8.7 45.9 14.8 33.2 92.0 12.2 8.9 41.8 17.7 28.4 18.6 5.7 25.6 78.3 19.9 10.7 6.5 19.5 18.3 24.7 20.7 41.0 43.0 114.0 69.9 1998 No. 54 118 88 39 20 941 294 86 1,162 184 287 140 828 115 113 193 1,111 101 241 155 102 654 55 235 488 121 836 220 63 50 49 111 125 118 252 106 1,564 219 266 328 177 75 228 67 1,851 169 50 285 1,577 152 115 174 88 126 189 429 360 457 7,469 879 Rate 7.8 13.5 13.0 6.3 3.7 25.1 26.6 13.6 46.8 32.0 21.3 15.4 14.1 10.0 20.9 14.0 14.0 6.2 10.8 30.3 6.9 20.4 5.8 12.1 10.9 17.2 55.6 13.8 7.2 8.0 4.7 9.5 13.6 19.2 22.7 12.1 39.8 14.4 25.5 58.9 10.2 11.4 17.3 12.0 20.1 16.9 9.6 26.1 73.3 13.6 7.9 6.1 16.5 11.5 16.3 16.0 22.1 34.9 85.9 45.0 Adults/ adolescents 504 1,541 986 700 340 14,116 3,427 871 12,333 1,560 4,939 1,635 12,057 1,555 1,321 1,813 18,561 1,770 2,984 1,588 2,020 11,116 887 5,137 6,810 905 10,957 2,924 1,043 627 691 1,400 1,250 874 3,569 1,627 17,436 2,553 3,853 6,019 3,565 634 3,148 935 38,440 1,382 301 2,516 21,039 2,892 1,750 2,989 1,005 2,582 2,172 6,014 5,812 6,158 107,097 15,120 Cumulative totals Children <13 years old 1 24 2 8 9 101 22 5 200 19 75 22 174 18 11 22 215 14 40 16 12 37 17 19 72 10 233 25 13 3 3 19 3 6 46 12 149 14 67 117 13 6 25 14 230 14 9 15 463 67 16 17 12 60 16 107 121 61 1,953 306 Total 505 1,565 988 708 349 14,217 3,449 876 12,533 1,579 5,014 1,657 12,231 1,573 1,332 1,835 18,776 1,784 3,024 1,604 2,032 11,153 904 5,156 6,882 915 11,190 2,949 1,056 630 694 1,419 1,253 880 3,615 1,639 17,585 2,567 3,920 6,136 3,578 640 3,173 949 38,670 1,396 310 2,531 21,502 2,959 1,766 3,006 1,017 2,642 2,188 6,121 5,933 6,219 109,050 15,426
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Table 4. AIDS cases and annual rates per 100,000 population, by metropolitan area and age group, reported through December 1998, United States (continued)
1997 Metropolitan area of residence (with 500,000 or more population) Norfolk, Va. Oakland, Calif. Oklahoma City, Okla. Omaha, Nebr. Orange County, Calif. Orlando, Fla. Philadelphia, Pa. Phoenix, Ariz. Pittsburgh, Pa. Portland, Oreg. Providence, R.I. Raleigh-Durham, N.C. Richmond, Va. Riverside-San Bernardino, Calif. Rochester, N.Y. Sacramento, Calif. Saint Louis, Mo. Salt Lake City, Utah San Antonio, Tex. San Diego, Calif. San Francisco, Calif. San Jose, Calif. San Juan, P.R. Sarasota, Fla. Scranton, Pa. Seattle, Wash. Springfield, Mass. Stockton, Calif. Syracuse, N.Y. Tacoma, Wash. Tampa-Saint Petersburg, Fla. Toledo, Ohio Tucson, Ariz. Tulsa, Okla. Ventura, Calif. Washington, D.C. West Palm Beach, Fla. Wichita, Kans. Wilmington, Del. Youngstown, Ohio Metropolitan areas with 500,000 or more population Central counties Outlying counties Metropolitan areas with 50,000 to 500,000 population Central counties Outlying counties Nonmetropolitan areas Total1
1Totals
1998 Rate 26.5 20.9 13.7 9.5 10.1 36.6 30.3 9.7 6.0 13.4 15.8 13.9 23.2 14.5 33.6 13.9 12.3 9.9 20.0 29.3 77.0 12.7 66.3 20.0 6.3 16.1 15.9 10.2 29.9 10.8 26.7 7.0 15.4 11.0 6.2 38.4 61.0 10.3 34.7 3.9 No. 346 417 146 42 342 483 1,311 469 121 157 123 124 207 494 121 183 200 114 268 538 970 149 1,066 74 42 280 98 49 64 53 549 23 122 75 45 1,594 538 41 127 30 Rate 22.4 18.0 14.1 6.1 12.6 32.1 26.5 16.0 5.2 8.6 13.6 11.5 21.6 15.9 11.2 11.9 7.8 9.0 17.4 19.3 57.6 9.1 53.1 13.6 6.8 12.1 16.6 8.9 8.7 7.8 24.3 3.8 15.4 9.7 6.1 34.1 52.1 7.5 22.5 5.1 Adults/ adolescents 3,200 7,406 1,530 659 5,085 5,165 15,888 4,308 2,162 3,536 1,728 1,713 2,242 6,148 2,071 2,907 4,138 1,438 3,575 9,591 26,295 2,870 13,758 1,224 400 6,140 1,421 660 1,126 727 7,358 515 1,316 988 728 19,845 6,489 621 1,721 304
Cumulative totals Children <13 years old 58 41 8 3 31 75 235 13 16 8 19 21 25 51 13 24 37 14 28 52 37 13 238 21 4 19 24 13 9 8 96 10 6 8 3 276 193 2 12 — Total 3,258 7,447 1,538 662 5,116 5,240 16,123 4,321 2,178 3,544 1,747 1,734 2,267 6,199 2,084 2,931 4,175 1,452 3,603 9,643 26,332 2,883 13,996 1,245 404 6,159 1,445 673 1,135 735 7,454 525 1,322 996 731 20,121 6,682 623 1,733 304
No. 410 475 141 65 269 535 1,495 277 141 239 143 146 220 443 364 209 314 124 301 798 1,286 206 1,321 107 39 368 94 55 221 72 595 43 120 84 45 1,770 618 55 194 23
49,123 47,835 1,288 6,325 5,910 415 4,368 60,270
29.1 31.1 8.5 13.1 13.8 7.5 8.0 22.1
39,344 38,337 1,007 5,007 4,636 371 3,465 48,269
23.0 24.7 6.5 10.3 10.7 6.7 6.3 17.6
570,846 559,683 11,163 66,286 62,006 4,280 39,373 679,739
7,164 7,037 127 790 722 68 483 8,461
578,010 566,720 11,290 67,076 62,728 4,348 39,856 688,200
include 3,258 persons whose area of residence is unknown.
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HIV/AIDS Surveillance Report
Figure 1.
Male adult/adolescent annual AIDS rates per 100,000 population, for cases reported in 1998, United States
16.9 6.4 14.0 5.3 2.5 30.3 15.8 38.8 9.3 5.4 21.2 18.0 12.8 10.5 17.7 15.2 25.8 17.4 27.9 43.5 9.9 29.5 P.R. 90.2 V.I. 49.7 43.1 65.6 22.1 34.8 20.2 36.1 28.4 4.1 1.9 8.3 8.0 14.8 27.9 85.0 4.6
17.4
10.7
Vt. 7.1 N.H. 6.1 Mass. 28.0 R.I. 23.4 Conn. 36.4 N.J. 43.7 Del. 42.0 Md. 55.3 D.C. 339.5 Rate per 100,000 _ 0 11.9 12 _ 23.9 24 _ 35.9 36+
30.6
27.4
19.2
U.S. rate: 34.1 N= 36,886
Figure 2.
Female adult/adolescent annual AIDS rates per 100,000 population, for cases reported in 1998, United States
2.3 1.6 1.3 1.2 0.5 1.1 5.8 1.7 1.6 6.0 2.3 1.2 2.9 4.6 2.2 2.6 9.9 7.8
1.8 3.5
0.4 1.7 1.0 1.6 3.2 33.6 7.7 2.5 2.4 6.1 14.3 5.5 7.8 2.4 1.1 7.8 5.9
1.5
4.9
Vt. 0.8 2.6 N.H. Mass. 9.2 R.I. 8.4 Conn. 13.9 N.J. 20.9 Del. 14.8 Md. 23.4 D.C. 120.2 Rate per 100,000 0 _ 2.4 2.5 _ 4.9 5.0 _ 7.4
3.0
12.0
P.R. 27.6 V.I. 27.9
23.6
7.5+
U.S. rate: 9.6 N=10,998
HIV/AIDS Surveillance Report
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Vol. 10, No. 2
Figure 3.
Male adult/adolescent HIV infection and AIDS cases reported in 1998, United States
387 23 186 26 17 217 212 5,001 5 6 12 8 61 60 125 44 277 256 5 4 23 155 180 167 150 62 67 995 112 254 223 375 362 Vt. N.H. Mass. R.I. Conn. N.J. Del. Md. D.C.
571 414 418 279 564 721 238 550 535 540 623
5,970 1,320 77 45
770 559 599 622
557 407
185 335
172 182 293 308
376 351
1,034
3,330 25
723 667 P.R. 1,272 V.I. 21 5 3,886 4,202
143
Figure 4.
Female adult/adolescent HIV infection and AIDS cases reported in 1998, United States
53 6 18 6 7 40 45 633 1 2 3 4 11 23 14 12 37 28 1 3 8 34 55 35 47 13 17 300 13 31 56 67 98 Vt. N.H. Mass. R.I. Conn. N.J. Del. Md. D.C.
134 167 400 63 85 117 179 41 143 215 235 266 9 15
2,610
224 240 188 381
87 66
21 50
28 55 116 188
104 163
249
619 4
223 346 P.R. 427 V.I. 13 5 1,513 2,568
17
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HIV/AIDS Surveillance Report
Table 5.
AIDS cases by age group, exposure category, and sex, reported through December 1998, United States
1998 Males Cumulative total (%) (45) (21) (5) (0) (7) No. 326,051 126,889 43,640 4,663 23,361 (%) (57) (22) (8) (1) (4) Females Cumulative 1998 total No. — 3,201 — 17 4,125 (%) — (29) — (0) (38) No. — 46,804 — 248 43,128 (%) — (43) — (0) (39) 1998 No. 16,642 11,070 1,984 162 6,736 Totals1 Cumulative total2 No. 326,051 173,693 43,640 4,911 66,490 (%) (48) (26) (6) (1) (10)
Adult/adolescent exposure category Men who have sex with men Injecting drug use Men who have sex with men and inject drugs Hemophilia/coagulation disorder Heterosexual contact:
No. 16,642 7,869 1,984 145 2,610
(%) (35) (23) (4) (0) (14)
Sex with injecting drug user Sex with bisexual male Sex with person with hemophilia Sex with transfusion recipient with HIV infection Sex with HIV-infected person, risk not specified
Receipt of blood transfusion, blood components, or tissue3 Other/risk not reported or identified4 Adult/adolescent subtotal Pediatric (<13 years old) exposure category Hemophilia/coagulation disorder Mother with/at risk for HIV infection: 4
631 — 4 23 1,952
8,015 — 47 373 14,926
1,212 190 28 24 2,671
18,231 3,132 382 562 20,821
1,843 190 32 47 4,624
26,246 3,132 429 935 35,748
156 7,480
(0) (20)
4,784 41,037
(1) (7)
137 3,518
(1) (32)
3,598 15,533
(3) (14)
293 11,000
(1) (23)
8,382 56,572
(1) (8)
36,886 (100)
570,425 (100)
10,998 (100)
109,311 (100)
47,887 (100)
679,739 (100)
— 172
— (91)
227 3,818
(5) (88)
— 169
— (88)
7 3,869
(0) (94)
— 341
— (89)
234 7,687
(3) (91)
Injecting drug use Sex with injecting drug user Sex with bisexual male Sex with person with hemophilia Sex with transfusion recipient with HIV infection Sex with HIV-infected person, risk not specified Receipt of blood transfusion, blood components, or tissue Has HIV infection, risk not specified
Receipt of blood transfusion, blood components, or tissue3 Risk not reported or identified4 Pediatric subtotal Total
42 26 2 1 — 48 1 52
1,525 715 82 17 11 555 73 840
41 18 2 — 1 38 2 67
1,507 685 83 12 14 582 81 905
83 44 4 1 1 86 3 119
3,032 1,400 165 29 25 1,137 154 1,745
1 17
(1) (9)
238 75
(5) (2)
— 23
— (12)
140 87
(3) (2)
1 40
(0) (10)
378 162
(4) (2)
190 (100) 37,076
4,358 (100) 574,783
192 (100) 11,190
4,103 (100) 113,414
382 (100) 48,269
8,461 (100) 688,200
1Includes 3 persons whose sex is unknown. 2Includes 12 persons known to be infected with human immunodeficiency virus type 2 (HIV-2). See MMWR 1995;44:603-06. 3Thirty-seven adults/adolescents and 2 children developed AIDS after receiving blood screened negative for HIV antibody. Thirteen
additional adults developed AIDS after receiving tissue, organs, or artificial insemination from HIV-infected donors. Four of the 13 received tissue, organs, or artificial insemination from a donor who was negative for HIV antibody at the time of donation. See N Engl J Med 1992;326:726-32. 4See table 17 and figure 6 for a discussion of the "other" exposure category. "Other" also includes 113 persons who acquired HIV infection perinatally but were diagnosed with AIDS after age 13. These 113 persons are tabulated under the adult/adolescent, not pediatric, exposure category.
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Table 6.
HIV infection cases1 by age group, exposure category, and sex, reported through December 1998, from the 33 areas with confidential HIV infection reporting2
1998 Males Cumulative total No. (%) 34,593 (45) 11,315 (15) 4,825 432 4,937 (6) (1) (6) Females Cumulative 1998 total No. (%) — — 689 (11) — — 4 (0) 2,242 (37) No. (%) — — 6,029 (22) — — 23 (0) 10,989 (40) 1998 Totals3 Cumulative total No. (%) 34,593 (33) 17,344 (17) 4,825 (5) 455 (0) 15,926 (15)
Adult/adolescent exposure category Men who have sex with men Injecting drug use Men who have sex with men and inject drugs Hemophilia/coagulation disorder Heterosexual contact:
No. (%) 5,163 (40) 1,254 (10) 476 32 1,040 (4) (0) (8)
No. (%) 5,163 1,943 476 36 3,282 (27) (10) (2) (0) (17)
Sex with injecting drug user Sex with bisexual male Sex with person with hemophilia Sex with transfusion recipient with HIV infection Sex with HIV-infected person, risk not specified
Receipt of blood transfusion, blood components, or tissue Other/risk not reported or identified4 Adult/adolescent subtotal Pediatric (<13 years old) exposure category Hemophilia/coagulation disorder Mother with/at risk for HIV infection:
163 — 1 11 865
1,146 — 12 74 3,705
507 128 14 13 1,580
3,327 860
104
86 6,612
670 128 15 24 2,445
4,473 860 116 160 10,317
30
(0)
347
(0)
41
(1)
379
(1)
71 8,113
(0) (43)
726
(1)
5,036 (39) 13,031 (100)
20,437 (27) 76,886 (100)
3,075 (51) 6,051 (100)
10,386 (37) 27,806 (100)
30,831 (29) 104,700 (100)
19,084 (100)
4 (3) 119 (81)
96 (10) 772 (82)
2 (1) 137 (85)
3 (0) 842 (90)
6 256
(2) (83)
99 (5) 1,614 (86)
Injecting drug use Sex with injecting drug user Sex with bisexual male Sex with person with hemophilia Sex with transfusion recipient with HIV infection Sex with HIV-infected person, risk not specified Receipt of blood transfusion, blood components, or tissue Has HIV infection, risk not specified
Receipt of blood transfusion, blood components, or tissue Risk not reported or identified4 Pediatric subtotal Total
19 9 1 — — 40 3 47
256 102 11 3 5 148 11 236
28 11 3 1 2 46 1 45
245 119 15 4 5 198 10 246
47 20 4 1 2 86 4 92
501 221 26 7 10 346 21 482
2 (1) 22 (15) 147 (100) 13,178
12 59
(1) (6)
3 (2) 20 (12) 162 (100) 6,213
23 68
(2) (7)
5 42
(2) (14)
35 127
(2) (7)
939 (100) 77,825
936 (100) 28,742
309 (100) 19,393
1,875 (100) 106,575
1Includes only persons reported with HIV infection who have not developed AIDS. 2See table 3 for areas with confidential HIV infection reporting. 3Includes 8 persons whose sex is unknown. 4For HIV infection cases, “risk not reported or identified” refers primarily to persons
whose mode of exposure was not reported and who have not been followed up to determine their mode of exposure, and to a smaller number of persons who are not reported with one of the exposures listed above after follow-up. See Technical Notes.
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HIV/AIDS Surveillance Report
Table 7.
AIDS cases by sex, age at diagnosis, and race/ethnicity, reported through December 1998, United States
White, not Hispanic No. 508 329 824 7,323 36,485 65,304 63,280 46,052 27,663 14,875 8,097 4,513 3,735 (%) (0) (0) (0) (3) (13) (23) (23) (17) (10) (5) (3) (2) (1) Black, not Hispanic No. (%) 2,040 424 761 6,385 23,263 39,387 42,407 33,062 18,916 9,710 5,362 2,926 2,420 (1) (0) (0) (3) (12) (21) (23) (18) (10) (5) (3) (2) (1) Hispanic No. (%) 741 271 446 3,839 15,090 24,450 22,705 15,857 8,827 4,639 2,574 1,403 1,120 (1) (0) (0) (4) (15) (24) (22) (16) (9) (5) (3) (1) (1) Asian/Pacific Islander No. (%) 16 9 23 153 539 957 953 764 460 243 151 64 57 (0) (0) (1) (3) (12) (22) (22) (17) (10) (6) (3) (1) (1) American Indian/ Alaska Native No. 11 4 19 70 299 429 354 245 97 39 25 15 9 (%) (1) (0) (1) (4) (19) (27) (22) (15) (6) (2) (2) (1) (1) Total1 No. (%) 3,319 1,039 2,075 17,797 75,773 130,672 129,884 96,120 56,034 29,550 16,236 8,935 7,349 (1) (0) (0) (3) (13) (23) (23) (17) (10) (5) (3) (2) (1)
Male Age at diagnosis (years) Under 5 5-12 13-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65 or older Male subtotal
278,988 (100)
187,063 (100)
101,962 (100)
4,389 (100)
1,616 (100)
574,783 (100)
Female Age at diagnosis (years) Under 5 5-12 13-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65 or older Female subtotal Total2
1Includes 2Includes
474 174 223 1,481 4,202 5,719 4,990 3,230 1,703 944 638 432 894
(2) (1) (1) (6) (17) (23) (20) (13) (7) (4) (3) (2) (4)
2,013 458 893 3,722 9,448 14,299 14,154 9,642 4,636 2,284 1,277 759 760
(3) (1) (1) (6) (15) (22) (22) (15) (7) (4) (2) (1) (1)
736 206 222 1,364 3,717 5,364 4,675 3,014 1,606 885 549 287 254
(3) (1) (1) (6) (16) (23) (20) (13) (7) (4) (2) (1) (1)
14 7 7 35 76 111 104 82 61 26 18 22 22
(2) (1) (1) (6) (13) (19) (18) (14) (10) (4) (3) (4) (4)
13 — 2 27 48 76 64 39 28 14 6 3 3
(4) — (1) (8) (15) (24) (20) (12) (9) (4) (2) (1) (1)
3,255 848 1,348 6,640 17,507 25,617 24,023 16,025 8,060 4,158 2,493 1,505 1,935
(3) (1) (1) (6) (15) (23) (21) (14) (7) (4) (2) (1) (2)
25,104 (100) 304,094
64,345 (100) 251,408
22,879 (100) 124,841
585 (100) 4,974
323 (100) 1,940
113,414 (100) 688,200
765 males and 178 females whose race/ethnicity is unknown. 3 persons whose sex is unknown.
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Table 8.
HIV infection cases1 by sex, age at diagnosis, and race/ethnicity, reported through December 1998, from the 33 areas with confidential HIV infection reporting2
White, not Hispanic No. 154 87 667 4,492 7,945 8,159 5,756 3,338 1,677 905 375 201 196 (%) (0) (0) (2) (13) (23) (24) (17) (10) (5) (3) (1) (1) (1) Black, not Hispanic No. 477 96 1,098 4,518 6,791 7,833 6,721 4,544 2,325 1,095 544 261 262 (%) (1) (0) (3) (12) (19) (21) (18) (12) (6) (3) (1) (1) (1) Hispanic No. (%) 79 28 91 633 1,233 1,313 1,005 567 281 122 70 42 34 (1) (1) (2) (12) (22) (24) (18) (10) (5) (2) (1) (1) (1) Asian/Pacific Islander No. 3 2 7 34 62 64 28 19 11 6 1 2 2 (%) (1) (1) (3) (14) (26) (27) (12) (8) (5) (2) (0) (1) (1) American Indian/ Alaska Native No. 2 1 10 85 119 109 71 38 15 8 4 2 — (%) (0) (0) (2) (18) (26) (23) (15) (8) (3) (2) (1) (0) — Total3 No. 719 220 1,894 9,873 16,382 17,734 13,782 8,642 4,381 2,171 1,007 516 504 (%) (1) (0) (2) (13) (21) (23) (18) (11) (6) (3) (1) (1) (1)
Male Age at diagnosis (years) Under 5 5–12 13–19 20–24 25–29 30–34 35–39 40–44 45–49 50–54 55–59 60–64 65 or older Male subtotal
33,952 (100)
36,565 (100)
5,498 (100)
241 (100)
464 (100)
77,825 (100)
Female Age at diagnosis (years) Under 5 5–12 13–19 20–24 25–29 30–34 35–39 40–44 45–49 50–54 55–59 60–64 65 or older Female subtotal Total4 156 40 479 1,206 1,510 1,395 1,013 497 313 124 75 38 73 (2) (1) (7) (17) (22) (20) (15) (7) (5) (2) (1) (1) (1) 502 107 1,650 3,198 3,795 3,786 2,851 1,816 832 383 214 120 133 (3) (1) (9) (16) (20) (20) (15) (9) (4) (2) (1) (1) (1) 79 29 100 268 398 420 272 149 96 45 26 11 5 (4) (2) (5) (14) (21) (22) (14) (8) (5) (2) (1) (1) (0) 4 2 4 23 20 16 10 5 3 1 3 — 1 (4) (2) (4) (25) (22) (17) (11) (5) (3) (1) (3) — (1) 7 1 17 28 26 32 28 18 6 2 2 1 — (4) (1) (10) (17) (15) (19) (17) (11) (4) (1) (1) (1) — 756 180 2,265 4,755 5,807 5,716 4,214 2,512 1,265 561 324 170 217 (3) (1) (8) (17) (20) (20) (15) (9) (4) (2) (1) (1) (1)
6,919 (100) 40,871
19,387 (100) 55,953
1,898 (100) 7,396
92 (100) 333
168 (100) 632
28,742 (100) 106,575
1Includes only persons reported with HIV infection who have not developed AIDS. 2See table 3 for areas with confidential HIV infection reporting. 3Includes 1,105 males, 278 females, and 7 persons of unknown sex whose race/ethnicity 4Includes 8 persons whose sex is unknown.
is unknown.
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HIV/AIDS Surveillance Report
Table 9.
Male adult/adolescent AIDS cases by exposure category and race/ethnicity, reported through December 1998, United States
White, not Hispanic 1998 Cumulative total No. (%) 208,655 25,394 22,500 3,621 4,665 (75) (9) (8) (1) (2) Black, not Hispanic 1998 No. (%) 4,553 4,041 695 20 1,491 (31) (27) (5) (0) (10) Cumulative total No. (%) 69,741 64,513 13,910 528 13,162 (38) (35) (8) (0) (7) 1998 No. (%) 2,720 2,164 334 19 638 (36) (29) (4) (0) (8) Hispanic Cumulative total No. (%) 43,180 36,353 6,790 414 5,329 (43) (36) (7) (0) (5)
Exposure category Men who have sex with men Injecting drug use Men who have sex with men and inject drugs Hemophilia/coagulation disorder Heterosexual contact:
No. (%) 9,082 1,597 927 101 451 (65) (11) (7) (1) (3)
Sex with injecting drug user Sex with person with hemophilia Sex with transfusion recipient with HIV infection Sex with HIV-infected person, risk not specified
Receipt of blood transfusion, blood components, or tissue Risk not reported or identified1 Total
118 2 5 326
1,719 26 147 2,773
367 — 8 1,116
4,672 11 133 8,346
140 2 10 486
1,571 10 85 3,663
65 1,804
(0) (13)
3,092 10,224
(1) (4)
57 3,883
(0) (26)
1,006 21,739
(1) (12)
25 1,611
(0) (21)
561 8,323
(1) (8)
14,027 (100)
278,151 (100)
14,740 (100)
184,599 (100)
7,511 (100)
100,950 (100)
Asian/Pacific Islander 1998 Exposure category Men who have sex with men Injecting drug use Men who have sex with men and inject drugs Hemophilia/coagulation disorder Heterosexual contact: No. (%) 185 17 9 2 22 (56) (5) (3) (1) (7) Cumulative total No. (%) 3,212 233 154 64 139 (74) (5) (4) (1) (3)
American Indian/Alaska Native 1998 No. (%) 53 24 16 2 3 (45) (21) (14) (2) (3) Cumulative total No. (%) 919 252 268 28 39 (57) (16) (17) (2) (2)
Cumulative totals2 1998 No. (%) 16,642 7,869 1,984 145 2,610 (45) (21) (5) (0) (7) Cumulative total No. (%) 326,051 126,889 43,640 4,663 23,361 (57) (22) (8) (1) (4)
Sex with injecting drug user Sex with person with hemophilia Sex with transfusion recipient with HIV infection Sex with HIV-infected person, risk not specified
Receipt of blood transfusion, blood components, or tissue Risk not reported or identified Total
1See figure 6. 2Includes 760
6 — — 16
36 — 7 96
— — — 3
13 — 1 25
631 4 23 1,952
8,015 47 373 14,926
9 85
(3) (26)
108 454
(2) (10)
— 19
— (16)
8 87
(0) (5)
156 7,480
(0) (20)
4,784 41,037
(1) (7)
329 (100)
4,364 (100)
117 (100)
1,601 (100)
36,886 (100)
570,425 (100)
men whose race/ethnicity is unknown.
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Vol. 10, No. 2
Table 10.
Male adult/adolescent HIV infection cases1 by exposure category and race/ ethnicity, reported through December 1998, from the 30 areas with confidential HIV infection reporting2
White, not Hispanic 1998 Cumulative total (%) (58) (8) (6) (0) (4) No. 20,698 2,978 2,741 329 932 (%) (61) (9) (8) (1) (3) Black, not Hispanic 1998 No. 1,564 682 143 10 772 (%) (25) (11) (2) (0) (12) Cumulative total No. 11,316 6,964 1,712 85 3,613 (%) (31) (19) (5) (0) (10) 1998 No. 560 161 43 1 81 (%) (41) (12) (3) (0) (6) Hispanic Cumulative total No. 1,998 1,233 286 10 340 (%) (37) (23) (5) (0) (6)
Exposure category Men who have sex with men Injecting drug use Men who have sex with men and inject drugs Hemophilia/coagulation disorder Heterosexual contact:
No. 2,931 394 280 21 177
Sex with injecting drug user Sex with person with hemophilia Sex with transfusion recipient with HIV infection Sex with HIV-infected person, risk not specified
Receipt of blood transfusion, blood components, or tissue Risk not reported or identified3 Total
39 — 2 136
241 3 17 671
109 — 9 654
791 8 54 2,760
14 1 — 66
98 1 2 239
10 1,202
(0) (24)
165 5,868
(0) (17)
17 3,158
(0) (50)
149 12,153
(0) (34)
2 532
(0) (39)
24 1,500
(0) (28)
5,015 (100)
33,711 (100)
6,346 (100)
35,992 (100)
1,380 (100)
5,391 (100)
Asian/Pacific Islander 1998 Exposure category Men who have sex with men Injecting drug use Men who have sex with men and inject drugs Hemophilia/coagulation disorder Heterosexual contact: No. 27 1 2 — 3 (%) (59) (2) (4) — (7) Cumulative total No. 121 16 5 2 15 (%) (51) (7) (2) (1) (6)
American Indian/Alaska Native 1998 No. 50 11 6 — 2 (%) (57) (13) (7) — (2) Cumulative total No. 232 67 61 2 22 (%) (50) (15) (13) (0) (5)
Cumulative totals4 1998 No. 5,163 1,254 476 32 1,040 (%) (40) (10) (4) (0) (8) Cumulative total No. 34,593 11,315 4,825 432 4,937 (%) (45) (15) (6) (1) (6)
Sex with injecting drug user Sex with person with hemophilia Sex with transfusion recipient with HIV infection Sex with HIV-infected person, risk not specified
Receipt of blood transfusion, blood components, or tissue Risk not reported or identified Total
— — — 3
4 — 1 10
1 — — 1
10 — — 12
163 1 11 865
1,146 12 74 3,705
— 13
— (28)
1 76
(0) (32)
— 18
— (21)
2 75
(0) (16)
30 5,036
(0) (39)
347 20,437
(0) (27)
46 (100)
236 (100)
87 (100)
461 (100)
13,031 (100)
76,886 (100)
1Includes only persons reported with HIV infection who have not developed AIDS. 2See table 3 for areas with confidential HIV infection reporting for adults and adolescents. 3For HIV infection cases, "risk not reported or identified" refers primarily to persons whose
mode of exposure was not reported and who have not been followed up to determine their mode of exposure, and to a smaller number of persons who are not reported with one of the exposures listed above after follow-up. See Technical Notes. 4Includes 1,095 men whose race/ethnicity is unknown.
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HIV/AIDS Surveillance Report
Table 11. Female adult/adolescent AIDS cases by exposure category and race/ethnicity, reported through December 1998, United States
White, not Hispanic Cumulative 1998 total Exposure category Injecting drug use Hemophilia/coagulation disorder Heterosexual contact: No. 718 4 765 (%) (35) (0) (38) No. 10,379 97 9,690 (%) (42) (0) (40) Black, not Hispanic Cumulative 1998 total No. 1,876 11 2,419 (%) (28) (0) (36) No. 27,114 98 22,800 (%) (44) (0) (37) Hispanic Cumulative 1998 total No. 577 — 906 (%) (28) — (44) No. 9,016 45 10,220 (%) (41) (0) (47)
Sex with injecting drug user Sex with bisexual male Sex with person with hemophilia Sex with transfusion recipient with HIV infection Sex with HIV-infected person, risk not specified
Receipt of blood transfusion, blood components, or tissue Risk not reported or identified1 Total
253 62 19 10 421
4,023 1,353 272 292 3,750
675 92 4 12 1,636
9,200 1,215 69 157 12,159
275 33 4 1 593
4,866 480 34 94 4,746
42 502
(2) (25)
1,773 2,517
(7) (10)
71 2,398
(1) (35)
1,183 10,679
(2) (17)
21 551
(1) (27)
535 2,121
(2) (10)
2,031 (100)
24,456 (100)
6,775 (100)
61,874 (100)
2,055 (100)
21,937 (100)
Asian/Pacific Islander Cumulative 1998 total Exposure category Injecting drug use Hemophilia/coagulation disorder Heterosexual contact: No. (%) 7 — 24 (12) — (41) No. 97 5 267 (%) (17) (1) (47)
American Indian/Alaska Native Cumulative 1998 total No. 16 — 4 (%) (53) — (13) No. 146 1 111 (%) (47) (0) (36)
Cumulative totals2 Cumulative 1998 total No. (%) No. (%) 3,201 17 4,125 (29) (0) (38) 46,804 248 43,128 (43) (0) (39)
Sex with injecting drug user Sex with bisexual male Sex with person with hemophilia Sex with transfusion recipient with HIV infection Sex with HIV-infected person, risk not specified
Receipt of blood transfusion, blood components, or tissue Risk not reported or identified Total
1See figure 6. 2Includes 170
5 3 1 1 14
75 63 5 18 106
3 — — — 1
56 15 2 — 38
1,212 190 28 24 2,671
18,231 3,132 382 562 20,821
3 25
(5) (42)
91 104
(16) (18)
— 10
— (33)
13 39
(4) (13)
137 3,518
(1) (32)
3,598 15,533
(3) (14)
59 (100)
564 (100)
30 (100)
310 (100)
10,998 (100)
109,311 (100)
women whose race/ethnicity is unknown.
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Vol. 10, No. 2
Table 12.
Female adult/adolescent HIV infection cases1 by exposure category and race/ ethnicity, reported through December 1998, from the 30 areas with confidential HIV infection reporting2
White, not Hispanic 1998 Cumulative total (%) (19) (0) (41) No. 1,839 11 2,820 (%) (27) (0) (42) Black, not Hispanic 1998 No. 387 3 1,514 (%) (9) (0) (36) Cumulative total No. 3,689 12 7,290 (%) (20) (0) (39) 1998 No. 55 — 184 (%) (12) — (40) Hispanic Cumulative total No. 418 — 741 (%) (23) — (41)
Exposure category Injecting drug use Hemophilia/coagulation disorder Heterosexual contact:
No. 239 1 519
Sex with injecting drug user Sex with bisexual male Sex with person with hemophilia Sex with transfusion recipient with HIV infection Sex with HIV-infected person, risk not specified
Receipt of blood transfusion, blood components, or tissue Risk not reported or identified3 Total
148 45 10 3 313
978 315 68 30 1,429
302 75 4 7 1,126
2,004 505 30 47 4,704
50 7 — 3 124
295 27 6 9 404
9 500
(1) (39)
126 1,927
(2) (29)
30 2,296
(1) (54)
227 7,560
(1) (40)
1 221
(0) (48)
21 610
(1) (34)
1,268 (100)
6,723 (100)
4,230 (100)
18,778 (100)
461 (100)
1,790 (100)
Asian/Pacific Islander 1998 Exposure category Injecting drug use Hemophilia/coagulation disorder Heterosexual contact: No. 1 — 11 (%) (5) — (55) Cumulative total No. 6 — 39 (%) (7) — (45)
American Indian/Alaska Native 1998 No. 6 — 6 (%) (26) — (26) Cumulative total No. 57 — 62 (%) (36) — (39)
Cumulative totals4 1998 No. 689 4 2,242 (%) (11) (0) (37) Cumulative total No. 6,029 23 10,989 (%) (22) (0) (40)
Sex with injecting drug user Sex with bisexual male Sex with person with hemophilia Sex with transfusion recipient with HIV infection Sex with HIV-infected person, risk not specified
Receipt of blood transfusion, blood components, or tissue Risk not reported or identified Total
2 — — — 9
8 1 — — 30
3 1 — — 2
35 8 — — 19
507 128 14 13 1,580
3,327 860 104 86 6,612
1 7
(5) (35)
2 39
(2) (45)
— 11
— (48)
1 40
(1) (25)
41 3,075
(1) (51)
379 10,386
(1) (37)
20 (100)
86 (100)
23 (100)
160 (100)
6,051 (100)
27,806 (100)
1Includes only persons reported with HIV infection who have not developed AIDS. 2See table 3 for areas with confidential HIV infection reporting for adults and adolescents. 3For HIV infection cases, "risk not reported or identified" refers primarily to persons whose
mode of exposure was not reported and who have not been followed up to determine their mode of exposure, and to a smaller number of persons who are not reported with one of the exposures listed above after follow-up. See Technical Notes. 4Includes 269 women whose race/ethnicity is unknown.
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HIV/AIDS Surveillance Report
Table 13.
AIDS cases in adolescents and adults under age 25, by sex and exposure category, reported through December 1998, United States
13-19 years old Cumulative 1998 total 20-24 years old Cumulative 1998 total No. 488 90 41 23 83 (%) (54) (10) (5) (3) (9) No. 11,079 2,199 1,853 623 792 (%) (62) (12) (10) (4) (4)
Male exposure category Men who have sex with men Injecting drug use Men who have sex with men and inject drugs Hemophilia/coagulation disorder Heterosexual contact:
No. 47 11 5 16 7
(%) (32) (7) (3) (11) (5)
No. 704 130 103 740 77
(%) (34) (6) (5) (36) (4)
Sex with injecting drug user Sex with person with hemophilia Sex with transfusion recipient with HIV infection Sex with HIV-infected person, risk not specified
Receipt of blood transfusion, blood components, or tissue Risk not reported or identified1 Male subtotal
— — — 7
21 1 — 55
14 — — 69
256 4 10 522
8 53 147
(5) (36) (100)
90 231 2,075
(4) (11) (100)
2 180 907
(0) (20) (100)
105 1,146 17,797
(1) (6) (100)
Female exposure category Injecting drug use Hemophilia/coagulation disorder Heterosexual contact: 14 1 61 (9) (1) (41) 190 12 708 (14) (1) (53) 87 — 289 (15) — (49) 1,827 13 3,614 (28) (0) (54)
Sex with injecting drug user Sex with bisexual male Sex with person with hemophilia Sex with transfusion recipient with HIV infection Sex with HIV-infected person, risk not specified
Receipt of blood transfusion, blood components, or tissue Risk not reported or identified Female subtotal Total
1See
13 3 — — 45
255 37 13 2 401
62 11 3 1 212
1,463 255 51 22 1,823
3 71 150
(2) (47) (100)
88 350 1,348
(7) (26) (100)
2 216 594
(0) (36) (100)
114 1,072 6,640
(2) (16) (100)
297
3,423
1,501
24,437
figure 6.
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Vol. 10, No. 2
Table 14.
HIV infection cases1 in adolescents and adults under age 25, by sex and exposure category, reported through December 1998, from the 30 areas with confidential HIV infection reporting2
13-19 years old 1998 Cumulative total (%) (52) (3) (1) (2) (7) No. 911 99 95 104 134 (%) (48) (5) (5) (5) (7) No. 575 50 53 4 88 1998 (%) (50) (4) (5) (0) (8) 20-24 years old Cumulative total No. 5,475 562 655 83 614 (%) (55) (6) (7) (1) (6)
Male exposure category Men who have sex with men Injecting drug use Men who have sex with men and inject drugs Hemophilia/coagulation disorder Heterosexual contact:
No. 145 7 4 5 19
Sex with injecting drug user Sex with person with hemophilia Sex with transfusion recipient with HIV infection Sex with HIV-infected person, risk not specified
Receipt of blood transfusion, blood components, or tissue Risk not reported or identified3 Male subtotal
2 — — 17
25 2 1 106
9 — 1 78
94 1 7 512
— 99 279
— (35) (100)
9 542 1,894
(0) (29) (100)
1 368 1,139
(0) (32) (100)
30 2,454 9,873
(0) (25) (100)
Female exposure category Injecting drug use Hemophilia/coagulation disorder Heterosexual contact: 16 — 183 (4) — (41) 158 — 1,106 (7) — (49) 42 1 313 (5) (0) (36) 611 3 2,117 (13) (0) (45)
Sex with injecting drug user Sex with bisexual male Sex with person with hemophilia Sex with transfusion recipient with HIV infection Sex with HIV-infected person, risk not specified
Receipt of blood transfusion, blood components, or tissue Risk not reported or identified Female subtotal Total4
21 7 3 — 152
221 73 19 4 789
43 16 — 2 252
545 192 30 17 1,333
— 249 448
— (56) (100) 728
15 986 2,265
(1) (44) (100) 4,161
2 502 860
(0) (58) (100) 1,999
26 1,998 4,755
(1) (42) (100)
14,628
1Includes only persons reported with HIV infection who have not developed AIDS. 2See table 3 for areas with confidential HIV infection reporting for adults and adolescents. 3For HIV infection cases, "risk not reported or identified" refers primarily to persons whose
mode of exposure was not reported and who have not been followed up to determine their mode of exposure, and to a smaller number of persons who are not reported with one of the exposures listed above after follow-up. See Technical Notes. 4Includes 2 persons whose sex is unknown.
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HIV/AIDS Surveillance Report
Table 15.
Pediatric AIDS cases by exposure category and race/ethnicity, reported through December 1998, United States
White, not Hispanic 1998 Cumulative total (%) — (95) No. 158 1,116 (%) (11) (75) Black, not Hispanic 1998 No. — 209 (%) — (88) Cumulative total No. 35 4,702 (%) (1) (95) 1998 No. — 75 (%) — (89) Hispanic Cumulative total No. 37 1,798 (%) (2) (92)
Exposure category Hemophilia/coagulation disorder Mother with/at risk for HIV infection:
No. — 55
Injecting drug use Sex with injecting drug user Sex with bisexual male Sex with person with hemophilia Sex with transfusion recipient with HIV infection Sex with HIV-infected person, risk not specified Receipt of blood transfusion, blood components, or tissue Has HIV infection, risk not specified
Receipt of blood transfusion, blood components, or tissue Risk not reported or identified1 Total
19 8 — — — 10
—
468 215 65 17 8 135 43 165
47 23 3 — — 58 2 76
1,825 690 60 5 8 743 77 1,294
17 12 1 1 1 18 1 24
718 482 38 7 9 245 33 266
18
— 3
— (5)
187 24
(13) (2)
— 28
— (12)
89 109
(2) (2)
1 8
(1) (10)
92 27
(5) (1)
58 (100)
1,485 (100)
237 (100)
4,935 (100)
84 (100)
1,954 (100)
Asian/Pacific Islander 1998 Exposure category Hemophilia/coagulation disorder Mother with/at risk for HIV infection: No. — 1 (%) — (50) Cumulative total No. 3 31 (%) (7) (67)
American Indian/ Alaska Native 1998 No. — — (%) — — Cumulative total No. 1 27 (%) (4) (96)
Cumulative totals2 1998 No. — 341 (%) — (89) Cumulative total No. 234 7,687 (%) (3) (91)
Injecting drug use Sex with injecting drug user Sex with bisexual male Sex with person with hemophilia Sex with transfusion recipient with HIV infection Sex with HIV-infected person, risk not specified Receipt of blood transfusion, blood components, or tissue Has HIV infection, risk not specified
Receipt of blood transfusion, blood components, or tissue Risk not reported or identified Total
1See figure 6, footnote 1. 2Includes 13 children whose
— 1 — — — — — —
4 5 2 — — 9 1 10
— — — — — — — —
12 7 — — — 3 — 5
83 44 4 1 1 86 3 119
3,032 1,400 165 29 25 1,137 154 1,745
— 1
— (50)
10 2
(22) (4)
— — —
— — —
— —
— —
1 40
(0) (10)
378 162
(4) (2)
2 (100)
46 (100)
28 (100)
382 (100)
8,461 (100)
race/ethnicity is unknown.
HIV/AIDS Surveillance Report
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Vol. 10, No. 2
Table 16.
Pediatric HIV infection cases1 by exposure category and race/ethnicity, reported through December 1998, from the 33 areas with confidential HIV infection reporting2
White, not Hispanic Cumulative 1998 total Black, not Hispanic Cumulative 1998 total No. 3 177 (%) (1) (84) No. (%) 21 1,069 (2) (90) Hispanic Cumulative 1998 total No. 1 34 (%) (2) (79) No. 5 191 (%) (2) (89)
Exposure category Hemophilia/coagulation disorder Mother with/at risk for HIV infection:
No. 2 41
(%) (4) (89)
No. 70 331
(%) (16) (76)
Injecting drug use Sex with injecting drug user Sex with bisexual male Sex with person with hemophilia Sex with transfusion recipient with HIV infection Sex with HIV-infected person, risk not specified Receipt of blood transfusion, blood components, or tissue Has HIV infection, risk not specified
Receipt of blood transfusion, blood components, or tissue Risk not reported or identified3 Total
12 8 1 1 — 7 — 12
106 67 4 4 4 61 6 79
28 10 3 — — 65 4 67
337 119 15 2 4 239 13 340
7 2 — — 2 11 — 12
50 32 3 — 2 43 2 59
1 2
(2) (4)
18 18
(4) (4)
1 30
(0) (14)
9 83
(1) (7)
3 5 43
(7) (12) (100)
7 12
(3) (6)
46 (100)
437 (100)
211 (100)
1,182 (100)
215 (100)
Asian/Pacific Islander Cumulative 1998 total Exposure category Hemophilia/coagulation disorder Mother with/at risk for HIV infection: No. (%) No. 1 7 (%) (9) (64)
American Indian/ Alaska Native Cumulative 1998 total No. — — (%) — — No. 1 8 (%) (9) (73)
Cumulative totals4 Cumulative 1998 total No. 6 256 (%) (2) (83) No. 99 1,614 (%) (5) (86)
— — 3 (100)
Injecting drug use Sex with injecting drug user Sex with bisexual male Sex with person with hemophilia Sex with transfusion recipient with HIV infection Sex with HIV-infected person, risk not specified Receipt of blood transfusion, blood components, or tissue Has HIV infection, risk not specified
Receipt of blood transfusion, blood components, or tissue Risk not reported or identified Total
— — — — — 2 — 1
2 — 2 — — 2 — 1
— — — — — — — —
3 2 1 1 — — — 1
47 20 4 1 2
501 221 26 7 10 346
86 21 4 92 482
— —
— —
1 2
(9) (18)
— — —
— — —
— 2
— (18)
5 42
(2) (14)
35 127
(2) (7)
3 (100)
11 (100)
11 (100)
309 (100)
1,875 (100)
1Includes only persons reported with HIV infection who have not developed AIDS. 2See table 3 for areas with confidential HIV infection reporting. 3For HIV infection cases, "risk not reported or identified" refers primarily to persons
whose mode of exposure was not reported and who have not been followed up to determine their mode of exposure, and to a smaller number of persons who are not reported with one of the exposures listed above after follow-up. See Technical Notes. 4Includes 19 children whose race/ethnicity is unknown.
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HIV/AIDS Surveillance Report
Figure 5.
Pediatric AIDS cases reported in 1998, United States
1 0 0 0 0 0 1 0 20 0 1 1 2 3 6 18
0 P.R 12 1 V.I. 1
0 1 1 9 0 0 9 3 1 4 0 4 1 2 4 12 20 131
0
1 3
0
5 49
Table 17. Health care workers with documented and possible occupationally acquired AIDS/HIV infection, by occupation, reported through December 1998, United States1
Documented occupational transmission2 Occupation Dental worker, including dentist Embalmer/morgue technician Emergency medical technician/paramedic Health aide/attendant Housekeeper/maintenance worker Laboratory technician, clinical Laboratory technician, nonclinical Nurse Physician, nonsurgical Physician, surgical Respiratory therapist Technician, dialysis Technician, surgical Technician/therapist, other than those listed above Other healthcare occupations Total
1Health
Possible occupational transmission3 No. 6 2 12 14 12 16 — 33 12 6 2 3 2 10 4 134
No. — 1 — 1 1 16 3 22 6 — 1 1 2 — — 54
care workers are defined as those persons, including students and trainees, who have worked in a health care, clinical, or HIV laboratory setting at any time since 1978. See MMWR 1992;41:823-25. 2Health care workers who had documented HIV seroconversion after occupational exposure or had other laboratory evidence of occupational infection: 46 had percutaneous exposure, 5 had mucocutaneous exposure, 2 had both percutaneous and mucocutaneous exposures, and 1 had an unknown route of exposure. Forty-nine exposures were to blood from an HIV-infected person, 1 to visibly bloody fluid, 1 to an unspecified fluid, and 3 to concentrated virus in a laboratory. Twenty-five of these health care workers developed AIDS. 3These health care workers have been investigated and are without identifiable behavioral or transfusion risks; each reported percutaneous or mucocutaneous occupational exposures to blood or body fluids, or laboratory solutions containing HIV, but HIV seroconversion specifically resulting from an occupational exposure was not documented.
HIV/AIDS Surveillance Report
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Vol. 10, No. 2
Figure 6.
Results of investigations of adult/adolescent AIDS cases ever classified as risk not reported or identified, through December 1998, United States1
108,108 Total 56,425 Not reclassified 51,683 Reclassified 38,692 Males Men who have sex with men (MSM) Injecting drug use (IDU) MSM/IDU Heterosexual contact Blood/blood products Other4 12,991 Females
40,801 Under investigation
15,624 Closed, risk not identified
55% 23% 5% 15% 2% 0%
— 27% — 68% 4% 1%
3,048 Formerly reported as Pattern-II associated 2
11,577 Incomplete investigation (died, lost to follow-up, or declined interview)
999 Complete investigation3
1Excludes
162 children under 13 years of age classified as “other/risk not reported or identified” in table 3; 150 whose risk is not identified, 2 who were exposed to HIV-infected blood in a household setting, as supported by seroconversion, epidemiologic, and/or laboratory evidence (see MMWR 1992;41:228-31 and N Engl J Med 1993;329:1835-41) and 10 children who had sexual contact with an adult with or at high risk for HIV infection (Pediatrics 1998;102:e46). An additional 472 children who were initially reported without risk information have been reclassified after investigation. 2Cases associated with persons born in Pattern-II countries are no longer classified as heterosexual transmission. See Technical Notes. 3Investigations of these persons included patient interviews. Based on available information, these persons could not be reclassified into an exposure category. This group includes persons possibly infected through heterosexual contact with a partner who is not known to be HIV infected or at risk for HIV infection; persons who may choose not to disclose high-risk information; and persons with possible occupational exposure. These 999 persons report heterosexual contact, sexually transmitted disease infections, non-injecting drug use, hepatitis infections, and occupational exposures to blood or body fluids. 4One hundred forty-nine adults/adolescents are included in the “other” exposure category listed here and in table 5, and 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. See table 17, MMWR 1993;42:329-31, MMWR 1993;42:948-51, and XI International Conference on AIDS; Vancouver, Canada; Jul. 7-12, 1996;1:179 [abstract Mo.D.1728]. Three persons were infected following intentional inoculation with HIV-infected blood. One hundred thirteen persons acquired HIV infection perinatally and were diagnosed with AIDS after age 13.
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HIV/AIDS Surveillance Report
Table 18. Adult/adolescent AIDS cases by single and multiple exposure categories, reported through December 1998, United States
AIDS cases Exposure category Single mode of exposure Men who have sex with men Injecting drug use Hemophilia/coagulation disorder Heterosexual contact Receipt of transfusion1 Receipt of transplant of tissues, organs, or artificial insemination 2 Other3 Single mode of exposure subtotal Multiple modes of exposure Men who have sex with men; injecting drug use Men who have sex with men; hemophilia/coagulation disorder Men who have sex with men; heterosexual contact Men who have sex with men; receipt of transfusion/transplant Injecting drug use; hemophilia/coagulation disorder Injecting drug use; heterosexual contact Injecting drug use; receipt of transfusion/transplant Hemophilia/coagulation disorder; heterosexual contact Hemophilia/coagulation disorder; receipt of transfusion/transplant Heterosexual contact; receipt of transfusion/transplant Men who have sex with men; injecting drug use; hemophilia/coagulation disorder Men who have sex with men; injecting drug use; heterosexual contact Men who have sex with men; injecting drug use; receipt of transfusion/transplant Men who have sex with men; hemophilia/coagulation disorder; heterosexual contact Men who have sex with men; hemophilia/coagulation disorder; receipt of transfusion/transplant Men who have sex with men; heterosexual contact; receipt of transfusion/transplant Injecting drug use; hemophilia/coagulation disorder; heterosexual contact Injecting drug use; hemophilia/coagulation disorder; receipt of transfusion/transplant Injecting drug use; heterosexual contact; receipt of transfusion/transplant Hemophilia/coagulation disorder; heterosexual contact; receipt of transfusion/transplant Men who have sex with men; injecting drug use; hemophilia/coagulation disorder; heterosexual contact Men who have sex with men; injecting drug use; hemophilia/coagulation disorder; receipt of transfusion/transplant Men who have sex with men; injecting drug use; heterosexual contact; receipt of transfusion/transplant Men who have sex with men; hemophilia/coagulation disorder; heterosexual contact; receipt of transfusion/transplant Injecting drug use; hemophilia/coagulation disorder; heterosexual contact; receipt of transfusion/transplant Men who have sex with men; injecting drug use; hemophilia/coagulation disorder; heterosexual contact; receipt of transfusion/transplant Multiple modes of exposure subtotal Risk not reported or identified4 Total
1Includes 2Thirteen
No.
(%)
312,148 138,503 3,969 64,844 8,369 13 147 527,993
(46) (20) (1) (10) (1) (0) (0) (78)
37,315 168 9,988 3,405 191 32,203 1,642 103 803 1,646 47 5,468 606 21 38 278 81 36 1,014 36 13 14 171 5 23 6
(5) (0) (1) (1) (0) (5) (0) (0) (0) (0) (0) (1) (0) (0) (0) (0) (0) (0) (0) (0) (0) (0) (0) (0) (0) (0)
95,321 56,425 679,739
(14) (8) (100)
37 adult/adolescents who developed AIDS after receiving blood screened negative for HIV antibody. adults developed AIDS after receiving tissue, organs, or artificial insemination from HIV-infected donors. Four of the 12 received tissue or organs from a single donor who was negative for HIV antibody at the time of donation. See N Engl J Med 1992;326:726-32. 3See table 17 and figure 6 for a discussion of the "other" exposure category. "Other" also includes 113 persons who acquired HIV infection perinatally, but were diagnosed with AIDS after age 13. 4See figure 6.
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Table 19.
AIDS cases and annual rates per 100,000 population, by race/ethnicity, age group, and sex, reported in 1998, United States
Adults/adolescents Males Females No. 2,031 6,775 2,055 59 30 10,998 Rate 2.4 49.8 16.6 1.4 3.8 9.6 Total No. 16,060 21,515 9,566 388 148 47,887 Rate 9.9 84.7 37.8 4.8 9.7 21.5 Children <13 years No. 58 237 84 2 0 382 Rate 0.2 3.2 0.9 0.1 0.0 0.7 Total No. 16,118 21,752 9,650 390 148 48,269 Rate 8.2 66.4 28.1 3.8 7.4 17.6
Race/ethnicity White, not Hispanic Black, not Hispanic Hispanic Asian/Pacific Islander American Indian/Alaska Native Total1
1Totals
No. 14,027
Rate 17.8
14,740 125.2 7,511 329 117 36,886 58.2 8.5 15.7 34.1
include 211 persons whose race/ethnicity is unknown, and 3 persons whose sex is unknown.
Table 20.
Adult/adolescent AIDS cases among Hispanics, by exposure category and place of birth, reported in 1998, United States
Place of birth United States1 Central/South America No. (%) 241 (36) 29 14 ( 4) ( 2) Cuba No. (%) 68 (34) 15 7 15 ( 8) ( 4) ( 8) Mexico No. (%) 476 (48) 75 27 ( 8) ( 3) Puerto Rico No. (%) 354 (14) 1,194 (46) 98 ( 4) Total2 No. (%) 2,720 (28) 2,741 (29) 334 ( 3)
Adult/adolescent exposure category Men who have sex with men Injecting drug use Men who have sex with men and inject drugs Heterosexual contact Hemophilia/coagulation disorder or receipt of blood transfusion, blood components, or tissue Risk not reported or identified
3
No. (%) 1,023 (37) 777 (28) 123 ( 4)
321 (12)
113 (17)
114 (11)
655 (25)
1,544 (16)
24
( 1)
5
( 1)
1
( 1)
14
( 1)
11
( 0)
65
( 1)
514 (18)
272 (40)
94 (47)
287 (29)
282 (11)
2,162 (23)
Total
1Excludes
2,782 (100)
674 (100)
200 (100)
993 (100)
2,594 (100)
9,566 (100)
persons born in U.S. dependencies, possessions, and independent nations in free association with the United States. Ancestry data for U.S.-born Hispanics are not collected. 2Includes 238 Hispanics born in locations other than those listed, and 2,085 Hispanics whose place of birth is unknown. 3See figure 6.
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Table 21.
Deaths in persons with AIDS, by race/ethnicity, age at death, and sex, occurring in 1996 and 1997, and cumulative totals reported through December 1998, United States1
Males Female Cumulative total 591 2,475 52,833 76,298 34,256 14,432 181,017 1,394 2,336 31,647 45,742 19,435 8,225 108,874 614 1,288 19,274 24,266 9,625 3,916 59,033 18 34 676 1,046 506 223 2,504 12 24 344 352 104 38 877 2,632 6,162 104,832 147,815 63,966 26,855 352,545 1996 30 34 422 580 218 107 1,391 117 114 1,125 1,751 675 247 4,029 43 43 414 583 215 101 1,399 2 — 12 10 5 5 34 — — 8 11 6 — 25 192 191 1,982 2,936 1,121 460 6,882 1997 10 20 239 330 139 53 791 56 96 701 1,136 516 182 2,687 15 23 208 336 127 76 785 — — 4 7 8 3 22 — — 6 6 4 — 16 81 139 1,158 1,816 794 314 4,302 Cumulative total 410 453 4,367 4,563 1,728 1,612 13,154 1,366 1,303 10,705 13,042 4,362 1,923 32,733 552 462 4,209 4,402 1,517 748 11,901 15 5 71 94 58 41 286 8 3 61 56 23 7 158 2,352 2,228 19,416 22,166 7,693 4,334 58,255 1996 64 115 3,416 6,215 2,935 1,075 13,820 250 241 3,741 6,647 3,164 1,289 15,332 87 103 1,817 2,830 1,286 512 6,635 2 1 59 123 57 28 270 1 3 36 55 18 2 115 406 463 9,073 15,875 7,467 2,910 36,194 Both sexes 1997 31 54 1,487 2,882 1,467 605 6,526 126 175 2,166 3,933 2,206 920 9,526 39 72 948 1,629 710 332 3,730 — — 30 60 25 21 136 — — 23 34 11 — 68 196 301 4,657 8,543 4,421 1,878 19,996 Cumulative total 1,001 2,928 57,200 80,861 35,984 16,044 194,171 2,760 3,639 42,352 58,784 23,797 10,148 141,607 1,166 1,750 23,483 28,668 11,142 4,664 70,934 33 39 747 1,140 564 264 2,790 20 27 405 408 127 45 1,035 4,984 8,390 124,248 169,981 71,659 31,189 410,800
Race/ethnicity and age at death2 White, not Hispanic Under 15 15-24 25-34 35-44 45-54 55 or older All ages Black, not Hispanic Under 15 15-24 25-34 35-44 45-54 55 or older All ages Hispanic Under 15 15-24 25-34 35-44 45-54 55 or older All ages Asian/Pacific Islander Under 15 15-24 25-34 35-44 45-54 55 or older All ages
1996 34 81 2,994 5,635 2,717 968 12,429 133 127 2,616 4,896 2,489 1,042 11,303 44 60 1,403 2,247 1,071 411 5,236 — 1 47 113 52 23 236 1 3 28 44 12 2 90
1997 21 34 1,248 2,552 1,328 552 5,735 70 79 1,465 2,797 1,690 738 6,839 24 49 740 1,293 583 256 2,945 — — 26 53 17 18 114 — — 17 28 7 — 52 115 162 3,499 6,727 3,627 1,564 15,694
American Indian/Alaska Native Under 15 15-24 25-34 35-44 45-54 55 or older All ages All racial/ethnic groups Under 15 15-24 25-34 35-44 45-54 55 or older All ages
1Data
214 272 7,091 12,939 6,346 2,450 29,312
tabulations for 1996 and 1997 are based on date of death occurrence. Data for deaths occurring in 1998 are incomplete and not tabulated separately, but are included in the cumulative totals. Tabulations for 1996 and 1997 may increase as additional deaths are reported to CDC. 2Data tabulated under "all ages" include 349 persons whose age at death is unknown. Data tabulated under "all racial/ethnic groups" include 263 persons whose race/ethnicity is unknown.
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Table 22.
Estimated male adult/adolescent AIDS incidence, by exposure category and race/ ethnicity, diagnosed in 1997, and cumulative totals through 1997, United States1
White, not Hispanic 1997 Cumulative total (%) (73) (13) (7) (1) (5) No. 212,890 26,228 22,671 3,704 5,338 (%) (78) (10) (8) (1) (2) Black, not Hispanic 1997 No. 6,561 5,926 991 42 2,554 (%) (40) (37) (6) (0) (16) Cumulative total No. 74,930 69,396 14,585 644 16,110 (%) (42) (39) (8) (0) (9) 1997 No. 3,543 2,827 447 25 1,026 (%) (45) (36) (6) (0) (13) Hispanic Cumulative total No. 45,264 38,625 7,065 471 6,491 (%) (46) (39) (7) (0) (7)
Exposure category Men who have sex with men Injecting drug use Men who have sex with men and inject drugs Hemophilia/coagulation disorder Heterosexual contact:
No. 10,236 1,826 1,009 113 657
Sex with injecting drug user Sex with person with hemophilia Sex with transfusion recipient with HIV infection Sex with HIV-infected person, risk not specified
Receipt of blood transfusion, blood components, or tissue Risk not reported or identified Total
196 1 5 455
1,936 28 165 3,209
656 2 20 1,876
5,425 13 158 10,514
254 1 9 762
1,878 9 94 4,510
98 34 13,973
(1) (0) (100)
3,243 519
(1) (0)
83 47
(1) (0)
1,131 2,561
(1) (1)
51 28
(1) (0)
626 282
(1) (0)
274,593 (100)
16,204 (100)
179,357 (100)
7,947 (100)
98,824 (100)
Asian/Pacific Islander 1997 Exposure category Men who have sex with men Injecting drug use Men who have sex with men and inject drugs Hemophilia/coagulation disorder Heterosexual contact: No. 225 50 8 3 37 (%) (68) (15) (2) (1) (11) Cumulative total No. 3,311 371 167 67 200 (%) (78) (9) (4) (2) (5)
American Indian/Alaska Native 1997 No. 76 34 12 1 14 (%) (55) (25) (9) (1) (10) Cumulative total No. 945 260 262 28 51 (%) (61) (17) (17) (2) (3)
Cumulative totals2 1997 No. 20,704 10,722 2,469 184 4,302 (%) (53) (28) (6) (0) (11) Cumulative total No. 337,745 135,109 44,774 4,923 28,252 (%) (60) (24) (8) (1) (5)
Sex with injecting drug user Sex with person with hemophilia Sex with transfusion recipient with HIV infection Sex with HIV-infected person, risk not specified
Receipt of blood transfusion, blood components, or tissue Risk not reported or identified Total
1These
7 — — 30
50 — 8 142
2 — — 12
17 — 1 33
1,118 3 34 3,147
9,319 50 427 18,456
6 1 330
(2) (0) (100)
107 27
(3) (1)
— 1
(0) (1)
9 5
(1) (0)
239 112
(1) (0)
5,126 3,400
(1) (1)
4,250 (100)
138 (100)
1,560 (100)
38,732 (100)
559,329 (100)
numbers do not represent actual cases of men with AIDS. Rather, these numbers are point estimates adjusted for delays in the reporting of AIDS cases and for redistribution of cases initially reported with no identified risk, but not adjusted for incomplete reporting of cases. See Technical Notes. 2Totals include estimates of men whose race/ethnicity is unknown.
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Table 23.
Estimated female adult/adolescent AIDS incidence, by exposure category and race/ethnicity, diagnosed in 1997, and cumulative totals through 1997, United States 1
White, not Hispanic Cumulative 1997 total Black, not Hispanic Cumulative 1997 total No. 2,799 40 4,226 (%) (39) (1) (58) No. 29,113 200 27,636 (%) (49) (0) (47) Hispanic Cumulative 1997 total No. 756 12 1,364 (%) (35) (1) (63) No. 9,502 80 11,195 (%) (44) (0) (52)
Exposure category
No.
(%) (41) (0) (55)
No. 10,762 123 10,938
(%) (45) (1) (46)
Injecting drug use 862 Hemophilia/coagulation disorder 7 Heterosexual contact: 1,156
Sex with injecting drug user Sex with bisexual male Sex with person with hemophilia Sex with transfusion recipient with HIV infection Sex with HIV-infected person, risk not specified
Receipt of blood transfusion, blood components, or tissue Risk not reported or identified Total 43 18
370 111 11 15 649
(2) (1)
4,476 1,515 282 316 4,349
1,862 207 (8) (1)
1,208 169 8 19 2,822
149 41 (2) (1)
10,695 1,439 77 183 15,241
1,376 1,063 (2) (2) 33 13
428 53 3 4 876
(2) (1)
5,184 528 34 100 5,349
574 75 (3) (0)
2,086 (100)
23,892 (100)
7,255 (100)
59,388 (100)
2,178 (100)
21,426 (100)
Asian/Pacific Islander Cumulative 1997 total Exposure category Injecting drug use Hemophilia/coagulation disorder Heterosexual contact: No. 15 1 34 (%) (28) (2) (63) No. 117 6 317 (%) (22) (1) (58)
American Indian/Alaska Native Cumulative 1997 total No. 13 — 16 (%) (43) (0) (53) No. 145 1 128 (%) (49) (0) (44)
Cumulative totals2 Cumulative 1997 total No. 4,464 61 6,824 (%) (38) (1) (59) No. 49,718 414 50,302 (%) (47) (0) (48)
Sex with injecting drug user Sex with bisexual male Sex with person with hemophilia Sex with transfusion recipient with HIV infection Sex with HIV-infected person, risk not specified
Receipt of blood transfusion, blood components, or tissue Risk not reported or identified Total
1These
9 4 — 1 20
2 2 (4) (4) 94 10
93 66 4 19 135
(17) (2) 1 —
7 2 — — 7
(3) (0) 14 5
61 17 2 — 48
(5) (2)
2,030 341 22 39 4,391
229 74 (2) (1)
20,537 3,574 399 619 25,173
3,924 1,362 (4) (1)
54 (100)
544 (100)
30 (100)
293 (100)
11,651 (100)
105,720 (100)
numbers do not represent actual cases of women with AIDS. Rather, these numbers are point estimates adjusted for delays in the reporting of AIDS cases and for redistribution of cases initially reported with no identified risk, but not adjusted for incomplete reporting of cases. See Technical Notes. 2Totals include estimates of women whose race/ethnicity is unknown.
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Table 24.
Estimated AIDS incidence in adolescents and adults under age 25, by sex and exposure category, diagnosed in 1997, and cumulative totals through 1997, United States1
13-19 years old Cumulative 1997 total 20-24 years old Cumulative 1997 total No. 601 154 44 21 103 (%) (65) (17) (5) (2) (11) No. 11,387 2,461 1,890 626 917 (%) (65) (14) (11) (4) (5)
Male exposure category Men who have sex with men Injecting drug use Men who have sex with men and inject drugs Hemophilia/coagulation disorder Heterosexual contact:
No. 77 20 6 11 21
(%) (50) (13) (4) (7) (14)
No. 751 180 109 742 104
(%) (37) (9) (5) (36) (5)
Sex with injecting drug user Sex with person with hemophilia Sex with transfusion recipient with HIV infection Sex with HIV-infected person, risk not specified
Receipt of blood transfusion, blood components, or tissue Risk not reported or identified Male subtotal
6 — — 15
29 1 — 74
21 — — 82
292 4 12 609
6 12 153
(4) (8) (100)
88 66 2,040
(4) (3) (100)
3 2 928
(0) (0) (100)
116 118 17,515
(1) (1) (100)
Female exposure category Injecting drug use Hemophilia/coagulation disorder Heterosexual contact: 30 — 100 (19) (0) (65) 262 14 861 (20) (1) (66) 136 2 471 (22) (0) (75) 2,066 22 4,133 (32) (0) (64)
Sex with injecting drug user Sex with bisexual male Sex with person with hemophilia Sex with transfusion recipient with HIV infection Sex with HIV-infected person, risk not specified
Receipt of blood transfusion, blood components, or tissue Risk not reported or identified Female subtotal Total
1These
23 5 — — 72
305 44 13 3 496
117 16 1 1 336
1,633 287 53 25 2,135
8 17 155
(5) (11) (100) 308
96 80 1,313
(7) (6) (100)
13 3 625
(2) (0) (100)
143 85 6,449
(2) (1) (100)
3,353
1,553
23,964
numbers do not represent actual cases of persons with AIDS. Rather, these numbers are point estimates adjusted for delays in the reporting of AIDS cases and for redistribution of cases initially reported with no identified risk, but not adjusted for incomplete reporting of cases. See Technical Notes.
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HIV/AIDS Surveillance Report
Figure 7.
Estimated AIDS incidence, by region of residence and year of diagnosis, 1996 and 1997, United States1
25,000
23,506
Year of Diagnosis 1996 (N=60,669)
20,222
20,000
1997 (N=50,384)
18,700
Number of cases
15,000
15,190
10,614
10,000
8,531 5,739
5,000
4,591 2,110 1,850
0
Northeast
Midwest
South
West
U.S. dependencies, possessions and associated nations
Region of residence
1These
numbers do not represent actual cases of persons diagnosed with AIDS. Rather, these numbers are point estimates of persons diagnosed with AIDS adjusted for reporting delays, but not for incomplete reporting. See Technical Notes for a list of states or U.S. dependencies, possessions, and associated nations which comprise each region of residence.
Figure 8.
Estimated AIDS incidence, by race/ethnicity and year of diagnosis, 1996 and 1997, United States1
30,000
26,619
Year of Diagnosis 1996 (N=60,669)
23,459
25,000
Number of cases
21,213
1997 (N=50,384)
20,000
16,059
15,000
11,972 10,125
10,000
5,000
530 383 198 170
0
White, not Hispanic
Black, not Hispanic
Hispanic
Asian/ Pacific Islander
American Indian/ Alaska Native
Race/ethnicity
1These
numbers do not represent actual cases of persons diagnosed with AIDS. Rather, these numbers are point estimates of persons diagnosed with AIDS adjusted for reporting delays, but not for incomplete reporting. Cases with missing or unknown race/ethnicity data are included in the totals. See Technical Notes.
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Figure 9.
Estimated male adult/adolescent AIDS incidence, by exposure category and year of diagnosis, 1996 and 1997, United States1
30,000
Year of Diagnosis
26,087 25,000 20,704 20,000
1996 (N=47,478) 1997 (N=38,732)
Number of cases
15,000
13,061 10,722
10,000
5,000
4,587 4,302 3,072 2,469 256
In us jec e tin (ID g U dru ) g
0
M w en ith w m ho en h (M ave SM se ) x
184
299
239
116
112
1These
numbers do not represent actual cases of men diagnosed with AIDS. Rather, these numbers are point estimates of men diagnosed with AIDS adjusted for reporting delays and for redistribution of cases initially reported with no identified risk, but not for incomplete reporting. See Technical Notes.
Figure 10.
Estimated female adult/adolescent AIDS incidence, by exposure category and year of diagnosis, 1996 and 1997, United States1
8,000 7,000 6,000 7,518 6,824
Number of cases
5,256 5,000 4,464 4,000 3,000 2,000 1,000 58 61 284 229 75 74 0
e
t
H co emo ag p ula hili tio a/ n dis or d
Exposure category
1These
numbers do not represent actual cases of women diagnosed with AIDS. Rather, these numbers are point estimates of women diagnosed with AIDS adjusted for reporting delays and for redistribution of cases initially reported with no identified risk, but not for incomplete reporting. See Technical Notes.
Vol. 10, No. 2
35
R tra ece ns ipt fu of sio n/ tra
He te
HIV/AIDS Surveillance Report
R or isk ide no nt t re ifie po d/ r te ot d he r
us
ac
er
ug
co
dr
g
jec
In
ro
se xu
tin
al
ns
pla
nt
nt
/ID U em co ag op ul hil at ia io / n di so rd er H et er os ex ua lc on ta ct R ec tra e ns ip fu t o si f on /tr an sp la nt H
Exposure category
Year of Diagnosis 1996 (N=13,191) 1997 (N=11,652)
R or isk id no en t tif rep ie o d/ rt ot ed he r
M
SM
Figure 11.
Estimated pediatric AIDS incidence, by year of diagnosis, 1992 through 1997, United States1
947 908 810
Number of cases
675
506
310
1992
1993
1994
1995
1996
1997
Year of diagnosis
1These
numbers do not represent actual cases of children diagnosed with AIDS. Rather, these numbers are point estimates based on cases diagnosed using the 1987 definition, adjusted for reporting delays. The 1993 AIDS surveillance case definition change affected only the adult/adolescent cases, not pediatric cases.
Table 25.
Estimated persons living with AIDS, by region of residence and year, 1992 through 1997, United States1
Year
2
Region of residence Northeast Midwest South West
1992 39,725 15,157 47,210 33,426 4,608 140,126
1993 51,760 18,410 59,598 39,251 5,736 174,755
1994 59,383 20,350 69,309 42,827 6,352 198,221
1995 66,201 21,766 77,068 45,912 6,819 217,766
1996 73,553 23,506 87,256 49,876 7,392 241,583
1997 82,073 25,943 99,442 55,126 8,255 270,839
U.S. dependencies, possessions, and associated nations Total
3
1These
numbers do not represent actual cases of persons living with AIDS. Rather, these numbers are point estimates of persons living with AIDS derived by subtracting the estimated cumulative number of deaths in persons with AIDS from the estimated cumulative number of persons with AIDS. Estimated AIDS cases and estimated deaths are adjusted for reporting delays, but not for incomplete reporting. Annual estimates are through the most recent year for which reliable estimates are available. See Technical Notes. 2See Technical Notes for a list of states or U.S. dependencies, possessions, and associated nations which comprise each region of residence. 3Totals may vary between tables due to rounding.
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Table 26.
Estimated persons living with AIDS, by race/ethnicity and year, 1992 through 1997, United States1
Year 1992 68,687 45,928 23,840 1,010 461 140,126 1993 80,692 60,806 31,195 1,283 555 174,755 1994 87,147 72,150 36,543 1,442 655 198,220 1995 92,281 81,644 41,149 1,602 706 217,766 1996 99,294 92,764 46,378 1,859 789 241,584 1997 108,398 106,240 52,537 2,100 886 270,841
Race/ethnicity White, not Hispanic Black, not Hispanic Hispanic Asian/Pacific Islander American Indian/Alaska Native Total2
1These
numbers do not represent actual cases of persons living with AIDS. Rather, these numbers are point estimates of persons living with AIDS derived by subtracting the estimated cumulative number of deaths in persons with AIDS from the estimated cumulative number of persons with AIDS. Estimated AIDS cases and estimated deaths are adjusted for reporting delays, but not for incomplete reporting. Annual estimates are through the most recent year for which reliable estimates are available. See Technical Notes. 2Totals include estimates of persons whose race/ethnicity is unknown. Totals may vary between tables due to rounding.
Table 27. Estimated persons living with AIDS, by age group, sex, exposure category, and year, 1992 through 1997, United States1
Male adult/adolescent exposure category Men who have sex with men Injecting drug use Men who have sex with men and inject drugs Hemophilia/coagulation disorder Heterosexual contact Receipt of blood transfusion, blood components, or tissue Risk not reported or identified Male subtotal Female adult/adolescent exposure category Injecting drug use Hemophilia/coagulation disorder Heterosexual contact Receipt of blood transfusion, blood components, or tissue Risk not reported or identified Female subtotal Pediatric (<13 years old) exposure category Total2
1These
Year 1992 73,139 26,176 11,325 1,426 4,096 847 1,071 118,080 1993 87,138 34,544 13,383 1,620 6,090 935 1,169 144,879 1994 95,833 40,367 14,330 1,703 7,920 982 1,117 162,252 1995 102,492 44,802 15,003 1,733 9,850 1,052 1,123 176,055 1996 112,056 49,414 15,588 1,752 12,380 1,134 1,175 193,499 1997 124,413 54,858 16,708 1,802 15,259 1,254 1,240 215,534
10,245 68 8,008 666 403 19,390
13,706 94 11,827 787 437 26,851
16,094 114 15,186 879 440 32,713
18,187 141 18,593 953 443 38,317
20,199 172 22,689 1,064 486 44,610
22,551 211 27,241 1,194 539 51,736
2,654 140,124
3,024 174,754
3,258 198,223
3,396 217,768
3,478 241,587
3,573 270,843
numbers do not represent actual cases of persons living with AIDS. Rather, these numbers are point estimates of persons living with AIDS derived by subtracting the estimated cumulative number of deaths in persons with AIDS from the estimated cumulative number of persons with AIDS. Estimated AIDS cases and estimated deaths are adjusted for reporting delays and for redistribution of cases initially reported with no identified risk, but not for incomplete reporting. Annual estimates are through the most recent year for which reliable estimates are available. See Technical Notes. 2Totals may vary between tables due to rounding.
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Table 28.
Estimated deaths of persons with AIDS, by region of residence and year of death, 1992 through 1997, United States1
Year of death
Region of residence2 Northeast Midwest South West U.S. dependencies, possessions, and associated nations Total
1These
1992 12,905 4,223 13,119 9,610 1,413 41,270
1993 13,966 4,738 14,369 10,271 1,553 44,896
1994 15,821 5,142 16,025 10,575 1,749 49,311
1995 15,792 5,391 16,980 10,055 1,679 49,897
1996 11,554 4,031 13,539 6,682 1,554 37,359
1997 6,775 2,185 8,166 3,311 1,001 21,437
numbers do not represent actual deaths of persons with AIDS. Rather, these numbers are point estimates adjusted for delays in the reporting of deaths, but not for incomplete reporting of deaths. Annual estimates are through the most recent year for which reliable estimates are available. See Technical Notes. 2See Technical Notes for a list of states or U.S. dependencies, possessions, and associated nations which comprise each region of residence.
Table 29.
Estimated deaths of persons with AIDS, by race/ethnicity and year of death, 1992 through 1997, United States1
Year of death
Race/ethnicity White, not Hispanic Black, not Hispanic Hispanic Asian/Pacific Islander American Indian/Alaska Native Total2
1These
1992 20,411 13,373 7,106 270 77 41,270
1993 21,438 15,320 7,666 306 132 44,896
1994 22,221 17,747 8,768 404 144 49,311
1995 21,550 18,813 8,949 357 186 49,897
1996 14,264 15,827 6,848 278 119 37,359
1997 6,992 10,183 4,034 144 74 21,437
numbers do not represent actual deaths of persons with AIDS. Rather, these numbers are point estimates adjusted for delays in the reporting of deaths, but not for incomplete reporting of deaths. Annual estimates are through the most recent year for which reliable estimates are available. See Technical Notes. 2Totals include estimates of persons whose race/ethnicity is unknown.
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Table 30.
Estimated deaths of persons with AIDS, by age group, sex, exposure category, and year of death, 1992 through 1997, United States1
Year of death 1992 22,791 8,105 2,783 333 1,195 328 230 35,762 1993 23,634 9,204 3,072 352 1,552 315 188 38,317 1994 24,919 10,266 3,382 345 1,956 301 155 41,320 1995 24,369 10,674 3,321 327 2,319 262 106 41,375 1996 16,523 8,449 2,488 237 2,058 217 64 30,036 1997 8,348 5,278 1,349 134 1,423 118 47 16,697
Male adult/adolescent exposure category Men who have sex with men Injecting drug use Men who have sex with men and inject drugs Hemophilia/coagulation disorder Heterosexual contact Receipt of blood transfusion, blood components, or tissue Risk not reported or identified Male subtotal
Female adult/adolescent exposure category Injecting drug use Hemophilia/coagulation disorder Heterosexual contact Receipt of blood transfusion, blood components, or tissue Risk not reported or identified Female subtotal 2,724 20 1,978 246 115 5,083 3,100 16 2,608 234 83 6,041 3,657 25 3,437 229 62 7,411 3,755 30 3,912 226 59 7,982 3,245 27 3,422 173 33 6,900 2,112 21 2,271 98 21 4,523
Pediatric (<13 years old) exposure category Total
1These
423 41,270
537 44,896
576 49,311
537 49,897
424 37,359
217 21,437
numbers do not represent actual deaths of persons with AIDS. Rather, these numbers are point estimates adjusted for delays in the reporting of deaths and for redistribution of cases initially reported with no identified risk, but not for incomplete reporting of deaths. Annual estimates are through the most recent year for which reliable estimates are available. See Technical Notes.
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Technical Notes
Surveillance of AIDS
All 50 states, the District of Columbia, U.S. dependencies, and possessions, and independent nations in free association with the United States1 report AIDS cases to CDC using a uniform surveillance case definition and case report form. The original definition was modified in 1985 (MMWR 1985;34:373-75) and 1987 (MMWR 1987;36[suppl. no. 1S]:1S-15S). The case definition for adults and adolescents was modified again in 1993 (MMWR 1992;41[no. RR-17]:1-19; see also MMWR 1995;44:64-67). The revisions incorporated a broader range of AIDS-indicator diseases and conditions and used HIV diagnostic tests to improve the sensitivity and specificity of the definition. The laboratory and diagnostic criteria for the 1987 pediatric case definition (MMWR 1987;36:225-30, 235 ) were updated in 1994 (MMWR 1994;43[no. RR-12]:1-19). For persons with laboratory-confirmed HIV infection, the 1987 revision incorporated HIV encephalopathy, wasting syndrome, and other indicator diseases that are diagnosed presumptively (i.e., without confirmatory laboratory evidence of opportunistic disease). In addition to the 23 clinical conditions in the 1987 definition, the 1993 case definition for adults and adolescents includes HIV-infected persons with CD4+ T-lymphocyte counts of less than 200/µL or a CD4+ percentage of less than 14, and persons diagnosed with pulmonary tuberculosis, recurrent pneumonia, and invasive cervical cancer. The pediatric case definition incorporates the revised 1994 pediatric classification system for evidence of HIV infection. Children with their first positive results on Western blot or HIV detection tests before October 1994 were categorized based on the 1987 classification system. Those tested during or after October 1994 are categorized under the revised 1994 pediatric classification system. For children of any age with an AIDS-defining condition that requires evidence of HIV infection, a single positive HIV-detection test (i.e., HIV culture, HIV PCR, or HIV antigen [p24]) is sufficient for a reportable AIDS diagnosis if the diagnosis is confirmed by a physician.
1Included
Although completeness of reporting of diagnosed AIDS cases to state and local health departments varies by geographic region and patient population, studies conducted by state and local health departments indicate that reporting of AIDS cases in most areas of the United States is more than 85% complete (J Acquir Immune Def Syndr, 1992;5:257-64 and Am J Public Health 1992;82:1495-99). In addition, multiple routes of exposure, opportunistic diseases diagnosed after the initial AIDS case report was submitted to CDC, and vital status may not be determined or reported for all cases. However, among persons reported with AIDS, reporting of deaths is estimated to be more than 90% complete (JAMA 1996;276:126-31). CDC estimates that fewer than 3% of AIDS cases are duplicates based on matching of the national coded surveillance database. Included in this report are persons known to be infected with human immunodeficiency virus type 2 (HIV-2). See MMWR 1995;44:603-06.
Surveillance of HIV infection
Through December 31, 1998, 29 states and the Virgin Islands had laws or regulations requiring confidential reporting by name of all persons with confirmed HIV infection, in addition to reporting of persons with AIDS. Two other states, Connecticut and Texas, required reporting by name of HIV infection only for children less than 13 years of age; and Oregon required reporting for children less than 6 years of age. These states initiated reporting at various times after the development of serum HIV-antibody tests. Before 1991, surveillance of HIV infection was not standardized and reporting of HIV infections was based primarily on passive surveillance. Consequently, many cases reported before 1991 do not have complete information. Since then, CDC has assisted states in conducting active surveillance of HIV infections using standardized report forms and software. However, collection of demographic and risk information still varies among states. HIV infection data should be interpreted with caution. HIV surveillance reports may not be representative of all persons infected with HIV since not all infected persons have been tested. Many HIV-reporting states offer anonymous HIV testing and home collection HIV test kits are widely available in the United States. Anonymous test results are not reported to
among the dependencies, possessions, and independent nations are Puerto Rico, the U.S. Virgin Islands, Guam, American Samoa, the Republic of Palau, the Republic of the Marshall Islands, the Commonwealth of the Northern Mariana Islands, and the Federated States of Micronesia. The latter 5 comprise the category “Pacific Islands, U.S.” listed in tables 1 and 2.
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state and local health departments’ confidential namebased HIV registries. Therefore, confidential HIV infection reports may not represent all persons testing positive for HIV infection. Furthermore, many factors may influence testing patterns, including the extent that testing is targeted or routinely offered to specific groups and the availability of and access to medical care and testing services. These data provide a minimum estimate of the number of persons known to be HIV infected in states with confidential HIV reporting. A few states use codes in lieu of names to conduct surveillance for HIV infection. These data are not included in the HIV data tables pending evaluations demonstrating acceptable performance under CDC guidelines and the development of methods to report such data to CDC. For this report, persons greater than 18 months of age were considered HIV infected if they had at least one positive Western blot or positive detection test (culture, antigen, or other detection test) or had a diagnosis of HIV infection documented by a physician. Before October 1994, children less than 15 months of age were considered HIV infected if they met the definition stated in the 1987 pediatric classification system for HIV infection (MMWR 1987;36:225-30, 235). Beginning October 1994, children less than 18 months of age are considered HIV infected if they meet the definition stated in the 1994 pediatric classification system for HIV infection (MMWR 1994;43[no. RR-12]:1-10). This report also includes children who were diagnosed by a physician as HIV infected. Although many states monitor reports of children born to infected mothers, only those with documented diagnosis of HIV infection are included in this report. Because states initiated reporting on different dates, the length of time reporting has been in place will influence the number of HIV infection cases reported. For example, data presented for a given annual period may include cases reported only during a portion of the year. Prior to statewide HIV reporting, some states collected reports of HIV infection in selected populations. Therefore, these states have reports prior to initiation of statewide confidential reporting. A state with confidential HIV infection reporting also may report persons testing positive in that state who are residents of other states. Therefore, when HIV data are presented by state of residence, persons reported prior to the date a state initiated reporting may have been reported from other states with confidential HIV infection reporting. Over time, persons with HIV infection will be diagnosed and reported with AIDS. HIV infection cases later reported with AIDS are deleted from the HIV infection tables and added to the AIDS tables. Persons
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with HIV infection may be tested at any point in the clinical spectrum of disease; therefore, the time between diagnosis of HIV infection and AIDS will vary. In addition, because surveillance practices differ, reporting and updating of clinical and vital status of cases vary among states. Completeness of reporting for HIV is estimated to be more than 85% complete (MMWR 1998;47:309-14). CDC estimates that fewer than 2% of HIV cases are duplicates based on matching of the national coded surveillance database. Included in this report are persons known to be infected with human immunodeficiency virus type 2 (HIV-2). See MMWR 1995;44:603-06.
Tabulation and presentation of data
Data in this report are provisional. Each issue of this report includes information received by CDC through the last day of the reporting period. In the first part of the report, HIV and AIDS data are tabulated by date of report to CDC. In the second part of the report, data are statistically adjusted to correct for temporal delays in the reports of cases, deaths, and unreported risk/ exposure data in order to improve the presentation of trends in the epidemic and the risk characteristics of affected populations. Data for U.S. dependencies and possessions and for associated independent nations are included in the totals. Age group tabulations are based on the person’s age at first documented positive HIV-antibody test for HIV infection cases, and age at diagnosis of AIDS for AIDS cases. Adult/adolescent cases include persons 13 years of age and older; pediatric cases include children under 13 years of age. Tabulations of persons living with HIV infection and AIDS (table 1) include persons whose vital status was reported “alive” as of last update; persons whose vital status is missing or unknown are not included. Tabulations of deaths in persons with AIDS include persons whose vital status was reported “dead” as of last update; persons whose vital status is missing or unknown are not included. Caution should be used in interpreting these data because states vary in the frequency with which they review the vital status of persons reported with HIV infection and AIDS. In addition, some cases may be lost to follow-up. Table 4 lists AIDS case counts for each metropolitan area with an estimated 1997 population of 500,000 or more. AIDS case counts for metropolitan areas with 50,000 to 500,000 population are reported as a combined subtotal. On December 31, 1992, the Office of Management and Budget announced new Metropolitan Statistical Area (MSA) definitions, which reflect changes in the U.S. population as determined
HIV/AIDS Surveillance Report
by the 1990 census. These definitions were updated most recently on June 30, 1998. The cities and counties which compose each metropolitan area listed in table 4 are provided in the publication “Metropolitan Areas as of June 30, 1998” (available by calling the National Technical Information Service, 1-703-4874650, and ordering accession no. PB98-502198 or by visiting www.census.gov/population/www/estimates/ metrodef.html). Standards for defining central and outlying counties of metropolitan areas were published in the Federal Register (FR 1990;55:1215460). The metropolitan area definitions are the MSAs for all areas except the 6 New England states. For these states, the New England County Metropolitan Areas (NECMA) are used. Metropolitan areas are named for a central city in the MSA or NECMA, may include several cities or counties, and may cross state boundaries. For example, AIDS cases and annual rates presented for the District of Columbia in table 2 include only persons residing within the geographic boundaries of the District. AIDS cases and annual rates for Washington, D.C., in table 4, include persons residing within the several counties in the metropolitan area, including counties in Maryland, Virginia, and West Virginia. State or metropolitan area data tabulations are based on the person’s residence at first positive HIV-antibody test result for HIV infection cases, and residence at diagnosis for the first AIDS indicator condition(s) for AIDS cases. Regions of residence included in this report are defined as follows. Northeast: Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, and Vermont; Midwest: Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota, and Wisconsin; South: Alabama, Arkansas, Delaware, District of Columbia, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, and West Virginia; West: Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, Washington, and Wyoming; Territories: Guam, Puerto Rico, the U.S. Pacific Islands listed in the footnote on the first page of these technical notes, and the U.S. Virgin Islands. Estimated AIDS incidence (tables 22, 23, and 24), estimated AIDS incidence trends (figures 7 through 11), estimated persons living with AIDS (tables 25, 26, and 27), and estimated deaths (tables 28, 29, and 30) are not actual counts of persons reported to the surveillance system. The estimates are adjusted for delays in reporting of cases and deaths and are based
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on a number of assumptions. While these tables use the best estimates currently available, there is inherent uncertainty in these estimates (Lecture Notes in Biomathematics 1989;83:58-88). Small numbers must be interpreted with caution because the inherent uncertainty in estimates is greater for small numbers.
Exposure categories
For surveillance purposes, HIV infection cases and AIDS cases are counted only once in a hierarchy of exposure categories. Persons with more than one reported mode of exposure to HIV are classified in the exposure category listed first in the hierarchy, except for men with both a history of sexual contact with other men and injecting drug use. They make up a separate exposure category. “Men who have sex with men” cases include men who report sexual contact with other men (i.e., homosexual contact) and men who report sexual contact with both men and women (i.e., bisexual contact). “Heterosexual contact” cases are in persons who report specific heterosexual contact with a person with, or at increased risk for, HIV infection (e.g., an injecting drug user). Adults/adolescents born, or who had sex with someone born, in a country where heterosexual transmission was believed to be the predominant mode of HIV transmission (formerly classified as Pattern-II countries by the World Health Organization) are no longer classified as having heterosexually-acquired AIDS. Similar to case reports for other persons who are reported without behavioral or transfusion risks for HIV, these reports are now classified (in the absence of other risk information which would classify them in another exposure category) as “no risk reported or identified” (MMWR 1994;43:155-60). Children whose mother was born, or whose mother had sex with someone born, in a Pattern II country are now classified (in the absence of other risk information which would classify them into another exposure category) as “Mother with/at risk for HIV infection: has HIV infection, risk not specified.” “No risk reported or identified” (NIR) cases are in persons with no reported history of exposure to HIV through any of the routes listed in the hierarchy of exposure categories. NIR cases include persons who are currently under investigation by local health department officials; persons whose exposure history is incomplete because they died, declined to be interviewed, or were lost to follow up; and persons who were interviewed or for whom other follow-up information was available and no exposure mode was identified. Persons who have an exposure mode identified
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at the time of follow-up are reclassified into the appropriate exposure category. Historically, investigations and follow up for modes of exposure by state health departments were conducted routinely for persons reported with AIDS and as resources allowed for persons reported with HIV infection. Therefore, the percentage of HIV infected persons with risk not reported or identified is substantially higher than for those reported with AIDS. Because recently reported AIDS cases are more likely to be reported as NIR, recent AIDS incidence in some exposure categories will be underestimated unless an adjustment is made. For estimated AIDS incidence tables and estimated AIDS trends figures, the adjustment of NIR adult/adolescent cases is based on sex-, race-, and region-specific exposure category redistributions of cases diagnosed from 1989 through 1996 that were initially assigned to the NIR category but have subsequently been reclassified. Similar adjustment of NIR pediatric cases are based on exposure category redistribution of all cases diagnosed between 1989 though 1996 and subsequently reclassified. See J Acquir Immune Def Syndr, 1992;5:54755 and J Acquir Immune Def Syndr, 1997;14:465-74.
on AIDS incidence, AIDS incidence remains an important measure of the impact and need for resources for the severely ill.
Reporting delays
Reporting delays (time between diagnosis of HIV infection or AIDS and report to CDC) may vary among exposure, geographic, racial/ethnic, age, and sex categories, and have been as long as several years for some AIDS cases. About 50% of all AIDS cases were reported to CDC within 3 months of diagnosis and about 80% were reported within 1 year. Among persons with AIDS, estimates in delay of reporting of deaths show that approximately 90% of deaths are reported within 1 year. For HIV infection cases diagnosed since implementation of uniform reporting through the HIV/AIDS reporting system on January 1, 1994, about 70% of all HIV infection cases were reported to CDC within 3 months of diagnosis and about 95% were reported within 1 year. See MMWR 1998;47:309-14. Reporting delay adjustments to estimated AIDS data are calculated by a maximum likelihood statistical procedure, taking into account differences in reporting delays among exposure, geographic, racial/ethnic, age, sex, and vital status categories, but assuming that reporting delays within these groups have not changed over time (Statist Med 1998;17:143-54 and Lecture Notes in Biomathematics 1989;83:58-88).
Trends in AIDS incidence
Because of the temporary distortion caused by the 1993 expansion of the case definition, trends in AIDS incidence were estimated by statistically adjusting cases reported based on the criteria added to the case definition in 1993. This adjustment estimated when persons reported on the basis of immunologic criteria (CD4+ T-lymphocytes counts less than 200/µL or percentage less than 14) would develop an AIDSrelated opportunistic illness (AIDS-OI), and thereby approximated trends in AIDS-OI incidence as if the case definition had not changed (J Acquir Immune Defic Syndr 1997;16:116-21). However, by the end of 1996, the temporary distortion caused by reporting prevalent as well as incident cases that met criteria added in 1993 had almost entirely waned. In addition, after the end of 1996, the incidence of AIDS-OIs could no longer be reliably estimated because data are not currently available to model the increasing effects of therapy on rate of disease progression. Therefore, from 1996 forward, trends in AIDS incidence will be adjusted for reporting delay, but not for the 1993 expansion of the case definition. These trends represent the incidence of AIDS (1993 criteria) in the population and represent persons newly diagnosed with HIV at the time of AIDS, those identified with HIV who did not seek or receive treatment, and those for whom treatment has failed. Thus, despite the effects of treatment
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Rates
Rates are calculated for the 12-month period per 100,000 population for AIDS cases. Population denominators for computing AIDS rates for the 50 states and the District of Columbia are based on official postcensus estimates from the U.S. Bureau of Census. Denominators for U.S. dependencies and possessions and associated independent nations are linear extrapolations of official 1980 and 1990 census counts. Each 12-month rate is the number of cases reported during the 12-month period, divided by the 1996 or 1997 population, multiplied by 100,000. The denominators used for computing the table of racespecific rates (year-end edition only) are based on 1997 census estimates published in the U.S. Bureau of Census publication PPL-91, “U.S. Population Estimates by Age, Sex, Race, and Hispanic Origin: 19901997.” Race-specific rates are the number of cases reported for a particular racial/ethnic group during the preceding 12-month period divided by the projected population for that race/ethnicity, multiplied by 100,000.
HIV/AIDS Surveillance Report