Date: Fri, 7 Apr 1995 17:19:13 +0500
From: ghmcleaf{CONTRACTOR/ASPEN/ghmcleaf}%NAC-GATEWAY.ASPEN@ace.aspensys.com
Subject: Surveillance Report 12/94 Summary
CDC HIV/AIDS Surveillance Report, Vol. 6, No. 2.
Year-end Edition
U.S. HIV and AIDS cases reported through December 1994
Report Description
The U.S. HIV and AIDS case data presented below are extracted from
the "HIV/AIDS Surveillance Report," published semi-annually quarter
by the Division of HIV/AIDS Prevention, National Center for
Prevention Services, Centers for Disease Control and Prevention,
Atlanta, GA, 30333. In addition to the data presented here, the
printed copy of the report contains maps and figures. Single copies
of the printed report are available from:
CDC National AIDS Clearinghouse
P.O. Box 6003
Rockville, MD 20849-6003
(800) 458-5231
(800) 243-7012 (TTY/TDD)
Suggested citation:
Centers for Disease Control and Prevention. HIV/AIDS Surveillance
Report, 1994;6(no.2).
Summary of findings
Trends in AIDS surveillance
Implementation of the expanded AIDS surveillance case
definition on January 1, 1993, continued to influence diagnosis and
reporting of AIDS in 1994, but to a lesser degree than in 1993.
The number of AIDS cases reported in 1994 (80,691) declined from
the number reported in 1993 (106,618), but remained substantially
higher than the number reported in 1992 (47,572; see MMWR
1995;44:64-67). The expanded case definition includes conditions
that occur earlier in HIV disease and therefore includes severely
immunosuppressed persons more recently infected with HIV. Persons
diagnosed with these conditions before January 1993 were reported
to CDC during 1993 and 1994, and accounted for the substantial
increase in the numbers of reported cases. Because temporal trends
in AIDS incidence for 1993 and 1994 were severely distorted by
these large proportionate increases, methods were needed to adjust
for the change in the case definition. This issue of the HIV/AIDS
Surveillance Report presents these adjustments (Tables 18, 19, and
20, and the cover graph), as well as data on HIV and AIDS cases re-
ported in 1994, 1993, and cumulatively.
In 1994, as in previous years, the AIDS epidemic continued to
affect primarily men who have sex with men. Men represented 82
percent of AIDS cases reported among adults/adolescents (13 years
old or older); men who have sex with men continued to account for
the largest proportion (44 percent) of all AIDS cases reported
among adults/adolescents. The estimated incidence of
AIDS-opportunistic illnesses (AIDS-OIs) increased 13 percent from
1990 to 1993 among men who have sex with men (Table 20).
In 1994, young men represented a population at high risk for HIV;
among men 20 to 24 years old reported with AIDS, 60 percent report-
ed sex with men. This percentage is higher than the percentage of
men who have sex with men among all men reported with AIDS (53
percent). Heterosexual injecting drug users and injecting drug
users who have sex with other men accounted for 24 percent and 6
percent of cases among men, respectively.
The proportion of cases among women has increased steadily
during the past decade (MMWR 1995;44:81-84). AIDS among women
represented 18 percent of adults/adolescents with AIDS reported in
1994. Among women reported with AIDS in 1994, most were infected
with HIV through injecting drug use (41 percent) or heterosexual
contact with a man who was at risk for or had HIV infection or AIDS
(38 percent). Nineteen percent of women with AIDS were reported
without risk for HIV exposure. After these cases were followed-up
by state and local health departments, most women for whom a risk
was identified were found to have become infected through
heterosexual contact (66 percent) or injecting drug use (27
percent; see Figure 7). However, some of the cases reported
without risk of HIV exposure are likely to represent unrecognized
heterosexual transmission. Among women, estimated AIDS-OI inci-
dence is increasing most rapidly among those infected hetero-
sexually (Table 20).
The epidemic in children (less than 13 years old) is closely
associated with the epidemic in women. In 1994, 1,017 pediatric
AIDS cases were reported, an 18 percent increase from the number
reported in 1993. Of these, 92 percent were acquired perinatally;
the mothers of these children were exposed to HIV through injecting
drug use (30 percent) and heterosexual contact with an infected man
(36 percent). For 34 percent of mothers, their risk of exposure was
not reported. Future trends in AIDS incidence among children will
be affected by current Public Health Service recommendations for
routine counseling and voluntary prenatal HIV testing for women,
and the use of zidovudine to prevent perinatal transmission (MMWR
1994;43[no. RR11]:1-20).
Estimated AIDS-OI incidence increased more rapidly during
1990-1993 among blacks and Hispanics than among whites (Table 19).
Among reported cases, 1994 was the first year when blacks and
Hispanics together accounted for the majority (53 percent) of all
cases reported among men. As in past years, most women reported
with AIDS were black or Hispanic (57 percent and 20 percent,
respectively). Although AIDS surveillance case reports do not
record measures of socioeconomic status, or other social/cultural
factors that may predict risk of exposure to HIV, the dispro-
portionate impact of the epidemic on minority communities is
reflected in AIDS incidence rates which are 6 times and 3 times
higher, respectively, among blacks and Hispanics than among whites.
>From 1990 to 1993, the estimated incidence of AIDS-OIs increased in
the Northeast and South, whereas it leved in the Midwest and West
(Table 18). The majority of reported cases (58 percent) in 1994, as
in previous years, were residents of five states: New York,
California, Florida, Texas, and New Jersey. In both 1993 and 1994,
84 percent of reported cases were among residents of large
metropolitan areas (500,000 or more population).
HIV infection (not AIDS)
As of December 31, 1994, 25 states required confidential
reporting by name of all persons with confirmed HIV infection, in
addition to reporting of persons with AIDS. Two states, Connect-
icut and Texas, required reporting by name of children with HIV
infection. Consistent with the temporal changes in the
characteristics of persons reported with AIDS, persons reported
with HIV infection (not AIDS) from states that require confidential
reporting are disproportionately racial/ethnic minorities, younger,
and female. Although HIV reporting does not measure HIV incidence
or prevalence, these reports represent persons who are more
recently infected and more likely to be alive than persons reported
with AIDS; thus HIV reporting may be particularly useful in
directing and evaluating HIV prevention activities within states
and local communities. In these states, reports of children
perinatally exposed to HIV (with subsequent follow-up to determine
infection status) will be useful in evaluating implementation of
guidelines to prevent perinatal transmission.
This issue of the HIV/AIDS Surveillance Report includes a new
table (Table 24) that displays pediatric HIV infection (not AIDS)
cases by exposure category and race/ethnicity. In addition, Table
27 has been revised to tabulate persons living with HIV infection
(not AIDS) and living with AIDS by adult and pediatric age group,
as well as by state.
Summary
Data presented in this report show that men who have sex with
men continue to be most severely affected by the AIDS epidemic.
However, comparisons between AIDS cases reported in 1994 and in
earlier years, and temporal trends in estimated AIDS-OI incidence,
indicate that women, blacks and Hispanics, and persons with
heterosexually acquired HIV infections account for dynamic growth
in the epidemic. Injecting drug use and sex with at-risk partners,
especially among heterosexuals and young homosexual/bisexual men,
continue to challenge HIV prevention programs. As the epidemic
evolves, HIV/AIDS surveillance data continue to reflect past
transmission patterns, and to assist in directing HIV prevention
efforts.